Menopause

Introduction

Menopause is a normal and natural part of a woman’s aging process.  Menopause, commonly called “the change of life”, occurs around the age of 50.  During this time, hormones change and menstruation (“getting periods”) stops.  Common symptoms include hot flashes, mood swings, insomnia, night sweats, and irregular periods.  Menopausal onset age, duration, and symptoms differ among women.  Your doctor can recommend ways to ease the symptoms that bother you.

Anatomy

The internal female reproductive system includes the ovaries, fallopian tubes, uterus, cervix, and vagina.  The ovaries are two small organs that produce eggs (ova) and hormones.  During a female’s reproductive years, an ovary typically releases one mature egg each month.  Two fallopian tubes extend from near the ovaries to the uterus.  The fallopian tubes transport the mature eggs to the uterus (womb).
The uterus is a pear-shaped organ where a baby grows in during pregnancy.  During the reproductive years, the lining of the uterus undergoes cyclic changes to facilitate and maintain pregnancy.  The uterus is joined to the vagina by the cervix.  The vagina is a muscular passageway that extends from the cervix to the external female genitalia.

Causes

Menopause is a normal and natural process in the aging female.  Menopause occurs when a woman’s ovaries stop producing eggs and her body produces less estrogen and progesterone hormones.  Menstruation becomes less frequent and eventually stops all together.  When menopause is complete, pregnancy cannot occur.

Symptoms

Age of onset, duration, and symptoms of menopause vary from woman to woman.  Symptoms occur as the production of estrogen and progesterone decrease.  Some women stop menstruating abruptly, but most women experience periods that taper off before stopping.  Your periods may become farther apart or closer together.  You may experience bleeding between periods.  Although the duration varies, menopause usually takes from one to five years to complete.  When menopause is completed, a woman can no longer get pregnant.

The severity and type of menopausal symptoms vary.  Potential symptoms include hot flashes, skin flushing, heart palpations, and night sweats.  You may have problems falling or remaining asleep at night.  Your moods may change, and you may feel more irritable, depressed, or anxious than usual.  You may feel tired and have difficulty concentrating.  Menopause can cause vaginal dryness, urinary changes, and a decrease in sex drive.  Menopausal symptoms usually stop when menopause is complete.

Menopause can cause long-term changes to your body.  You may experience bone density loss and eventual osteoporosis. Menopause is associated with increased cholesterol levels, which leads to an increased risk of heart disease. 

Diagnosis

Menopause is a normal and healthy part of a female’s life.  You should contact your doctor if you experience symptoms that bother you.  Blood tests can measure your hormones to determine if you are experiencing menopause.  Women of menopausal age should receive an annual physical examination including a breast exam, pelvic exam, pap smear, mammogram, and cholesterol test.  You should also discuss your risk factors and receive screening for heart disease, colon cancer, and bone density loss.

Treatment

In the past, hormone replacement therapy (HRT) was used to treat symptoms of menopause and prevent osteoporosis.  However, a major research study by the Women’s Health Initiative found that the risks of HRT greatly outweighed the benefits.  HRT may increase the risk of heart attack, strokes, breast cancer, and blood clots.  You should carefully discuss the appropriateness of HRT with your doctor.  It is also important to discuss the vast array of herbal supplements on the market and their safety and efficacy before you take them.

Prevention

Menopause is a natural part of the female aging process.  You may prevent the severity of symptoms by exercising, maintaining an appropriate weight, and avoiding caffeine, alcohol, and spicy foods.  Your doctor can prescribe medications to ease mood swings, anxiety, depression, hot flashes, and insomnia.

Am I at Risk

Women typically experience menopause at age 50, but it can occur earlier or later than that.  Menopause may be induced if the ovaries are surgically removed.  Cigarette smoking appears to be associated with premature menopause, before the age of 40.

Complications

You should contact your doctor if you are spotting blood between periods.  You should contact your doctor if you have not had a period for 12 months in a row, but then begin bleeding again.  These can be signs of other medical conditions and warrant evaluation.

Post-menopausal women are at risk for developing bone loss and osteoporosis. Cholesterol levels also rise during menopause. This can increase a woman’s risk for a heart attack. Ask your doctor about appropriate screening tests.

Advancements

A major research study by the Women’s Health Initiative found that the risks of HRT greatly outweighed the benefits.  HRT may increase the risk of heart attack, strokes, breast cancer, and blood clots.  HRT is not recommended as a safe treatment for menopausal symptoms.  For severe symptoms, HRT may be used for short periods of time.