Menopause refers to the time when a woman stops menstruating for good. This means her ovaries no longer release an egg (ovum) every month and so she can no longer have children. Menopause is considered finished when the woman has not had a period for a year. The average age for menopause in Canada is 52. But it can occur any time in a woman's 40s or 50s.
A woman goes through menopause because her body stops making enough of the two hormones, estrogen and progesterone. At the right levels, these hormones help keep her fertile. As a woman approaches her fifties, her ovaries makes less and less of them. Decreasing progesterone levels cause periods to become irregular and make getting pregnant harder. Decreasing estrogen levels affect, among other things, the uterine lining, the vaginal walls, the breasts, and the bones.
Also on the decline around menopause is the hormone testosterone, which normally peaks just before ovulation (when the ovary releases the egg) and which contributes to a woman's sex drive. The gradual decrease in hormone production usually takes place over a 5-year period ending with menopause, although for some women it can take up to 10 years. After menopause, a woman's ovaries still manufacture small amounts of estrogen (and other organs and tissues make hormones that are converted to estrogen).
Many women welcome menopause; they don't feel any the worse for wear. Indeed, for some, the years following menopause are among the most productive and creative years in their life. For others, however, the decrease in hormone production leading up to menopause (perimenopause) and in the years after (postmenopause), causes uncomfortable symptoms that makes it difficult for them to see this time in a positive light.
Chief among the symptoms associated with perimenopause are irregular periods and heightened premenstrual symptoms. Otherwise most of the symptoms are similar to those that often occur with menopause. Among them, the most common are hot flashes, which, recent estimates suggest, are experienced by 75 percent of women, with 10 percent having them for more than 5 years. Other common complaints include:
Why one woman sails through the menopausal years while another finds it hard going is not easy to answer. Because menopause tends to occur when many other life-changing experiences may be happening (such as children leaving home, parents dying), it is sometimes blamed for the tumultuous emotions and increased levels of anxiety that a midlife woman may be feeling. Certainly lifestyle, family support, genetics, and alcohol consumption all figure in determining a woman's emotional and mental state at this time and the physical changes accompanying menopause may just be the last straw.
Happily, it is sometimes possible to reduce these symptoms through exercise and dietary changes but if you feel the symptoms are too much for you to handle alone, talk to your doctor who can talk to you about additional options, including the possibility of taking hormone replacement therapy (HRT).
Sexual desire is such an individual experience that it should not be surprising to learn that in midlife some women report an increased interest in sex, while others report a reduced interest. There are, however, certain sexual changes that are commonly associated with menopause including:
Whether these changes translate into less sexual desire is a very personal thing. Libido depends on a wide spectrum of issues, ranging from body image and societal expectations to fatigue and health status, from prior sexual history to the health of the partner, from stress and time considerations to just plain boredom.
If you find you are unhappy with your level of sexual desire, talk to your doctor. Some studies suggest that supplements of the male hormone testosterone may help increase libido and intensity of orgasm. For discomfort during intercourse, there are estrogen-based creams and lubricants your doctor can prescribe. In addition, your pharmacist can advise you about over-the-counter vaginal lubricants.
Menopause marks a natural stage in the aging process and not a disease to be cured. If you are concerned about any midlife changes, visit your doctor who will confirm menopause based on your symptoms, past medical history, a physical exam, and laboratory analysis of hormone levels. The mainstays of any treatment plan should be exercise and a healthy diet.
We all know that physical exercise is good for our bodies at any time in our lives, but many women are now finding that exercise is essential for their wellbeing during their menopausal years. Exercise not only strengthens bones (thus helping to prevent osteoporosis) and works the heart, but it can also reduce menopausal symptoms as well as help you relax and feel more centred.
Popular choices include walking, jogging, weights, yoga, tai chi, and dance. The important thing is to exercise regularly, at least 5 times a week and for a minimum of half an hour.
With menopause, many woman gain extra poundage, particularly around the waist. Besides exercise, to maintain a healthy weight, eat fibre-rich and low-fat foods, and watch the portions (small) not the calories. Be sure to get the calcium you need to help prevent osteoporosis (fragile bones that break easily) or take calcium supplements if necessary. The recommended daily calcium intake for peri- and postmenopausal woman is 1200 to 1500 mg. Your doctor or pharmacist will help you determine if you need calcium supplements and, if so, which ones are best for you.
Along with a healthy diet, reducing your intake of alcohol and caffeine may minimize your perimenopausal symptoms such as hot flashes, fatigue, anxiety, and depression. And, naturally, don't smoke. Not only is smoking associated with early menopause, but it is also linked to bone reduction and thus osteoporosis.
Hormone replacement therapy involves either a combination of progestin (synthetic progesterone) and estrogen, or estrogen alone. Although estrogen effectively treats menopausal symptoms, progestin is necessary to protect the uterus.
At one time, not too long ago, combination HRT was commonly prescribed for midlife women. It was thought that along with an alleviation of symptoms caused by normal hormone reduction, HRT reduced the risk of osteoporosis and heart disease, and possibly also Alzeimer's disease.
A shift in expert opinion has occurred in the last few years based on findings from a variety of recent clinical trials. In particular, a trial conducted by the Women's Health Initiative (which involved a set of studies conducted by the National Institutes of Health, a division of the U.S. Department of Health and Human Services) found that long-term use (5 years or more) of combination HRT resulted in an increase in a woman's risk of breast cancer, blood clots, heart attacks, and strokes. For each of these problems, the increased risk involved about 8 more events per 10,000 women per year, compared to women who did not take HRT.
There is now a general consensus among health-care providers that HRT should only be used if menopausal symptoms affect quality of life and then only for short term. In addition, your doctor should keep you fully informed of the risks and assess your condition regularly.
Now that HRT is no longer considered as safe as it once was, many women are exploring other alternatives to dealing with their menopausal symptoms. Natural products containing estrogenlike substances, soy products, and so-called hormonal stabilizers such as black cohosh or evening primrose oil are popular choices. Unfortunately, there is still little scientific evidence that these work as a rule and certainly no information regarding their effects with long-term usage.
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Menopause and U
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The patient information leaflets are provided by Vigilance Santé Inc. This content is for information purposes only and does not in any manner whatsoever replace the opinion or advice of your health care professional. Always consult a health care professional before making a decision about your medication or treatment.