MENOPAUSE
Menopause, or the permanent end of menstruation and fertility, is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss.
Hormonal changes cause the physical symptoms of menopause, but mistaken beliefs about the menopausal transition are partly to blame for the emotional ones. First, menopause doesn't mean the end is near — you've still got as much as half your life to go. Second, menopause will not snuff out your femininity and sexuality. In fact, you may be one of the many women who find it liberating to stop worrying about pregnancy and periods.
Most important, even though menopause is not an illness, you shouldn't hesitate to get treatment if you're having severe symptoms. Many treatments are available, from lifestyle adjustments to hormone therapy.
Symptoms
Technically, you don't actually "hit" menopause until it's been one year since your final menstrual period. In the United States, that happens about age 51, on average.
The signs and symptoms of menopause, however, often appear long before the one-year anniversary of your final period. They include:
- Irregular periods
- Decreased fertility
- Vaginal dryness
- Hot flashes
- Sleep disturbances
- Mood swings
- Increased abdominal fat
- Thinning hairLoss of breast fullness
Causes
Menopause begins naturally when your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation. The process gets under way in your late 30s. By that time, fewer potential eggs are ripening in your ovaries each month, and ovulation is less predictable. Also, the post-ovulation surge in progesterone — the hormone that prepares your body for pregnancy — becomes less dramatic. Your fertility declines, perhaps partially due to these hormonal effects.
These changes are more pronounced in your 40s, as are changes in your menstrual pattern. Your periods may become longer or shorter, heavier or lighter, and more or less frequent. Eventually, your ovaries shut down and you have no more periods. It's possible, but very unusual, to menstruate every month right up to your last period. You're much more likely, though, to have a gradual tapering off.
Unfortunately, there's no way to know exactly which period will be your last. You have to wait until well after the fact — 12 months after, by official definition. In your final months before reaching menopause, it's still possible to get pregnant, but it's quite unlikely.
Because this process takes place over years, menopause is commonly divided into the following two stages:
Perimenopause. This is the time you begin experiencing menopausal signs and symptoms, even though you still menstruate. Your hormone levels rise and fall unevenly, and you may have hot flashes and other symptoms. Perimenopause may last four to five years or longer.
Postmenopause. Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and no progesterone, and they don't release eggs. The years that follow are called postmenopause.
Screening and diagnosis
The signs and symptoms of menopause are enough to tell most women they have begun going through the transition. If you have concerns about irregular periods or hot flashes, talk with your doctor. In some cases further evaluation may be recommended.
Under certain circumstances, your doctor may check your level of follicle-stimulating hormone (FSH) and estrogen (estradiol) with a blood test. As menopause occurs, FSH levels increase and estradiol levels decrease. Your doctor may also recommend a blood test to determine your level of thyroid-stimulating hormone, because hypothyroidism can cause symptoms similar to those of menopause.
Treatment
Menopause itself requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and on preventing or lessening chronic conditions that may occur with aging. Treatments include:
Hormone therapy.
Estrogen therapy remains, by far, the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you.
Low-dose antidepressants.
Venlafaxine (Effexor), an antidepressant related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), has been shown to decrease menopausal hot flashes. Other SSRIs can be helpful, including fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalopram (Celexa) and sertraline (Zoloft).
Gabapentin (Neurontin).
This drug is approved to treat seizures, but it also has been shown to significantly reduce hot flashes.
Clonidine (Catapres, others).
Clonidine, a pill or patch typically used to treat high blood pressure, may significantly reduce the frequency of hot flashes, but unpleasant side effects are common.
Bisphosphonates.
Doctors may recommend these nonhormonal medications, which include alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva), to prevent or treat osteoporosis. These medications effectively reduce both bone loss and your risk of fractures and have replaced estrogen as the main treatment for osteoporosis in women.
Selective estrogen receptor modulators (SERMs).
SERMs are a group of drugs that includes raloxifene (Evista). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen.
Vaginal estrogen.
To relieve vaginal dryness, estrogen can be administered locally using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each.
