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Menopause: you don’t know whether to laugh or cry, so sometimes you do both! It is the permanent end of menstruation and fertility, officially beginning 12 months after the last menstrual period. It’s a natural biological process, a transition between two phases of a woman’s life, and certainly not a medical disease.
Nonetheless, what happens at this time sometimes takes a significant physical and emotional toll. I have told patients that almost any symptom is possible as a result of the chemical and hormonal changes that occur in a woman’s body at this time.
By her late thirties, a woman’s ovaries start making less estrogen and progesterone. Ovulation becomes less predictable and fewer eggs ripen each month. These changes become more pronounced in the forties: menstrual periods often become longer or shorter, heavier or lighter, and more or less frequent. The production of hormones by the ovaries diminishes and finally stops.
The average age of menopause in the United States is 51 years, with the typical range being 48 to 55.
The hormonal changes associated with menopause actually begin three to four years prior, and those years are known as perimenopause. Smokers, and women who have never been pregnant tend to experience menopause earlier. Classic symptoms include irregular periods, vaginal dryness, hot flashes, sleep disturbances, mood swings, increased abdominal fat, thinning of the hair, and loss of breast fullness.
Women who undergo partial hysterectomies where the uterus is removed, but the ovaries remain, do not enter menopause as a result – the intact ovaries still produce estrogen and progesterone. A total hysterectomy, however, removes both uterus and ovaries, causing a “surgical menopause.”
The female hormones estrogen and progesterone have been found to impart protective health effects. After menopause, when these hormone levels fall, there may be negative consequences, including:
•Higher risk of heart disease, which is currently the leading cause of death for both men and women.
•Osteoporosis, the condition of brittle bones, leading to fractures. During the first few years of menopause, lower estrogen levels can lead to a rapid decline of bone density.
•Urinary incontinence, because lower levels of estrogen lead to loss of elasticity of the vagina and urethra. Some women experience frequent, sudden, strong urges to urinate followed by an involuntary loss of urine.
Your doctor will usually make the menopause diagnosis by taking a simple health history. If you are the appropriate age, menses have stopped, and some symptoms are present, the diagnosis is usually menopause. Blood tests, looking for increased levels of follicle-stimulating hormone (FSH) and decreased levels of estrogen (estradiol), can be ordered to confirm the diagnosis. Occasionally, other conditions can have symptoms that mimic menopause, such as hypothyroidism.
Treatment has become highly controversial. Until recently, the prevailing medical approach was to use hormone replacement therapy (HRT) in order to avoid symptoms. In 1991, however, the National Institute for Health launched the Women’s Health Initiative, a major 15-year study that found that women undergoing HRT had an increased risk of heart attack, stroke, blood clots, and breast cancer. (On the other hand, the risk of colorectal cancer dropped, and there were fewer fractures.) As a result, treatment changed dramatically.
Where once HRT was recommended for most women, physicians now prescribe HRT to a limited number of patients whose lives have been significantly impacted by menopausal symptoms. The decision to take HRT remains complicated, and this decision should be made in partnership with your physician. There are alternatives available to treat menopausal symptoms, including the following:
•For hot flashes, many use botanical products that naturally contain or act like estrogen. These include soybeans, chickpeas, other legumes, whole grains, some fruits and vegetables; and herbs, such as black cohosh. Research is still limited. Low dose antidepressants have provided some relief, as well as Neurontin, a seizure drug that is also used for chronic pain.
•To help prevent osteoporosis, several therapies have been helpful for building up bone. Foods and supplements that are rich in calcium and vitamin D are recommended. Moderate exposure to sunlight also helps the body produce vitamin D. An active lifestyle, including regular weight-bearing exercise, and not smoking help to stop bone loss. Medication includes bisphosphonates such as Fosamax, as well as a newer class of medications known as selective estrogen receptor modulators (SERMs), such as Evista. Note that it is also important to limit alcohol consumption, in order to reduce the risk of falls.
•To reduce the risk of heart disease, follow a heart-healthy lifestyle: not smoking, limiting consumption of saturated fat and cholesterol, limiting salt and alcohol intake, maintaining a healthy weight, and being physically active. Sometimes, medications are also needed to control high blood pressure, high blood cholesterol, or diabetes.
Good health to you all!
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.
Published: September 22, 2011 – Volume 10 – Issue 23