Menopause Facts

Definition

The transition period in a woman's life when the ovaries stop producing eggs, menstrual activity decreases and eventually ceases, and the body decreases the production of the female hormones estrogen and progesterone.

Causes, Incidence and Risk Factors

Menopause, which normally occurs between the ages of 40 and 55, is a natural event in a woman's life. On average, menopause begins at about age 51. During menopause ovulation (egg production) ceases, eliminating the possibility of pregnancy, and menstruation becomes less frequent and eventually stops. In some women, menstrual activity stops suddenly, but usually it tapers off, both in amount and duration of flow, and frequently the menstrual periods become more closely or more widely spaced. This irregularity may last for 2 or 3 years before menstruation finally ceases.
The symptoms of menopause are caused by changes in estrogen and progesterone levels. As the ovaries become less functional, they produce less estrogen/progesterone and the body subsequently reacts. Some women experience few if any symptoms, while others experience various symptoms ranging from mild to fairly severe. This variation is normal. A gradual decrease of estrogen allows the body to slowly adjust to the hormone change, but in some women a sudden decrease in estrogen level occurs, causing severe symptoms. This result is often seen when menopause is caused by surgical removal of the ovaries (surgical menopause).

Estrogen is responsible for the buildup of the epithelial lining of the uterine cavity. During the reproductive years this lining builds and is then shed (menstruation) on a monthly basis (usually). The menopausal decrease in estrogen prevents this buildup from occurring. However, androgenic hormones produced by the adrenal glands are converted to estrogen, and sometimes this will cause postmenopausal bleeding. This is usually nothing to worry about, but because postmenopausal bleeding may be an early indication of other problems, including cancer, it should always be checked by a physician.

A reduction in estrogen is associated with a number of side effects that can be very annoying. Hot flashes, caused by an increase of blood flow in the blood vessels of the face, neck, chest and back, and vaginal dryness, caused by thinning of the tissues of the vaginal wall, are the two side effects most frequently experienced. The mood changes and lack of sex drive that are also sometimes associated with menopause may result partially from the hormone decrease, but may also result from having to deal with hot flashes and vaginal dryness. In addition to these side effects there are others that may go undetected for many months or years. Decreased estrogen levels increase the risk for osteoporosis (loss of calcium from the bones, causing bone fragility), which sometimes isn't detected until a bone fracture occurs.

Symptoms

Symptoms, when present, may include:

• Hot flashes and skin flushing.
• Mood changes.
• Decreased libido (sex drive).
• Irregular menstrual periods.
• Vaginal dryness.

Signs And Tests

A Pap smear may indicate changes in the vaginal lining (mucosa) caused by changes in estrogen levels. Blood and urine tests can be used to measure the levels of estrogen, progesterone, and plasma estradiol and estrone (part of the reproductive steroid group).
Examples of tests of this type include:

·        17-hydroxycorticosteroids

·        17-OH progesterone

·        serum progesterone

·        estradiol

·        FSH

Two factors have been identified as influencing when menopause occurs:

-Familial factors as well as genetic polymorphisms of the estrogen receptor influence the age of onset of perimenopause (as well as influencing the risk for surgical menopause).
 

-Current smoking has been identified as a cause of earlier menopause, producing a shift of approximately 1.5 years. There is a dose-response relationship with the number of cigarettes smoked and the duration of smoking.

Limited data support the association of the timing of menopause with the following:

• Multiparity and increased body mass index (BMI) are associated with menopause occurring later than average.
   
• Nulliparity, medically treated depression, toxic chemical exposure, and treatment of childhood cancer with pelvic radiation and alkylating agents are associated with menopause occurring earlier than average.
   
• Higher cognitive scores in childhood are associated with a later menopause.

No link has been found between menopause age and use of oral contraceptives, socioeconomic or marital status, race, or age at menarche.

Treatment

Natural menopause usually requires no treatment. Surgical menopause that occurs prior to natural menopause may require estrogen replacement therapy (ERT). Not all postmenopausal women need to be treated with ERT. Each woman should discuss her individual risks and benefits with her health care provider.
Many physicians recommend estrogen replacement therapy to:

• Reduce the undesirable symptoms of menopause.
• Help decrease vaginal drying.
• Prevent osteoporosis after menopause.

Some side effects of estrogen replacement therapy include:

• Vaginal bleeding.
• Breast tenderness.
• Nausea.
• Vomiting.
• Abdominal bloating.
• Uterine cramps.

To reduce the risks of estrogen replacement therapy and still gain the benefits of the treatment, physicians may recommend:

·        Adding progesterone to the estrogen.

·        Adding testosterone to the estrogen.

·        Using the lowest possible dose of estrogen.

·        Having frequent and regular physical exams, including a pelvic examination and Pap smear to detect problems as early as possible.

Prognosis

Although menopause is a difficult period for some, most women will experience menopause without long-term problems. Many women report an increase in energy, more self-confidence, and a better attitude.

Complications

Decreased estrogen levels are associated with an increased risk of developing osteoporosis and an increased risk of cardiovascular disease.

Calling Your Health Care Provider

Call for an appointment with your health-care provider if you are a woman older than age 40 who is experiencing the symptoms of menopause and would like treatment for them. Specific symptoms may include:

·        Irregular menstrual periods

·        Hot flashes.

·        Vaginal dryness.

Call your physician if you are postmenopausal and are experiencing any bleeding.
Also, call your physician if you are experiencing the symptoms of menopause and you are under the age of 40.

(Source: North American Menopause Society)

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