Menopause

Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified. It is the end of fertility, the end of the childbearing years.
Menopause is the time in a woman's life when the function of the ovaries ceases. The ovary, or female gonad, is one of a pair of reproductive glands in women. The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. The hormones also regulate the menstrual cycle and pregnancy. Estrogens also protect the bones.

 

Menopause is a natural biological process, not a medical illness. Although it's associated with hormonal, physical and psychosocial changes in your life, menopause isn't the end of your youth or of your sexuality. Several generations ago, few women lived beyond menopause. Today, you may spend as much as half of your life after menopause.

Signs and Symptoms

Every woman experiences menopause differently. Even the age at which menopause begins may be unique to you. Some women reach menopause in their 30s or 40s, and some not until their 60s, but menopause most often occurs between the ages of 45 and 55.
Your signs and symptoms also are likely to be very individual. You may breeze through menopause with few signs and symptoms. Or you may experience a number of physical and emotional changes, including:

• Irregular periods. Your menstrual periods may stop suddenly, or gradually get lighter or heavier and then stop. The unpredictability of your periods may be your first clue that menopause is approaching.
• Decreased fertility. When ovulation begins to fluctuate, you're less likely to become pregnant. Until you haven't had a period for a year, however, pregnancy is still possible.
• Vaginal and urinary changes. As your estrogen level declines, the tissues lining your vagina and urethra — the opening to your bladder — become drier, thinner and less elastic. With decreased lubrication you may experience burning or itching, along with increased risk of infections of your urinary tract or vagina. These changes may make sexual intercourse uncomfortable or even painful. You may feel the need to urinate more frequently or more urgently, and you may experience urinary incontinence.
• Hot flashes. As your estrogen level drops, your blood vessels may expand rapidly, causing your skin temperature to rise. This can lead to a feeling of warmth that moves upward from your chest to your shoulders, neck and head. You may sweat, and as the sweat evaporates from your skin, you may feel chilled, weak and slightly faint. Your face might look flushed, and red blotches may appear on your chest, neck and arms. Most hot flashes last from 30 seconds to several minutes, although they can last much longer. The frequency, as well as the duration, of hot flashes varies from person to person. You may have them once every hour or only occasionally. They can occur any time during the day or night. They may be a part of your life for a year or more, or you may never have them.
• Sleep disturbances and night sweats. Night sweats are often a consequence of hot flashes. You may awaken from a sound sleep with soaking night sweats followed by chills. You may have difficulty falling back to sleep or achieving a deep, restful sleep. Lack of sleep may affect your mood and overall health.
• Changes in appearance. Many women gain a modest amount of weight — about 5 pounds on average — during the menopausal transition. The fat that once was concentrated in your hips and thighs may settle above your waist and in your abdomen. You may notice a loss of fullness in your breasts, thinning hair and wrinkles in your skin. If you previously experienced adult acne, it may become worse. Although your estrogen level drops, your body continues to produce small amounts of the male hormone testosterone. As a result, you may develop coarse hair on your chin, upper lip, chest and abdomen.
• Emotional and cognitive changes. You may experience irritability, fatigue, decreased memory and diminished concentration as you approach menopause. These symptoms have sometimes been attributed to hormonal fluctuations. Yet other factors are more likely to contribute to these changes, including sleep deprivation and stressful life events — such as the illness or death of a parent, grown children leaving home or returning home, and retirement.
  

More about Menopause

Causes

Menopause begins naturally when your ovaries start making less estrogen and progesterone. During your reproductive years, these hormones regulate your monthly cycles of ovulation and menstruation. In your late 30s, the amount of progesterone your body produces diminishes, and the remaining eggs from your ovaries are less likely to be fertilized. Eventually your menstrual periods stop, and you can no longer become pregnant. Because this process takes place over years, menopause is commonly divided into the following two stages:

• Perimenopause. This is the time you begin experiencing menopausal signs and symptoms, even though you're still ovulating. Your hormone levels rise and fall unevenly, and you may have hot flashes and variations in your periods. For instance, your flow may be irregular or heavier or lighter than usual. This is a normal process leading up to menopause and may last four to five years or longer.
• Postmenopause. Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and progesterone, and they don't release eggs. The years that follow are called postmenopause.
  

Risk Factors

Menopause is usually a natural process. But certain surgical or medical treatments can bring on menopause earlier than expected. These include:

• Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still release eggs. But an operation that removes both your uterus and ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause. There's no perimenopausal phase. Instead, your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptoms.
• Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during the course of treatment or within three to six months.
• Premature ovarian failure. Approximately 1 percent of women experience menopause before age 40. Premature menopause may result from genetic factors or autoimmune disease, but often no cause can be found.
  

Diagnosis

The signs and symptoms of menopause are enough to tell most women they have begun going through the transition. If you have concerns about irregular periods or hot flashes, talk with your doctor. In some cases further evaluation may be recommended.

Under certain circumstances, your doctor may check your level of follicle-stimulating hormone (FSH) and estrogen (estradiol) with a blood test. As menopause occurs, FSH levels increase and estradiol levels decrease. Your doctor may also recommend a blood test to determine your level of thyroid-stimulating hormone, because hypothyroidism can cause symptoms similar to those of menopause.

Treatment Approach

Menopause itself requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and on preventing or lessening chronic conditions that may occur with aging. Treatments include:

• Hormone therapy (HT). Results from several recent, long-term studies suggest that benefits of HT use may be outweighed by the risks. One large study called the Women's Health Initiative (WHI), funded by the National Institutes of Health, was halted early when researchers found that women given a certain type of combined estrogen and progesterone were at increased risk of heart attack, stroke and breast cancer. Later results from the WHI study showed that estrogen alone also increased stroke risk, but did not increase breast cancer or heart disease risk. Although these results have changed the landscape for women taking or considering taking estrogen, it's important to put the risks in perspective. In the WHI study, fewer than 10 additional cases each of heart attack, stroke and breast cancer occurred each year among 10,000 women taking combination hormone therapy compared with 10,000 women taking placebo. Estrogen therapy remains the most effective treatment option for menopausal symptoms such as hot flashes and vaginal discomfort. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you.
• Low-dose antidepressants. Venlafaxine (Effexor), an antidepressant related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), may decrease hot flashes by up to 60 percent. Other drugs in the SSRI class that can be helpful include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalopram (Celexa) and sertraline (Zoloft). These medications may cause side effects including nausea, dizziness or sexual dysfunction.
• Gabapentin (Neurontin). This drug is approved to treat seizures and is commonly used to manage chronic, nerve-related pain, but it also has been shown to significantly reduce hot flashes. Side effects may include drowsiness, dizziness, nausea and swelling.
• Clonidine (Catapres, others). Clonidine, a pill or patch typically used to treat high blood pressure, may significantly reduce the frequency of hot flashes, but side effects such as dizziness, drowsiness, dry mouth and constipation are common.
• Bisphosphonates. Doctors may recommend these nonhormonal medications, which include alendronate (Fosamax) and risedronate (Actonel ), to prevent or treat osteoporosis. These medications effectively reduce both bone loss and your risk of fractures and have replaced estrogen as the main treatment for osteoporosis in women. Side effects may include nausea, abdominal pain and irritation of the esophagus.
• Selective estrogen receptor modulators (SERMs). SERMs are a group of drugs that includes raloxifene (Evista). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots.
• Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered locally using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen locally to vaginal tissue, and can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms. Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each.
  

Medications