Menopause

According to the National Institute on Aging (NIA), over a third of all women in the United States have been through menopause. And as life expectancy increases, today's woman can expect to live more than one third of her life after menopause.

Menopause does bring many changes to a woman. The most obvious is that menstruation comes to an end, as does a woman's natural ability to bear children. But the American College of Obstetricians and Gynecologists (ACOG) says menopause doesn't happen all at once. There are a number of gradual changes taking place for 3-5 years before a woman's periods actually stop. This transitional time is called perimenopause. In order to understand what can happen during perimenopause and menopause, it's helpful to remember what goes on during menstruation in the first place.

Hormonal changes and symptoms

The hormones estrogen and progesterone are produced by a woman's ovaries. Starting at puberty, these hormones help regulate a woman's menstrual cycle, causing the lining of the uterus to thicken each month as a new egg is released from a follicle in the ovaries. (Read about "The Ovaries") If a woman becomes pregnant, the fertilized egg is implanted in the uterus and the thickened lining protects the developing fetus. If the woman doesn't become pregnant, hormone levels drop off again, the lining sloughs off and menstruation occurs. This is repeated each month. (Read about "Menstrual Disorders")

But during the mid-thirties, hormonal production by the ovaries starts to decline. By the late forties, hormonal levels decline even more. The National Institutes of Health say changing levels in the hormones produced by the ovaries not only disrupt a woman's menstrual periods; they can also affect other glands in the body that regulate body functions such as metabolism. (Read about "Endocrine System")

It's these changes that can manifest themselves as a host of symptoms women associate with menopause. In addition, if a woman has had both ovaries removed surgically, due to cancer for example, she will experience an abrupt menopause, which can cause a sudden onset of symptoms. According to ACOG, changes can include:

• Hot flashes or flushes - These are the most common and earliest symptoms of menopause. During a hot flash, a woman experiences a sudden sensation of intense heat; her face and neck may become flushed; profuse sweating (Read about "Sweating") can be followed by cold shivering as body temperature readjusts. They can happen at any time, even during sleep. A hot flash can last a few moments or 30 minutes or longer. A woman may experience hot flashes for a year or two, although in some women they last longer. Estrogen hormones and/or natural medicines can be used to help control hot flashes. However, if you can't control hot flashes, it can be helpful to dress in layers so you can adjust your clothing to your body's temperature. Some women also find it helpful to drink a glass of cold water at the very start of a hot flash.
• Vaginal/urinary tract changes - As a woman gets older, the walls of the vagina become thinner, dryer, less elastic and more vulnerable to infection. (Read about "Genital Health - Female") These changes can make sexual intercourse uncomfortable or painful. Your healthcare provider (HCP) can suggest lubricants that can help or prescribe estrogen cream or tablets. You should also see a HCP if urinary tract infections are a problem. (Read about "Urinary Tract Infections") Changes in the urinary tract (Read about "The Urinary System") can also cause the involuntary loss of urine or incontinence. (Read about "Incontinence") Although many women are uncomfortable talking about this, there are treatments including bladder training and pelvic exercises. Talk with a doctor to find out what's most appropriate in your case.
• Headaches, night sweats, trouble sleeping and tiredness - Many women suffer an increased number of headaches during menopause. (Read about "Headaches") The American Academy of Family Physicians (AAFP) says trouble sleeping and feeling tired may be caused by hot flashes and night sweats.
• Melasma - which is also called chloasma, according to the American Academy of Dermatology (AAD). It is a benign skin condition that is fairly common. (Read about "Melasma/Chloasma") When it occurs, the skin takes on a darker appearance compared to the surrounding skin. It is most often found on the face and other portions of the body exposed to the sun. AAD says that hormonal changes brought about by pregnancy, hormonal treatments during menopause or any other type of hormonal drugs are common causes. AAD adds most cases will clear up when hormones are brought back into balance. Sun exposure is also a risk factor and women who avoid the sun while they are taking hormone drugs are less likely to experience melasma. AAD also recommends sunscreen (Read about "Sunscreen") to help in this area. Treatments can include various topical applications.

There may also be mental changes. Although some women feel that menopause produces a number of mental changes including depression and mood swings (Read about "Depressive Illnesses"), NIH says studies show that this is not necessarily the case. It's possible that mental changes result from things taking place in a woman's life at the same time she's going through menopause.

Health risks

In addition to these symptoms, menopause can cause other serious health problems for women. One is an increased risk for heart disease and stroke. (Read about "Stroke") In fact, according to the American Heart Association (AHA), heart disease is the number one killer of American women. (Read about "Heart Disease and Women")

The other is an increased risk of osteoporosis. In osteoporosis, bones become brittle and weaken, making them more likely to break. (Read about "Osteoporosis" "Age and Bone Loss") Because of that, calcium supplements (Read about "Calcium") may be suggested to help prevent bone loss.

For menopausal women, the Institute of Medicine (IOM) recommends, depending on your age and other health issues, between 1000 and 1200 milligrams per day of calcium. You should discuss with your healthcare provider what your needs are. IOM also says the upper intake level for calcium is between 2000 and 3000 milligrams per day. Once again, it depends on your age and other health factors how much calcium you should be getting. Upper intake levels represent the upper safe boundary and should not be misunderstood as amounts people need or should strive to consume, according to IOM.

In addition, the U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis in women 65 years and older and in postmenopausal women younger than 65 years at increased risk of osteoporosis.

Hormone replacement

Because osteoporosis and other symptoms of menopause, such as hot flashes, are associated with declining estrogen levels, doctors have turned to hormone replacement therapy. When the hormone estrogen is given alone, it is usually referred to as "ERT." When the hormone progestin is combined with estrogen, it is generally called "HRT." ACOG says the hormones can be given in pill form, although skin patches and vaginal rings or creams can be used too.

ERT and HRT are not without risks. According to the National Women's Health Information Center (NWHIC), when estrogen is taken alone and a women still has her uterus or cervix, it raises the risk of endometrial cancer (Read about "Uterine Cancer"). Adding progestin (a synthetic form of progesterone) with estrogen reduces this risk by preventing the overgrowth (or hyperplasia) of cells in the lining of the uterus. This is why women who have had a total hysterectomy (Read about "Hysterectomy") and do not have a uterus or cervix may be given ERT, whereas women who do have a uterus may be given the combined replacement therapy or HRT.

But there are other problems. AAFP points out that the use of hormonal replacement therapy has been linked with an increased risk of serious problems such as blood clots, stroke, gallstones and breast disease including cancer. (Read about "Deep Vein Thrombosis" "Gallstones" "Breast Diseases and Conditions") And there can be side effects, such as bloating, breast tenderness, nausea, weight gain, vaginal discharge (Read about "Vaginal Discharge"), headaches and mood swings.

In addition, while some initial studies linked HRT with a reduced risk of heart disease, a large-scale study in 2001 found no such link. (Read about "Clinical Studies") As a result, AHA began to advise against prescribing HRT for the sole purpose of preventing heart attacks and strokes in women who already have cardiovascular disease. In July 2002, the National Heart, Lung, and Blood Institute (NHLBI) stopped a major clinical trial of the risks and benefits of combined estrogen and progestin in healthy menopausal women due to an increased risk of invasive breast cancer. (Read about "Breast Cancer") This study also found increases in coronary heart disease, stroke and pulmonary embolism in study participants on estrogen plus progestin compared to women taking placebo pills. (Read about "Coronary Heart Disease" "Pulmonary Embolism") While this study found an association between HRT and fewer cases of hip fractures (Read about "Hip Fractures") and fewer cases of colon cancer (Read about "Colorectal Cancer"), it determined that, on balance, the harm was greater than the benefit.

Some more recent studies have found possible cardiovascular benefits from short-term ERT use to relieve hot flashes among younger postmenopausal women.

ACOG says that some women and their physicians may feel that the benefits of HRT and ERT outweigh the risks. Therefore, a decision to use HRT or ERT is one each woman and her doctor must make on an individual basis. A woman should also ask her doctor or healthcare provider about non-estrogen medications that can prevent bone loss or even build bone.

Other therapies

There are also other treatments that focus on relieving some of the symptoms of menopause, or reducing some of the potential health risks. Some of the therapies that are sometimes used for hot flashes include antidepressants. (Read about "Depressive Illnesses") There are also medications that are primarily used to treat other conditions, such as high blood pressure or seizures, that have been found to reduce the severity of hot flashes. Drugs that are used to reduce the amount of bone loss associated with menopause include bisphosphonates, as well as selective estrogen receptor modulators (SERMs). (Read about "Osteoporosis") You should discuss the benefits and risks of any treatment with your doctor.

There are also lifestyle changes that can help, such as:

• dressing in layers, which can be easily removed when a hot flash occurs
• using vaginal lubricant to help with dryness
• doing Kegel exercises (contracting and releasing the pelvic floor muscles) to strengthen the pelvic floor and reduce urinary incontinence

In addition, regardless of whether they use medications or not, women going through menopause should pay particular attention to healthy lifestyle. If they smoke, they should quit. (Read about "Quit Smoking") They should also focus on getting enough calcium (Read about "Calcium") and incorporating the right amount of exercise into their lives (Read about "Menopause and Exercise"). The National Cancer Institute (NCI) stresses that all women in their forties and older get screened for breast cancer with mammography every year. (Read about "Mammograms")

In addition, the American Association of Clinical Endocrinologists (AACE) warns women approaching menopause that thyroid symptoms sometimes mirror symptoms of menopause. (Read about "Thyroid") AACE says that women who think they are having perimenopausal or menopausal signs should raise the issue of thyroid disease with their HCP. It is also crucial to remember that any vaginal bleeding after menopause could be a sign of a serious problem that requires immediate medical attention.

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