Menopause

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Overview

In the years leading up to menopause (perimenopause), the balance of hormones in a woman’s body changes. These hormonal changes can lead to symptoms like hot flashes (also called hot flushes), sleep problems and mood swings. Various things provide relief. Different women may experience this phase of their life very differently. Only few have severe menopause-related problems over a long period of time.

Around their mid-forties, women’s bodies gradually start making less of the female sex hormone estrogen. Their monthly periods become less regular and eventually stop completely. A woman has reached menopause when she has had her last period. The word “menopause” might be misleading because it is not a “pause,” but an ending. Women can no longer get pregnant after menopause.

The average age of menopause is 51, although some women might go through it much earlier, or later. Many women are happy that the hassle of contraception and periods are now a thing of the past. But the idea of no longer being “fertile” can also feel like closing a chapter in your life. And menopause is often accompanied by other significant life changes – many people mainly associate it with getting older.

Symptoms

In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:

Irregular periods

Vaginal dryness

Hot flashes

Chills

Night sweats

Sleep problems

Mood changes

Weight gain and slowed metabolism

Thinning hair and dry skin

Loss of breast fullness

Causes

Menopause is a natural process that occurs as the ovaries age and produce less reproductive hormones.

The body begins to undergo several changes in response to lower levels of:

estrogen

progesterone

testosterone

follicle-stimulating hormone (FSH)

luteinizing hormone (LH)

One of the most notable changes is the loss of active ovarian follicles. Ovarian follicles are the structures that produce and release eggs from the ovary wall, allowing menstruation and fertility.

Most women first notice the frequency of their period becoming less consistent, as the flow becomes heavier and longer. This usually occurs at some point in the mid-to-late 40s. By the age of 52, most U.S. women have undergone menopause.

In some cases, menopause is induced, or caused by injury or surgical removal of the ovaries and related pelvic structures.

Common causes of induced menopause include:

bilateral oophorectomy, or surgical removal of the ovaries

ovarian ablation, or the shutdown of ovary function, which may be done by hormone therapy, surgery, or radiotherapy techniques in women with estrogen receptor-positive tumors

pelvic radiation

pelvic injuries that severely damage or destroy the ovaries

Risk factors

While women generally enter menopause between the ages of 41 and 55, there are many factors that can interrupt the normal cycle of a woman’s reproductive system. This can bring on menopause earlier than normal.

Premature menopause is also referred to as “premature ovarian failure.” It occurs when a woman begins menopause before age 40.

According to the American Pregnancy Association, about 1 in 1,000 women ages 15 to 29 and 1 in 100 women between the ages of 30 and 39 experience early menopause.

In some cases, premature menopause is the result of a surgery. Removal of the ovaries or damage through radiation are examples. In other cases, premature menopause may be due to a genetic disorder or pre-existing condition. Risk factors for premature menopause include the following.

Surgeries

Women who have some surgeries are at a higher risk for early menopause. This includes women who have one ovary removed (single oophorectomy) or a removal of the uterus (hysterectomy). These surgeries can cause a reduced amount of estrogen and progesterone in the body. Early menopause can also develop as a side effect among women who have cervical cancer surgery or pelvic surgery. The removal of both ovaries (bilateral oophorectomy) causes immediate menopause.

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Complications

After menopause, your risk of certain medical conditions increases. Examples include:

Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. So it's important to get regular exercise, eat a healthy diet and maintain a normal weight. Ask your doctor for advice on how to protect your heart, such as how to reduce your cholesterol or blood pressure if it's too high.

Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists.

Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). You may have urinary tract infections more often.

Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help relieve symptoms of incontinence. Hormone therapy may also be an effective treatment option for menopausal urinary tract and vaginal changes that can result in urinary incontinence.

Sexual function. Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido).

Water-based vaginal moisturizers and lubricants may help. If a vaginal lubricant isn't enough, many women benefit from the use of local vaginal estrogen treatment, available as a vaginal cream, tablet or ring

Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows. You may need to eat less and exercise more, just to maintain your current weight.


Prevention

Some cases of early menopause are unavoidable. Other times there are steps you can take to prevent or delay it. Prevention tips include:

Stop smoking immediately.

Exercise regularly, which can keep you healthy and prevent obesity.

Maintain a healthy weight.

Use natural skin care products that are free of hormones.

Eat natural, healthy foods as much as possible (especially those rich in phytoestrogen), and avoid processed foods.

Maintain a healthy weight, eat a well-balanced diet, and exercise regularly. Take steps to enjoy high-quality sleep, maintain good bone strength, and monitor your blood pressure levels. Taking good care of yourself is key to enjoying an active and healthy life in your menopausal and post-menopausal years.