Menopause is the biological process that occurs naturally to end fertility and the menstrual cycles in women. It is marked at one year (12 months) after the last menstrual period. On average, it comes to women in the United States at about 51 years of age.
During the time leading up to menopause, known as peri-menopause, women may experience irregular periods. Menopause may bring hot flashes and night sweats, along with mood swings, insomnia and other sleep problems, and vaginal dryness. A woman’s hair may begin to thin, her skin may become dryer and she may gain weight as her metabolism slows.
The most common cause of menopause is the natural reduction in the production of estrogen and progesterone, which are reproductive hormones. A hysterectomy that involves the complete removal of both the uterus and the ovaries may also trigger menopause; in this case, there is no peri-menopause transition and the symptoms may be extreme. Chemotherapy and radiation treatments may also trigger menopause; however, in these cases, the condition may reverse itself when the treatments end. Finally, primary ovarian insufficiency may cause early menopause. In this situation, due to genetic causes, autoimmune disorders or other factors, the ovaries simply fail to produce adequate amounts of estrogen and progesterone.
Many women face an increased risk of cardiovascular disease following menopause, with the incidence of heart attacks in women rising about 10 years post-menopause. This may be attributed to the loss of estrogen that helps to keep the walls of arteries and veins flexible.
Osteoporosis risk also increases after menopause. Half of women over 50 will break a bone due to osteoporosis caused by bone loss due to reduced estrogen levels. With the condition, bones become weak and brittle.
Many women experience urinary incontinence, as well. The vaginal and urethra tissues aren’t as elastic, leading to the frequent, unexpected need to urinate known as “urge incontinence.” It may also manifest as “stress incontinence,” when coughing, laughing or lifting causes an involuntary release of urine. Post-menopausal women may be susceptible to more urinary tract infections, as well.
That same lack of elasticity in the vagina, coupled with vaginal dryness, may also lead to decreased sensation during sex, along with pain or pressure and some light bleeding. Combined, these may show up as reduced libido and interest in sex.
Finally, as menopause comes, a woman’s metabolism slows. Without dietary and exercise changes, this can lead to stubborn weight gain.
Generally, there are no tests performed to diagnose menopause. A calendar to track the last menstrual period typically pinpoints the arrival of menopause. However, if the symptoms come earlier than expected or with other signs, a doctor may order a check for follicle-stimulating hormone (FSH) or estradiol levels. An underactive thyroid may mimic menopause symptoms, so the doctor may order a thyroid-stimulating hormone (TSH) level test, as well, if there is reason to suspect the thyroid as the culprit.
On its own, menopause is not a life-threatening concern; it is a natural biological process that comes with aging. While the lowered levels of reproductive hormones may contribute to other health issues, menopause does not cause heart disease, stroke or other diseases and conditions.
For some women, no treatment is necessary, as their symptoms are minimal. In those cases, a doctor may recommend calcium and vitamin D supplements. For others, especially those whose menopause is caused by hysterectomy, hormone replacement therapy may be the best option. Systemic hormone therapy is effective for easing hot flashes, night sweats and vaginal dryness or discomfort, whether it comes in the form of a pill, a gel or a patch. Other HRT options include low-dose estrogen creams, rings or tablets used vaginally; this option does not help with night sweats or hot flashes. For women experiencing menopause without uterus removal, the prescription for estrogen usually also includes progesterone or progestin to help keep the lining of the uterus from growing, which increases the risk of uterine cancer.
Hormone replacement therapy does carry some risks, however. Some studies show that long-term use, especially in older women, may raise the probability of developing heart disease, breast cancer, blood clots or stroke. It can also make tissue in the breasts denser so that it is more difficult to diagnose breast cancer through mammography.
In some cases, antidepressants in low doses can help, as well. Selective serotonin reuptake inhibitors (SSRI) may help ease hot flashes. Gabapentin, an anti-seizure medication, may also reduce the discomfort of hot flashes and night sweats.
Hot flashes may be the most annoying consequence of menopause. One way to handle them is to identify anything that may trigger them. Caffeine, hot drinks, alcohol, spicy foods, hot weather and stress can bring on the discomfort. Once a trigger is pinpointed, avoiding it may help decrease the flashes. Dressing in layers that can be removed or replaced and drinking cold water may also help, as will hanging out in a cooler location.
Vaginal discomfort during sex can be alleviated with over-the-counter vaginal lubricants. Select water-based products and avoid those with glycerin in the ingredients list, as it can be irritating in sensitive people. Staying sexually active can also help, as it improves the blood flow to the vaginal tissues.
Getting adequate sleep is also important to controlling menopause symptoms. To help avoid insomnia, limit your consumption of both caffeine and alcohol. Moderate exercise can help chase away sleeplessness, but be careful not to exercise too close to bedtime.
Many therapeutic relaxation strategies help with menopause, too. Deep breathing and paced breathing are effective, as are guided imagery, progressive muscle relaxation and massage.
Using Kegel exercises to strengthen the pelvic floor may improve incontinence. These exercises can be done nearly anywhere and at nearly anytime. To learn them, begin by stopping urinating midstream to identify the muscles for the exercises. Then, empty your bladder completely. Lie on your back, squeeze the pelvic floor muscles and hold for 5 seconds. Relax for 5 seconds, and then repeat the process four or five times. Gradually work your way to tightening the muscles and relaxing them for 10 seconds each. For the exercises to be effective, you need to concentrate on not constricting your thighs, abdomen or buttocks, and don’t hold your breath while you complete three sets of 10 at least three times a day.
A balanced diet filled with fruits, vegetables and whole grains will help with symptom relief, along with limiting saturated fats, sugar and oils. Maintain a normal healthy weight through diet and moderate-intensity exercise for 30 minutes on most days, and forego using tobacco products. Adding phytoestrogens, or plant estrogens, found in soybeans, legumes, flaxseed, chickpeas and whole grains might also be helpful.
There is some evidence to support the theory that yoga, tai chi and qigong help control and decrease hot flashes, and that acupuncture is helpful. According to a National Center for Biotechnology study, qigong reduces insomnia while easing night sweats and hot flashes. The Group Health Research Institute found that yoga is not effective against the uncomfortable temperature swings, but it does help post-menopausal women get a higher quality of sleep. Tai chi’s slow, controlled movement aids in preventing or alleviating the effects of osteoporosis by improving muscle tone. It also reduces the risk of broken bones by improving balance, thus making falls less likely. Another NCBI report indicates that acupuncture helps reduce both the frequency and strength of hot flashes
There are also many claims to the effectiveness of botanical treatments and supplements, but there is no conclusive evidence to support those claims to date. Because some of these herbs and botanicals may have serious side effects, do not use them without consulting a physician to be sure they are safe in your situation. Another consideration is that there is no oversight to monitor the purity or quality of these types of supplements. Black cohosh has been touted for short-term relief of vaginal dryness, night sweats and hot flashes, but it is not recommended for use longer than six months. Some studies suggest that ginseng may be effective against mood swings and disturbed sleep, and St. John’s Wort has been reported to help with mild depression.
Vitamin D is essential to bone health, as it is used by the body for bone growth and renewal. For optimal health, you need 600 international units per day. The best source of vitamin D is sunshine, so head out for a daily walk for at least 15 minutes each time. Boost your vitamin D levels through your diet by adding mushrooms, salmon, sardines, tuna and eggs to your menu often.
Finally, regular exercise can reduce menopause symptoms, prevent or lessen the effects of osteoporosis and promote general good health. Aim for 30 minutes a day of moderate-intensity, low-impact activity at least five days a week, including walking, jogging, biking and swimming.
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