Menopause

Menopause is the time in a woman’s life when the function of the ovaries ceases.

The ovary, or female gonad, is one of a pair of reproductive glands in women.
The process of menopause does not occur overnight, but rather is a gradual
process. This so-called perimenopausal transition period is a different experience
for each woman.
The average age of menopause onset is 51 years old. There is no single method to
predict when a woman will experience menopause.
The age at which a woman starts having menstrual periods is not related to the
age of menopause onset.
A women is in menopause when she has had no menstrual periods (menses) for
12 months and has no other medical reason for her menses to stop.
Symptoms of menopause can be divided into early and late onset symptoms.

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Early symptoms include abnormal vaginal bleeding, hot flashes, and mood
changes. Late symptoms include vaginal dryness and irritation, osteoporosis, and
heart disease.
Treatments for menopause are directed toward alleviating the symptoms present
in the particular woman affected.
*What is menopause?
Menopause is the time in a woman’s life when the function of the ovaries ceases. The
ovary, or female gonad, is one of a pair of reproductive glands in women. They are
located in the pelvis, one on each side of the uterus. Each ovary is about the size and
shape of an almond. The ovaries produce eggs (ova) and female hormones. During each
monthly menstrual cycle, an egg is released from one ovary. The egg travels from the
ovary through a fallopian tube to the uterus.


The ovaries are the main source of female hormones, which control the development of
female body characteristics such as the breasts, body shape, and body hair. The hormones
also regulate the menstrual cycle and pregnancy.

The process of menopause does not occur overnight, but rather is a gradual process. This
so-called perimenopausal transition period is a different experience for each woman.

Scientists are still determining all the factors that affect when this transition begins and
the details of how it occurs. The average age of menopause is 51 years old. Although
women tend to undergo menopause at an age similar to that of their mothers, this is only
a rough “rule of thumb.” In fact, there is no single method to predict when a woman will
experience menopause. The age at which a woman starts having menstrual periods is not
related to the age of menopause onset.

When does a woman know she is in menopause?
In order to be menopausal, a woman must have had no menstrual periods (menses) for 12
months and have no other medical reason for her menses to stop. Therefore, a woman
cannot know she is menopausal unless she has not had a menstrual period for 12 months.

Are hormone levels or other blood tests helpful in detecting menopause?
Because hormone levels may fluctuate greatly in an individual woman, even from one
day to the next, hormone levels are not a reliable indicator for diagnosing menopause.

Even if levels are low one day, they may be high the next day in the same woman.

Although hormone levels of several blood tests are available, there is no particular single
blood test yet that reliably allows a doctor to predict when a women is going to go
through menopause in the future, or if she is experiencing the beginning of the
menopausal transition. At present, there is no proven role for blood testing regarding
menopause except for tests to exclude medical causes of erratic menstrual periods other
than menopause. The only way to diagnose menopause is to observe lack of menstrual
periods for 12 months in a woman in the expected age range.

*What are the symptoms of menopause?
The symptoms of menopause can be divided into early and late onset symptoms.

Treatment is directed toward the particular symptoms present. Early symptoms include
abnormal vaginal bleeding, hot flashes, and mood changes. Late symptoms include
vaginal dryness and irritation, osteoporosis, and heart disease. These symptoms are
discussed in detail below:
Early Onset Symptoms (Perimenopause)
Abnormal Vaginal Bleeding
Abnormal vaginal bleeding may occur during menopause. In general, menstrual periods
(menses) at first occur more frequently (meaning the cycle shortens in duration), and
subsequently get farther and farther apart (meaning the cycle lengthens in duration) until
they stop. Because of this unpredictable pattern, many women will have a period after
going for several months without a period. In fact, this type of pattern is common. There
is not any set length of time it takes for an individual woman to complete her menopausal
transition since all women have different experiences. Some women have minimal
problems with erratic bleeding whereas others have unpredictable, excessive bleeding.

Although menopause is clearly not a disease or illness, a woman should report irregular
menses to her physician for an appropriate evaluation to confirm that the cause of the
problem is menopause.


Hot Flashes
Hot flashes are episodes that are experienced by many, but not all, women undergoing
menopause. A hot flash is a feeling of warmth, which is sometimes associated with
flushing, that spreads over the body and is sometimes followed by perspiration.

Menstruating women in their 40’s may have hot flashes. Additionally, this symptom may
last for a decade or more in some women. There is no way to predict when they will
cease in a given woman. They decrease in frequency over time. The cause of hot flashes
is not completely understood. Hot flashes may have more to do with the fluctuation of
hormone levels as opposed to low hormone levels per se.


Mood Symptoms
There is considerable controversy about exactly which behavior symptoms are due
directly to menopause. Moodiness and irritability seem to be linked with menopause, but
other symptoms are less clear. The research has been difficult for many reasons. Due to
the sleep disturbance from hot flashes, women can suffer from significant fatigue. Many
other symptoms that women associate with menopause, such as mood swings, could
actually be linked with the sleep disturbance itself. Research is now trying to determine
what factors can influence mood symptoms during menopause. Factors that have been
suspected and are being analyzed for their impact on menopausal mood symptoms
include education level, exercise level, familial support system, and history of
depression.

*Late Onset Symptoms (Postmenopause)
Vaginal Symptoms
Vaginal symptoms tend to begin some years after the cessation of menses.

Postmenopausal women (the term for women who have completed their menopausal
transition) may experience vaginal dryness, itching, or irritation due to the lack of
estrogen. Dyspareunia, or pain with intercourse, can also result from the vaginal effects
of estrogen loss.

Osteoporosis
Osteoporosis is the deterioration of the quality of bone that causes an increased risk of
fracture. Osteoporosis depletes both the calcium and the protein from the bone, resulting
in either abnormal bone quality or decreased bone density. Estrogen loss over many
years, such as after menopause, is the most firmly established and common cause of
osteoporosis.The osteoporosis process can operate silently for decades. Some
osteoporosis fractures may escape detection until years later. Patients may not thus be
aware of their osteoporosis until suffering a painful fracture. The symptoms are then
related to the location of the fractures.

Heart disease
Heart disease is the number one killer of women after menopause. One out of two
postmenopausal women will develop heart disease, and one out of three will die from it.

Although the onset of heart disease in women lags behind the onset in men by about a
decade, the occurrence of heart disease increases after menopause. Furthermore, there are
actually more women than men who eventually die of heart disease. Being a female over
the age of 55 is one of many risk factors for heart disease.

*What are the treatment options for menopause?
Treatments for menopause can be divided based on those symptoms that are present in a
given woman at a specific time.


Treatment of Early Onset Symptoms
Abnormal Vaginal Bleeding
Prior to treatment, a doctor excludes other causes of erratic vaginal bleeding during the
menopause transition (called the perimenopause). Women who have not yet completed
their menopausal transition tend to have considerable breakthrough bleeding if they start
the usual types of estrogen replacement therapy. Instead, oral contraceptives provide
multiple benefits to women with perimenopausal bleeding; regularization of menstrual
periods, contraception, and relief of hot flashes. Oral contraceptives are considered safe
in healthy, non-smoking women.

Hot Flashes
Hot flashes can be treated with either oral (by mouth) or transdermal (patch) forms of
estrogen. Both oral and transdermal estrogen therapies are available either as estrogen
alone, or estrogen combined with progesterone (see MedicineNet.com’s Hormone
Replacement Therapy article). All available prescription estrogen replacement therapies,
whether oral or transdermal, are effective in reducing hot flash frequency and severity.

Generally, available treatments decrease hot flash frequency by about 80 to 90%.

Mood Symptoms
Scientists are currently evaluating which types of mood symptoms, such as irritability or
tearfulness, are improved by estrogen replacement. Similarly, studies are underway to
determine which symptoms are actually due to menopause versus other factors. Women
may experience relief of irritability with oral estrogen replacement therapy. However,
estrogen replacement therapy alone will not adequately treat a true medical depression,
for example. Accordingly, and for many reasons (including because treatments are
different for menopause symptoms compared to depression), women who are
experiencing significant mood symptoms should discuss them with a doctor to confirm
that they are not symptoms of a medical depression or other problem.

Treatment of Late Onset Symptoms
Vaginal Symptoms
Prior to being treated for vaginal irritation, burning, and itching, women should first
undergo an evaluation by a doctor, including a pelvic exam, to verify that the symptoms
are due to estrogen deficiency. There are local (meaning vaginal) and oral treatments for
the symptoms of vaginal estrogen deficiency. Local treatments include the vaginal
estrogen ring, vaginal estrogen cream, or vaginal estrogen tablets. Oral treatments include
multiple types of estrogen either alone, or estrogen given with progesterone (see
MedicineNet.com’s Hormone Replacement Therapy article). Local and oral estrogen
treatments are both effective in relieving vaginal symptoms and are sometimes combined
for this purpose. In women for whom oral or vaginal estrogens are deemed inappropriate,
such as breast cancer survivors, or women who do not wish to take oral or vaginal
estrogen, there are a variety of over-the-counter vaginal lubricants. However, they are
probably not as effective in relieving vaginal symptoms as replacing the estrogen
deficiency with oral or local estrogen.

Osteoporosis
The goal of osteoporosis treatment is the prevention of bone fractures by stopping bone
loss and increasing bone density and strength. Although early detection and timely
treatment of osteoporosis can substantially decrease the risk of future fracture, none of
the available treatments for osteoporosis are complete cures. In other words, it is difficult
to completely rebuild bone that has been weakened by osteoporosis. Therefore, the
prevention of osteoporosis is as important as treatment. Osteoporosis treatment and
prevention measures are:
Lifestyle changes including quitting cigarette smoking, curtailing alcohol
intake, exercising regularly, and consuming a balanced diet with adequate
calcium and vitamin D.
Estrogen replacement therapy for postmenopausal women and those with other
low estrogen conditions.
Medications that stop bone loss and increase bone strength, such as alendronate
(Fosamax), risedronate (Actonel), raloxifene (Evista), and calcitonin (Calcimar).
Heart Disease
There is much controversy regarding whether or how much oral estrogen replacement
affects the risk of heart disease in postmenopausal women. Research with a large enough
number of women in well-designed studies is needed. Additionally, we need to be able to
separate out the effects of different types of estrogen preparations to get the answer. It
seems so far that estrogen replacement may protect against heart disease in women who
do not yet have heart disease, but may not be protective in women who are already
known to have heart disease. In the near future, we will have more information from
better-designed research studies regarding this issue.

Menopause At A Glance
Menopause is the time in a woman’s life when the function of the ovaries ceases.

The ovary, or female gonad, is one of a pair of reproductive glands in women.
The process of menopause does not occur overnight, but rather is a gradual
process. This so-called perimenopausal transition period is a different experience
for each woman.
The average age of menopause onset is 51 years old. There is no single method to
predict when a woman will experience menopause.
The age at which a woman starts having menstrual periods is not related to the
age of menopause onset.
A women is in menopause when she has had no menstrual periods (menses) for
12 months and has no other medical reason for her menses to stop.
Symptoms of menopause can be divided into early and late onset symptoms.

Early symptoms include abnormal vaginal bleeding, hot flashes, and mood
changes. Late symptoms include vaginal dryness and irritation, osteoporosis, and
heart disease.
Treatments for menopause are directed toward alleviating the symptoms present
in the particular woman affected.
HTML1DocumentEncodingutf-8What is menopause? When does a woman know she is
in menopause? Are hormone levels or other blood tests helpful in detecting menopause?
What are the symptoms of menopause?
Abnormal Vaginal Bleeding
Hot Flashes
Mood Symptoms
Vaginal Symptoms
Osteoporosis
Heart disease
What are the treatment options for menopause?
Abnormal Vaginal Bleeding
Hot Flashes
Mood Symptoms
Vaginal Symptoms
Osteoporosis
Heart Disease

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