While menopause is officially defined as the as a woman's final menstrual
period, most people think of menopause as the symptoms that occur when a
women's estrogen levels drop. Hot flashes, night sweats, insomnia, vaginal
dryness, and mood swings
can be just a few of the symptoms that signal the
beginning of menopause.
Some women get no symptoms at all and simply stop
having their periods while others may have symptoms years before they stop
having periods and continue having symptoms for decades.

The average age of menopause is 51, though menopause commonly occurs
anytime between the ages of 45 to 55. While we think of menopause as a
natural occurrence, 1000 years ago the average woman lived to age 24,  and
100 years ago the average woman lived to be 47. As life expectancy has
increased so has the chance that a woman will "outlive her ovaries" and
become menopausal.

What causes menopause?

Prior to menopause a woman's ovary produces an egg every month. In the
process of making a fertile egg, the ovary also makes estrogen and
progesterone. During menopause, a woman's ovaries stop making eggs and
they produce less estrogen and progesterone. Changes in these hormones
cause menopause symptoms. Periods occur less often and eventually stop.
Sometimes this happens suddenly. But most of the time, periods slowly stop
over time. Menopause is complete when you have not had a period for 1 year.
This is called the post-menopause. Women who are post-menopausal can no
longer get pregnant. Surgical menopause occurs when both ovaries are
removed for benign or cancerous conditions.

Symptoms

The symptoms of menopause vary from woman to woman. They may last 5 or
more years. Some women may have worse symptoms than others. Symptoms of
surgical menopause can be more severe and start more suddenly.
The first thing you may notice is that your periods start to change. They might
occur more often or less often. Some women might get their period every 3
weeks. This might last for 1 - 3 years before the periods completely stop.

Common symptoms of menopause include:
Menstrual periods that occur less often and eventually stop
Heart pounding or racing
Hot flashes, usually worst during the first 1 - 2 years
Night sweats
Skin flushing
Sleeping problems (insomnia)
Other symptoms of menopause may include:
Decreased interest in sex, possibly decreased response to sexual stimulation
Forgetfulness (in some women)
Headaches
Mood swings including irritability, depression, and anxiety
Urine leakage
Vaginal dryness and painful sexual intercourse
Vaginal infections
Joint aches and pains
Irregular heartbeat (palpitations)

Tests

Blood  tests can be used to look for changes in hormone levels. Test results
can help your doctor determine if you are close to menopause or if you have
already gone through menopause.

Tests that may be done include:

Estradiol and Follicle Stimulating Hormone

Thyroid tests and other pituitary hormone tests may be needed for women
younger than 45 who have menopausal symptoms.

Your doctor should perform a pelvic exam. Decreased estrogen can cause
changes in the lining of the vagina.

Bone density decreases by 5% per year or more for the first 4 to 5  years after
your last period. Your doctor may order a bone density test to look for bone loss
related to
osteoporosis.

Treatment

Treatment for menopause depends on many things, including how bad your
symptoms are, your overall health, and your preference. It may include lifestyle
changes or hormone therapy.

HORMONE THERAPY

Hormone replacement therapy may help if you have severe hot flashes, night
sweats, mood issues, or vaginal dryness. Hormone therapy is treatment with
estrogen and, sometimes, progesterone. Talk to your doctor about the benefits
and risks of hormone therapy. Your doctor should be aware of your entire
medical history before prescribing hormone therapy (HRT).

Several major studies have questioned the health benefits and risks of hormone
therapy, including the risk of developing breast cancer, heart attacks, strokes,
and blood clots.  As studies are on-going it is important to re-evaluated the use
of HRT every year at your annual exam, considering your health and medical
problems and current research and recommendations. At Canterbury Women's
Health Care we try to tailor any hormone regimen to fit you and your life style.

ALTERNATIVES TO HORMONE THERAPY


There are other medicines available to help with mood swings, hot flashes, and
other symptoms. These include:
Antidepressants, such as paroxetine (Paxil), venlafaxine (Effexor), bupropion
(Wellbutrin), and fluoxetine (Prozac)
A blood pressure medicine called clonidine
Gabapentin, a seizure drug that also helps reduce hot flashes

DIET AND LIFESTYLE CHANGES

Hormones are not always needed to reduce symptoms of menopause. There are
many steps you can take to reduce symptoms.

Diet changes:

Avoid caffeine, alcohol, and spicy foods.
Get plenty of calcium and vitamin D in food or supplements.
Exercise and relaxation techniques:
Get plenty of exercise.
Do Kegel exercises every day. They strengthen the muscles of your vagina and
pelvis.
Practice slow, deep breathing whenever a hot flash starts to come on. Try
taking six breaths a minute.
Try yoga, tai chi, or meditation.

Other tips:
Dress lightly and in layers.
Wear a neck cooler or use a cooling mattress pad at night
Keep having sex.
Use water-based lubricants or a vaginal moisturizer during sex.


Complications

Some women have vaginal bleeding after menopause.  However, you should tell
your health care provider if this occurs. It may be an early sign of other health
problems, including cancer.

Decreased estrogen levels have been linked with some long-term effects,
including:

Bone loss and osteoporosis in some women
Changes in cholesterol levels and greater risk of heart disease

Calling your doctor

Call your doctor immediately if:

You are spotting blood between periods
You have had 12 consecutive months with no period and suddenly vaginal
bleeding or spotting begins again, even if it is a very small amount
You get chest pain, shortness of breath, inability to speak,  find words, or move
any body part, or get pain and swelling in your legs

Prevention


You can reduce your risk of long-term problems such as osteoporosis and heart
disease by taking the following steps:

Control your blood pressure, cholesterol, and other risk factors for heart
disease.
Do NOT smoke. Cigarette use can cause early menopause.
Eat a low-fat diet.
Get regular exercise. Resistance exercises help strengthen your bones and
improve your balance.
If you show early signs of bone loss or have a strong family history of
osteoporosis, talk to your doctor about medications that can help stop further
weakening.
Take calcium and vitamin D.


Menopause