Menopause

When a woman's monthly cycle has stopped for a year, it is called menopause.

The transition between the reproductive stage and menopause is called the climacteric or perimenopause. Many people, however, incorrectly refer to this as menopause.

Menopause usually occurs in American women around the age of 51. Premature menopause happens when the ovaries fail before the age of 40. Why this happens is not known.

Artificial menopause occurs when a woman's ovaries have been removed surgically or she has had chemotherapy, radiation of the pelvis or any process that reduces the supply of blood to the ovaries.

Premature menopause may be associated with smoking, living at high altitude, or poor nutritional status.

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Symptoms

Symptoms of perimenopause vary widely from one woman to another. Common symptoms include:

  • Cold hands and feet
  • Constipation or diarrhea
  • Difficulty concentrating
  • Difficulty sleeping
  • Emotional or psychological symptoms such as anxiety, depression, nervousness or irritability which may be related to changing of hormones or to the stress of aging and changing roles
  • Fatigue
  • Headache
  • Hot flashes or flushes and sweating affect 75% of women. The flash may last from 30 seconds to five minutes and may be followed by chills
  • Intermittent dizziness, prickly sensations on the skin or rapidly beating heart
  • Memory loss
  • Weight gain

In the time leading up to menopause, a woman's monthly periods tend to become less frequent before they completely stop.

However, for some women, the bleeding becomes more frequent and heavier.

Women's cycles become less regular.

Changes in a woman's body occur, including:

  • An urgent and more frequent need to go to the bathroom
  • Difficulty or pain during sexual intercourse
  • Loss of pelvic muscle tone
  • Loss of interest in sex
  • Sex organs such as the uterus, the ovaries and the outer genitals (labia minora and clitoris) shrink
  • Swelling, redness and tenderness of the lining of the vagina
  • Thinning of the lining of the vagina and the skin of the vulva
  • Vaginal dryness

Causes and Risk Factors

Menopause is caused by falling hormones as the ovaries begin to stop producing eggs. As the ovaries age, they grow less responsive to the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) produced by the pituitary gland.

As a result, a woman's menstrual cycle becomes shorter. She releases eggs from the ovaries (ovulates) less often. Her cycle becomes less regular.

In time, the follicle fails to respond at all and doesn't produce estrogen. This sets off a series of hormonal changes.

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Diagnosis

A doctor will take a medical history and do a physical examination. Menopause is usually obvious based on the patient's age and symptoms. If the diagnosis is uncertain, it can be confirmed by a blood test to see if the patient's FSH levels are higher than normal.

It is important to rule out other conditions that may cause similar symptoms such as thyroid disease and diabetes.

A doctor may order a mammogram and a Pap smear.

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Treatments

Treatment will vary depending on the nature and severity of the symptoms. It is important for a woman to be aware of other health risk factors she may have that may be made worse by different treatment approaches.

A doctor may discuss the causes of menopause and the concerns, fears and stresses that come with this change of life. It is important that a woman discuss her individual health status and health risk factors with her doctor in deciding what the best treatment options are for her.

Emotional or psychological symptoms may require psychotherapy. Antidepressants or mild sedatives may be appropriate.

Estrogen replacement therapy relieves hot flashes and other symptoms of menopause. It may be helpful in reducing the risk of osteoporosis and heart disease. However, receiving estrogen by itself increases the risk of developing endometrial cancer in women who still have a uterus.

Combining estrogen and progestin will lower the risk of endometrial cancer. How much estrogen will be prescribed depends on how much is needed to control the symptoms.

Taking estrogen may increase the risk of breast cancer.

A woman should have regular physical examinations and annual mammograms regardless of whether the symptoms of perimenopause are treated.

A woman should not start estrogen replacement therapy if she has a history of estrogen-dependent endometrial cancer or breast cancer, blood clots or inflammation of the veins, uterine bleeding without a diagnosed cause and liver disease.

A woman's risk of developing certain conditions rises after menopause. These conditions are:

  • Cardiovascular disease, including stroke. Estrogen-replacement therapy may reduce the risks of developing this condition
  • Osteoporosis. Women who are small boned, white, smokers, heavy alcohol drinkers, taking corticosteroids or have an inactive lifestyle are at the greatest risk of developing this.
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