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 process of menopause does not occur overnight, but rather is a gradualprocess. This so-called perimenopausal transition period is a different experiencefor each woman. The average age of menopause onset is 51 years old. There is no single method topredict when a woman will experience menopause. The age at which a woman starts having menstrual periods is not related to theage of menopause onset.
A women is in menopause when she has had no menstrual periods (menses) for12 months and has no other medical reason for her menses to stop. Symptoms of menopause can be divided into early and late onset symptoms. Early symptoms include abnormal vaginal bleeding, hot flashes, and moodchanges. Late symptoms include vaginal dryness and irritation, osteoporosis, andheart disease.
Treatments for menopause are directed toward alleviating the symptoms presentin the particular woman affected. *What is menopause?Menopause is the time in a woman’s life when the function of the ovaries ceases. Theovary, or female gonad, is one of a pair of reproductive glands in women. They arelocated in the pelvis, one on each side of the uterus. Each ovary is about the size andshape of an almond.
The ovaries produce eggs (ova) and female hormones. During eachmonthly menstrual cycle, an egg is released from one ovary. The egg travels from theovary through a fallopian tube to the uterus. The ovaries are the main source of female hormones, which control the development offemale body characteristics such as the breasts, body shape, and body hair. The hormonesalso regulate the menstrual cycle and pregnancy. The process of menopause does not occur overnight, but rather is a gradual process.
Thisso-called perimenopausal transition period is a different experience for each woman. Scientists are still determining all the factors that affect when this transition begins andthe details of how it occurs. The average age of menopause is 51 years old. Althoughwomen tend to undergo menopause at an age similar to that of their mothers, this is onlya rough “rule of thumb. ” In fact, there is no single method to predict when a woman willexperience menopause.
The age at which a woman starts having menstrual periods is notrelated to the age of menopause onset. When does a woman know she is in menopause?In order to be menopausal, a woman must have had no menstrual periods (menses) for 12months and have no other medical reason for her menses to stop. Therefore, a womancannot know she is menopausal unless she has not had a menstrual period for 12 months. Are hormone levels or other blood tests helpful in detecting menopause?Because hormone levels may fluctuate greatly in an individual woman, even from oneday to the next, hormone levels are not a reliable indicator for diagnosing menopause. Even if levels are low one day, they may be high the next day in the same woman. Although hormone levels of several blood tests are available, there is no particular singleblood test yet that reliably allows a doctor to predict when a women is going to gothrough menopause in the future, or if she is experiencing the beginning of themenopausal transition.
At present, there is no proven role for blood testing regardingmenopause except for tests to exclude medical causes of erratic menstrual periods otherthan menopause. The only way to diagnose menopause is to observe lack of menstrualperiods for 12 months in a woman in the expected age range. *What are the symptoms of menopause?The symptoms of menopause can be divided into early and late onset symptoms. Treatment is directed toward the particular symptoms present. Early symptoms includeabnormal vaginal bleeding, hot flashes, and mood changes.
Late symptoms includevaginal dryness and irritation, osteoporosis, and heart disease. These symptoms arediscussed in detail below:Early Onset Symptoms (Perimenopause)Abnormal Vaginal BleedingAbnormal vaginal bleeding may occur during menopause. In general, menstrual periods(menses) at first occur more frequently (meaning the cycle shortens in duration), andsubsequently get farther and farther apart (meaning the cycle lengthens in duration) untilthey stop. Because of this unpredictable pattern, many women will have a period aftergoing for several months without a period. In fact, this type of pattern is common.
Thereis not any set length of time it takes for an individual woman to complete her menopausaltransition since all women have different experiences. Some women have minimalproblems with erratic bleeding whereas others have unpredictable, excessive bleeding. Although menopause is clearly not a disease or illness, a woman should report irregularmenses to her physician for an appropriate evaluation to confirm that the cause of theproblem is menopause. Hot FlashesHot flashes are episodes that are experienced by many, but not all, women undergoingmenopause.
A hot flash is a feeling of warmth, which is sometimes associated withflushing, that spreads over the body and is sometimes followed by perspiration. Menstruating women in their 40’s may have hot flashes. Additionally, this symptom maylast for a decade or more in some women. There is no way to predict when they willcease in a given woman. They decrease in frequency over time.
The cause of hot flashesis not completely understood. Hot flashes may have more to do with the fluctuation ofhormone levels as opposed to low hormone levels per se. Mood SymptomsThere is considerable controversy about exactly which behavior symptoms are duedirectly to menopause. Moodiness and irritability seem to be linked with menopause, butother symptoms are less clear.
The research has been difficult for many reasons. Due tothe sleep disturbance from hot flashes, women can suffer from significant fatigue. Manyother symptoms that women associate with menopause, such as mood swings, couldactually be linked with the sleep disturbance itself. Research is now trying to determinewhat factors can influence mood symptoms during menopause.
Factors that have beensuspected and are being analyzed for their impact on menopausal mood symptomsinclude education level, exercise level, familial support system, and history ofdepression. *Late Onset Symptoms (Postmenopause)Vaginal SymptomsVaginal symptoms tend to begin some years after the cessation of menses. Postmenopausal women (the term for women who have completed their menopausaltransition) may experience vaginal dryness, itching, or irritation due to the lack ofestrogen. Dyspareunia, or pain with intercourse, can also result from the vaginal effectsof estrogen loss.
OsteoporosisOsteoporosis is the deterioration of the quality of bone that causes an increased risk offracture. Osteoporosis depletes both the calcium and the protein from the bone, resultingin either abnormal bone quality or decreased bone density. Estrogen loss over manyyears, such as after menopause, is the most firmly established and common cause ofosteoporosis. The osteoporosis process can operate silently for decades. Someosteoporosis fractures may escape detection until years later.
Patients may not thus beaware of their osteoporosis until suffering a painful fracture. The symptoms are thenrelated to the location of the fractures. Heart diseaseHeart disease is the number one killer of women after menopause. One out of twopostmenopausal women will develop heart disease, and one out of three will die from it. Although the onset of heart disease in women lags behind the onset in men by about adecade, the occurrence of heart disease increases after menopause. Furthermore, there areactually more women than men who eventually die of heart disease.
Being a female overthe age of 55 is one of many risk factors for heart disease. *What are the treatment options for menopause?Treatments for menopause can be divided based on those symptoms that are present in agiven woman at a specific time. Treatment of Early Onset SymptomsAbnormal Vaginal BleedingPrior to treatment, a doctor excludes other causes of erratic vaginal bleeding during themenopause transition (called the perimenopause). Women who have not yet completedtheir menopausal transition tend to have considerable breakthrough bleeding if they startthe usual types of estrogen replacement therapy. Instead, oral contraceptives providemultiple benefits to women with perimenopausal bleeding; regularization of menstrualperiods, contraception, and relief of hot flashes. Oral contraceptives are considered safein healthy, non-smoking women.
Hot FlashesHot flashes can be treated with either oral (by mouth) or transdermal (patch) forms ofestrogen. Both oral and transdermal estrogen therapies are available either as estrogenalone, or estrogen combined with progesterone (see MedicineNet. com’s HormoneReplacement Therapy article). All available prescription estrogen replacement therapies,whether oral or transdermal, are effective in reducing hot flash frequency and severity. Generally, available treatments decrease hot flash frequency by about 80 to 90%. Mood SymptomsScientists are currently evaluating which types of mood symptoms, such as irritability ortearfulness, are improved by estrogen replacement.
Similarly, studies are underway todetermine which symptoms are actually due to menopause versus other factors. Womenmay experience relief of irritability with oral estrogen replacement therapy. However,estrogen replacement therapy alone will not adequately treat a true medical depression,for example. Accordingly, and for many reasons (including because treatments aredifferent for menopause symptoms compared to depression), women who areexperiencing significant mood symptoms should discuss them with a doctor to confirmthat they are not symptoms of a medical depression or other problem.
Treatment of Late Onset SymptomsVaginal SymptomsPrior to being treated for vaginal irritation, burning, and itching, women should firstundergo an evaluation by a doctor, including a pelvic exam, to verify that the symptomsare due to estrogen deficiency. There are local (meaning vaginal) and oral treatments forthe symptoms of vaginal estrogen deficiency. Local treatments include the vaginalestrogen ring, vaginal estrogen cream, or vaginal estrogen tablets. Oral treatments includemultiple types of estrogen either alone, or estrogen given with progesterone (seeMedicineNet. com’s Hormone Replacement Therapy article).
Local and oral estrogentreatments are both effective in relieving vaginal symptoms and are sometimes combinedfor this purpose. In women for whom oral or vaginal estrogens are deemed inappropriate,such as breast cancer survivors, or women who do not wish to take oral or vaginalestrogen, there are a variety of over-the-counter vaginal lubricants. However, they areprobably not as effective in relieving vaginal symptoms as replacing the estrogendeficiency with oral or local estrogen. OsteoporosisThe goal of osteoporosis treatment is the prevention of bone fractures by stopping boneloss and increasing bone density and strength. Although early detection and timelytreatment of osteoporosis can substantially decrease the risk of future fracture, none ofthe available treatments for osteoporosis are complete cures. In other words, it is difficultto completely rebuild bone that has been weakened by osteoporosis.
Therefore, theprevention of osteoporosis is as important as treatment. Osteoporosis treatment andprevention measures are:Lifestyle changes including quitting cigarette smoking, curtailing alcoholintake, exercising regularly, and consuming a balanced diet with adequatecalcium and vitamin D. Estrogen replacement therapy for postmenopausal women and those with otherlow estrogen conditions. Medications that stop bone loss and increase bone strength, such as alendronate(Fosamax), risedronate (Actonel), raloxifene (Evista), and calcitonin (Calcimar). Heart DiseaseThere is much controversy regarding whether or how much oral estrogen replacementaffects the risk of heart disease in postmenopausal women. Research with a large enoughnumber of women in well-designed studies is needed.
Additionally, we need to be able toseparate out the effects of different types of estrogen preparations to get the answer. Itseems so far that estrogen replacement may protect against heart disease in women whodo not yet have heart disease, but may not be protective in women who are alreadyknown to have heart disease. In the near future, we will have more information frombetter-designed research studies regarding this issue. Menopause At A GlanceMenopause 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 process of menopause does not occur overnight, but rather is a gradualprocess. This so-called perimenopausal transition period is a different experiencefor each woman. The average age of menopause onset is 51 years old. There is no single method topredict when a woman will experience menopause. The age at which a woman starts having menstrual periods is not related to theage of menopause onset.
A women is in menopause when she has had no menstrual periods (menses) for12 months and has no other medical reason for her menses to stop. Symptoms of menopause can be divided into early and late onset symptoms. Early symptoms include abnormal vaginal bleeding, hot flashes, and moodchanges. Late symptoms include vaginal dryness and irritation, osteoporosis, andheart disease. Treatments for menopause are directed toward alleviating the symptoms presentin the particular woman affected.
HTML1DocumentEncodingutf-8What is menopause? When does a woman know she isin menopause? Are hormone levels or other blood tests helpful in detecting menopause?What are the symptoms of menopause? Abnormal Vaginal Bleeding Hot Flashes Mood Symptoms Vaginal Symptoms Osteoporosis Heart disease What are the treatment options for menopause? Abnormal Vaginal Bleeding Hot Flashes Mood Symptoms Vaginal Symptoms Osteoporosis Heart Disease
