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Today, medical advances have resulted in a wide range of health care choices that can enhance quality of life during menopause and the decades afterward. It is vital for women to know that menopause itself carries no serious health risks. However, the chance for heart disease and osteoporosis (thinning of the bone) rises after menopause. Understanding menopause and the range of treatment options can help women make the best health decisions.

Remember, menopause is a perfectly natural occurrence.

The Facts About Menopause

Menopause is the medical term for the end of a woman's menstrual periods. It is a natural part of aging, and occurs when the ovaries stop making hormones called estrogens. This causes estrogen levels to drop, and leads to the end of monthly menstual periods. This usually happens between the ages of 45 and 60, but it can happen earlier. Menopause can also occur when the ovaries are surgically removed or stop functioning for any other reason.

Low estrogen levels are linked to some uncomfortable symptoms in many women. The most common and easy to recognize symptom is hot flashes ÷ sudden intense waves of heat and sweating. Some women find that these hot flashes disrupt their sleep, and others report mood changes. Other symptoms may include irregular periods, vaginal or urinary tract infections, urinary incontinence (leakage of urine or inability to control urine flow), and inflammation of the vagina. Because of the changes in the urinary tract and vagina, some women may have discomfort or pain during sexual intercourse. Many women also notice changes in their skin, digestive tract, and hair during menopause.

In the long term, some women experience problems linked to the low levels of estrogen found after menopause. These may include osteoporosis and increased risk for heart disease.

Understanding Estrogen & Progesterone

Estrogen is known as a 'female hormone' because it plays a key role in shaping the female body and preparing it for uniquely female functions such as pregnancy. For example, estrogen is vital for the development of breasts and hips. In addition, the vagina, uterus, and other female organs depend on the presence of estrogen in the body to mature.

Together with progesterone, another female hormone made by the ovaries, estrogen regulates the changes that occur with each monthly period and prepares the uterus for pregnancy. Prior to menopause, more than 90% of the estrogen in a woman's body is made by the ovaries. Other organs (including the adrenal glands, liver, and kidneys) also make small amounts of estrogen. That's why women continue to have low levels of estrogen after menopause. Because fat cells can also make small amounts of estrogen, women who are overweight when they are going through menopause may have fewer problems with hot flashes and osteoporosis (both of which are related to lack of estrogen).

Some of the other important benefits of estrogen become apparent when estrogen levels decline after menopause. For instance, estrogen stimulates skeletal growth and helps maintain healthy bones. It also helps protect the heart and veins by increasing 'good cholesterol' (HDL or high-density lipoprotein) and lowering 'bad cholesterol' (LDL or low-density lipoprotein). Estrogen may also affect a woman’s sexual desire.

Progesterone is the second most important female hormone. Like estrogen, most progesterone is made by the ovaries, with a smaller amount made by the adrenal glands. The job of progesterone is to:

• Stimulate the growth of a cushiony lining in the uterus where the fertilized egg can grow and develop into a baby
• Help the breast make milk
• Generally maintain pregnancy

Symptoms

About 75% of women report some troublesome symptoms during menopause, but the severity and frequency of symptoms varies from woman to woman. The most common symptoms are hot flashes and vaginal atrophy (this is, the tissue of the vagina becomes thinner, drier, and more delicate, and begins to shrink).

Irregular bleeding

The period of time leading up to menopause is often characterized by irregular periods. In fact, changes such as shorter or longer periods, heavier or lighter menstrual bleeding, and varying lengths of time between periods may be a sign that menopause is near.

You should talk to a physician if:

• Bleeding occurs more often than 21 days
• Your period lasts longer than 8 days or is very heavy
• Your period occurs after 6 months or more without a period

Hot flashes

Hot flashes are the classic sign of menopause, as well as the most common reason for seeking treatment. A hot flash produces a sudden sensation of warmth or even intense heat that spreads over various parts of the body, especially the chest, face, and head. Flushing and sweating usually occur as well, followed by a chill. Some women feel their heart beating very fast or hard and feel anxious.

These flashes last anywhere from a few seconds to several minutes. How often they occur varies from woman to woman. Women who have had a hysterectomy are more likely to have hot flashes. Many women experience most of their hot flashes in the first 2 years after menopause, and find that the hot flashes gradually lessen. However, some women have hot flashes for several years before menopause, and some have them for 10, 20, or even 40 years or longer after menopause.

Hot flashes can affect a woman's social life and work. Also, hot flashes that occur during the night can disrupt sleep. In fact, some women report that their bedsheets become dampened or even soaked with sweat when they have a hot flash during the night.

Vaginal thinning

Estrogen plays a key role in maintaining the function of a woman’s vagina and surrounding tissues, uterus, urinary bladder, and urethra (the organ through which urine is passed from the bladder). After menopause, all of these organs may weaken or shrink. When these changes occur in the bladder and urethra, they can lead to the involuntary leakage of urine, infection, or painful urination.

A thinning of the tissue lining the vagina may lead to pain during intercourse. Vaginal dryness can also occur, as may itching or irritation. Although few women experience serious problems with vaginal dryness and thinning right after menopause, both dryness and thinning continue to occur over time. Some doctors estimate that at least half of all women older than 60 years have some degree of vaginal dryness. Regular sexual intercourse can help to keep the vagina moist and toned.

Links between mood, menopause, and sexual function

The brain also responds to estrogen. In fact, estrogen is now thought to be important in memory and the healthy functioning of nerve cells in the brain. Some studies have shown that estrogen replacement therapy can preserve brain activity and even improve memory.

Depression may also be more likely in the years right before menopause. However, it is unclear whether depression is linked to low levels of estrogen or to the many changes women face during their 40s and 50s (such as career or marriage pressures, or care of children or aging parents).

Diagnosis

Menopause is usually diagnosed after the doctor reviews a woman's medical history and performs a physical examination. The doctor may also order blood tests to make sure the symptoms are related to menopause and to decide what therapy, if any, might be most appropriate.
 

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