Menopause

Quick look at menopause

Menopause is a natural event in a woman’s life when the ovaries are depleted of eggs and she has not menstruated for 12 consecutive months.

Perimenopause refers to the span of months or years leading up to menopause, during which time many of the symptoms associated with menopause occur.

Symptoms associated with menopause include irregular periods, hot flashes, mood swings, decreased fertility, insomnia and fatigue.

Treatment for symptoms may or may not be necessary depending on their severity and interference with daily life.

What is menopause?

Menopause is defined as the time in a woman’s life when she has not menstruated for 12 consecutive months. The absence of menstrual cycles and periods indicate that a woman’s egg supply is depleted. According to the National Institute on Aging, the average age of menopause for women in the United States is 51.

Much like puberty, menopause is a natural physiological transition involving reproductive hormones and processes. As a woman approaches menopause, her ovaries gradually stop making estrogen and progesterone, which are responsible for ovulation and menstruation.

Certain circumstances can cause women to experience menopause prematurely. These include surgical removal of the ovaries to treat an underlying condition such as endometriosis, and cancer treatments such as chemotherapy and radiation. A small number of women (about 1 in 100) experience premature ovarian failure (POF), which can lead to early menopause if left untreated.

The phases of menopause

When menopause occurs naturally, it is divided into three phases: Perimenopause, menopause and postmenopause.

Perimenopause

Perimenopause is the span of time leading up to menopause in which the ovaries slowly begin to produce fewer eggs and therefore less hormones. It may last anywhere from a few months to several years.

The symptoms of perimenopause usually come on gradually, intensifying as a woman approaches menopause. The symptoms of perimenopause are what many associate with someone “going through menopause.”

Some women experience mild and tolerable perimenopause symptoms, while others may experience them severely, leading them to seek medical treatment. The symptoms of perimenopause include:

• Irregular periods
• Decreased fertility
• Hot flashes and night sweats
• Mood swings
• Painful intercourse
• Reduced sex drive
• Vaginal dryness
• Insomnia
• Fatigue.

A physician can usually identify when a woman has entered perimenopause simply by an evaluation of symptoms. In certain uncommon circumstances, a blood test may be ordered to confirm this diagnosis.

Menopause

The occurrence of menopause is signaled by the absence of menstruation for 12 consecutive months, indicating that the ovaries are depleted of eggs. Medically speaking, menopause itself is not a process but a point in time signifying the transition from perimenopause into postmenopause.

Postmenopause

A woman’s life after menopause is referred to as postmenopause. In most cases, once a woman enters postmenopause, many of the unpleasant symptoms listed above will begin to subside.

Due to the loss of estrogen previously produced by the ovaries, postmenopausal women are at greater risk of certain health complications. Most notably, this hormonal change leads to an increased risk of osteoporosis and heart disease. The best way to lower the risks for postmenopausal complications is to lead a healthy, active lifestyle and maintain regular appointments with a primary care physician and an OB-GYN.

Treating perimenopause symptoms and menopause symptoms

Many women do not need to seek treatment for symptoms during perimenopause or those that continue immediately following menopause. However, in certain cases symptoms may be severe enough to interfere with daily life. Depending on the specific symptoms, there are a number of methods and treatment options available.

Hot flashes and night sweats

Hot flashes, which are called night sweats when they occur just before or during sleep, are commonly experienced by women approaching menopause. The severity and frequency of hot flashes can be reduced by implementing certain lifestyle changes, including:

• Maintaining a healthy body weight
• Not smoking
• Avoiding caffeine and alcohol
• Mindfulness practices such as yoga and meditation.

Women experiencing severe hot flashes may be prescribed medication. Paroxetine, a medication used to treat depression, is sometimes used to treat severe hot flashes. Prescription hormone therapy is also a very effective means of treating hot flashes, though there are some risks associated with hormonal medications. A licensed health care provider will discuss these risks with his or her patient before prescribing this type of treatment.

Insomnia and fatigue

A number of factors may cause a woman nearing menopause to struggle to get an adequate amount of rest. As hormones change, brain chemistry is disrupted, and night sweats can make falling and staying asleep particularly difficult. Some tips for battling menopausal insomnia include:

• Exercising regularly (but not right before bed)
• Maintaining a cool bedroom temperature
• Avoiding caffeine and large meals in the evening
• Going to bed and waking up at consistent times.

Vaginal dryness and painful intercourse

Pain during sex commonly occurs with menopause due in large part to vaginal dryness. Women can find relief and continue to engage in intercourse during this time by using water-based lubricants and vaginal moisturizers sold over-the-counter in drug and grocery stores. It is important that lubricants and moisturizers be water-based, as oil-based substances such as petroleum jelly can further irritate the vagina.

In circumstances in which these methods fail to provide relief, prescription medications, including hormone therapy, may be prescribed by a health care provider to treat vaginal dryness.

Other menopause symptoms

While hot flashes and difficulty sleeping are the most common symptoms, women may also experience mood swings, depression, irritability, headaches and, rarely, heart palpitations. Women should not hesitate to discuss any concerns about the symptoms associated with menopause with their provider.

Menopause Evaluation and Treatment

Patients are evaluated for signs and symptoms of menopause or perimenopause. After evaluation, the physician will make recommendations for therapy. Options may include medication (such as hormone replacement therapy), alternative medicinal therapy, herbal therapy, bioidentical hormone therapy, or observation. The decision of which therapy to use is based on the patient’s individual needs and risk factors.

Estrogen therapy has been the standard for post-menopausal hormone replacement for many years. Taking estrogens is the most effective treatment for reducing menopausal hot flashes, mood alterations and atrophy of the vagina and urethra. Some recent studies, notably the Women’s Health Initiative published in 2003, have raised concerns with women taking estrogens since this study showed a small increase in heart attack risk, venous clots and breast cancer when women took this medication. Unfortunately, this large study included many women who were older than those who typically start estrogen replacement therapy. Since these older women have a higher likelihood of developing these unfortunate outcomes, it is possible that these risks were falsely elevated in the group studied.

Nevertheless, ARM currently recommends estrogen therapy only in those women who have severe hot flashes or mood swings related to their low estrogen status. The Food and Drug Administration also recommends that women receive estrogens for the shortest time period and at the lowest dose possible. Post-menopausal women who take estrogens and still have a uterus will also need to take progesterone. Unopposed estrogen can lead to a condition known as “endometrial hyperplasia,” which is a precursor to cancer of the uterus. Formulations containing both estrogens and progesterones are available. The progesterone can also help to reduce hot flashes. In some cases where women are unable to take estrogens because of previous clots or a history of estrogen sensitive cancers, progesterone may be given alone in order to reduce low estrogen symptoms.

For women who cannot take estrogens due to previous health conditions, alternatives do exist. Serotonin reuptake inhibitors, a class of medications used in depression, can be used with moderate effectiveness. If symptoms are mild to moderate, these women can achieve a significant level of relief using these medications. Other medications, including evening primrose oil, Catapres and belladonna alkaloids have been used but there is no evidence that they are effective in relieving menopausal symptoms.

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