Prevention & Recovery

The ins and outs of menopause

By: Donnica Moore, MD

Author: Canadian Living

Prevention & Recovery

The ins and outs of menopause

By: Donnica Moore, MD
Menopause is when our fertility comes to an end and menstruation stops. It is a perfectly natural part of getting older. This time of life brings many hormonal, physical, mental, and emotional changes, some of which can be challenging. The good news is that plenty of help is available.

What is it?
Menopause is the stage in your life when your ovaries stop working. Having released an egg each month since you reached puberty, they now cease to do so. At the same time, they also stop producing both estrogen and progesterone. It is the drop in the level of these hormones in your bloodstream that gives rise to the symptoms of menopause. As a result of these changes, you stop having periods and can no longer conceive.

Menopause usually happens gradually. A few years before, perhaps as early as your 40s, you may notice that your periods become irregular and bleeding is heavier. This stage is called perimenopause and usually lasts about four years.

Some women can go through menopause without experiencing any problems at all, while others suffer from one or more symptoms, such as hot flushes, night sweats, and insomnia. Hot flushes are often worse during the perimenopausal stage, but then, within two years of their last menstrual period, many women notice a significant improvement and experience fewer hot flushes.

About 20 per cent of women never experience hot flushes, but if you have had a sudden menopause – for instance, after having your ovaries removed – your symptoms may be more severe. Few women get every menopausal symptom, but certain risk factors, such as smoking and being overweight, can make your symptoms worse.

Once you have gone for a full year without having a period, you are said to be "menopausal", or "postmenopausal". Until this time you should continue to use your chosen method of contraception. If you have gone for a year without a period, but then start bleeding again, you should see your doctor. It's important to make sure there is nothing abnormal happening in your uterus that is causing you to bleed.

Although some women have menopausal symptoms much earlier than others, the average age of menopause is about 51. Most women have reached menopause by the age of 59.

There are some exceptions:
• If your ovaries are removed surgically you will have an instantaneous menopause

• If you have chemotherapy or radiotherapy treatment, your periods usually stop, but they normally start again after finishing treatment

• If you smoke you are more likely to go through menopause about one to two years earlier than nonsmokers

• About 1 per cent of women will go through menopause before the age of 40. If you think that you may be experiencing an early menopause you should visit your doctor for advice.

After menopause, lower levels of estrogen and progesterone in your body may increase the likelihood of some long-term health problems. These include:
• Osteoporosis, or bone thinning
Heart disease
• Stroke

If you are suffering from any unexplained symptoms or feel concerned about these health problems, then talk to your doctor.

Page 1 of 5 - On page 2 find out what to do if you have symptoms.

Excerpted from Women's Health For Life, copyright 2009 Donnica Moore, MD and DK Publishing. Used by permission of DK Publishing.

All Rights Reserved. No part of this excerpt may be reproduced except with permission in writing from the publisher. Do I have the symptoms?
All women will experience menopause differently. You may have several symptoms, or you may suffer relatively few. Of all the various symptoms that women experience the most common ones include:

• Hot flushes and night sweats
• Irregular periods and/or heavy bleeding
An inability to sleep at night
• Vaginal dryness and discomfort during intercourse
• A loss of sex drive
• Bladder problems, such as incontinence and urinary tract infections
Mood swings, depression, and anxiety
• Poor concentration
• Short-term memory problems
• Feeling tired and lethargic
• Dry and itchy skin
• Thinning hair
• Weight gain
• Headaches
• Palpitations.

See your doctor if your symptoms are causing problems.

What next?
If you are having uncomfortable menopausal symptoms, or want to know if you are still fertile, talk to your doctor. He or she may be able diagnose menopause by your symptoms, age, and patterns of your period. Sometimes doctors use hormone tests, but none of these is definitive. They include a follicle-stimulating hormone (FSH) test to measure the level of FSH – the hormone that stimulates ovulation – in your blood.

My treatment options
There are many ways to deal with menopausal symptoms, from lifestyle changes to hormone replacement therapy (HRT) and complementary therapies. Your doctor can advise you on the best course of treatment. You may find one particular treatment that suits you, though many women get good results by using a combination of therapies together with self-help measures.

Hormone replacement therapy (HRT): This is the most effective way to treat the symptoms of menopause, including hot flushes, night sweats, vaginal dryness, and infections of the urinary tract.

The therapy works by replacing some of the hormones that your body stops producing during and after menopause. It usually means you take a combination of estrogen and progestogen (synthetic progesterone).

If you've had your uterus removed in a hysterectomy you can take estrogen-only HRT. So long as you don't have any contraindications. This was commonly offered to any woman thought suitable for HRT until the 1970s; at that point, researchers found that women with a uterus were more likely to develop uterine cancer if they only took estrogen. To make HRT more closely resemble the natural menstrual process, when the ovaries make both estrogen and progesterone, progestogen was added to the hormone medication. The increased risk of uterine cancer disappeared.

HRT was extremely popular in the 1980s and 1990s, and was used not only to treat symptoms of menopause, but also to reduce the risks of heart disease and osteoporosis. However, some studies done in the UK and the US, and released in 2002 and 2003, showed that women who take HRT with the combination of estrogen and progesterone for more than five years have a slightly increased risk of breast cancer, heart disease, and stroke. Many experts feel that the increased breast cancer risk is greatest after taking HRT for more than five years and that in otherwise healthy women with moderate to severe menopausal symptoms, the benefits may exceed the risks. Women considering HRT should discuss their risks and benefits carefully with their doctors.

Page 2 of 5 - on page 3: more on HRT!

Excerpted from Women's Health For Life, copyright 2009 Donnica Moore, MD and DK Publishing. Used by permission of DK Publishing.

All Rights Reserved. No part of this excerpt may be reproduced except with permission in writing from the publisher. More on HRT
Combined HRT comes in many forms – pills that are taken orally, adhesive skin patches that are placed on your stomach, chest (not breasts), back, upper arm or buttocks, implants, and skin gels. Vaginal creams, suppositories, and vaginal rings, which are applied or inserted into your vagina are very effective if you have problems such as vaginal dryness. All these different forms are also available in many different combinations of estrogen and progesterone and in different strengths. So if one type of HRT doesn't seem to agree with you, you can try another. There is truly no "one size fits all" for this type of therapy.

There are many benefits, but also some side effects, when taking HRT, so you should discuss these with your doctor before you start the therapy. The benefits include the following:
• Relief from hot flushes and night sweats
• Relief from vaginal dryness
• Improved quality of sleep
• Potential delay in the onset of Alzheimer’s disease
• Protection against osteoporosis
• Reduced risk of colon cancer.

You may also suffer from some of the side effects when taking HRT and these include:
• Tender breasts
• Heavier periods
• Water retention
Weight gain
• Depression
• Irritability.

Taking HRT in the long term is also associated with certain medical conditions; these include the following:
• Breast cancer
• Cancer of the lining of the uterus and ovaries
• Deep vein thrombosis
Heart disease
• Gallstones
• Stroke

If you do decide to take HRT then you will need to see your doctor for regular check-ups to make sure there are no problems and side effects.

Vaginal therapy:
If you only have problems with vaginal dryness, topical lubricants and moisturizers are readily available over the counter. However, for many women these really aren’t sufficient to relieve dryness and pain with intercourse, so vaginal estrogen creams, suppositories, and rings are available by prescription. The amount of estrogen absorbed from vaginal tablets and rings is minuscule; most oncologists will allow their breast cancer patients to use vaginal estrogens for moisture. If you use HRT patches or oral tablets, you may need to supplement them with vaginal therapy.

Antidepressants: These may be prescribed for women who prefer not to take hormonal therapy, but for whom natural self-help remedies don't work.

Commonly used antidepressants include drugs known as selective serotonin reuptake inhibitors (SSRIs) and serotonergic noradrenergic reuptake inhibitors, both of which can be helpful in relieving menopausal symptoms. Women who have had breast cancer, and for whom treatment with estrogen is not appropriate, may find significant relief with these medications.

However, the exact role of these drugs on menopause has yet to be clarified and they are not FDA-approved for this indication.

Page 3 of 5 – on the next page: how you can help yourself get through menopause!

Excerpted from Women's Health For Life, copyright 2009 Donnica Moore, MD and DK Publishing. Used by permission of DK Publishing.

All Rights Reserved. No part of this excerpt may be reproduced except with permission in writing from the publisher. Natural therapy: Herbal remedies may offer an alternative to conventional treatments for menopausal symptoms, and can sometimes be used in addition to mainstream medicine.

There is some data that shows that preparations of black cohosh, which is a member of the buttercup family, may be helpful in alleviating mild hot flushes. Two other commonly suggested herbal remedies are Vitex agnus castis and sage. However, you should be cautious about self-dosing with any herbal remedy. Very few such remedies have been subjected to rigorous clinical trials; some trials have found these products to be equallym effective as placebo.

If you are on other medication, always check with your doctor before taking any additional remedy. He or she will work with you to find the best treatment for your particular needs, taking into account your individual symptoms and the possible side effects of each treatment.

Herbs for hot flushes
Three herbs that may help to reduce hot flushes are sage, red clover, and black cohosh. Herbal remedies aren't regulated the same way as drugs, so make sure you buy them from a reputable supplier and always follow the manufacturer's advice on dosage.

How can I help myself?
If you're reluctant to use either hormonal or herbal therapies to relieve menopausal symptoms, there are plenty of non-medical options that you may be more comfortable with.

Lifestyle habits : Often, simple lifestyle habits are helpful. For example, to help relieve hot flushes and night sweats:

• Wear light clothing made of natural fibres, such as cotton
• Dress in layers that are easy to remove if a flush comes on
• Take regular exercise
• Reduce stress with relaxation techniques
Eat a balanced diet
• If you are suffering from night sweats, do all you can to keep your bedroom cool
• Avoid nightclothes and bed linen made from nylon or polyester
• Avoid known triggers, such as red wine and spicy foods

Soya-based foods

If none of the above lifestyle habits help, try adding soya-based foods to your diet. However, some specialists do not regard soya as particularly helpful if you are already taking estrogen replacement therapy.

Page 4 of 5 – on the next page: how to change your life to ease the effects of menopause!

Excerpted from Women's Health For Life, copyright 2009 Donnica Moore, MD and DK Publishing. Used by permission of DK Publishing.

All Rights Reserved. No part of this excerpt may be reproduced except with permission in writing from the publisher. Other lifestyle measures
The following medication-free, self-help measures may relieve symptoms such as irritability, anxiety, depression, and mood swings:
• A diet high in vitamin B, zinc, and magnesium
• 30 minutes of strenuous exercise to release endorphins (the body's natural stress-relieving chemicals)
• Relaxation techniques, such as yoga or meditation

To improve your quality of sleep:
• Go to bed at a regular time every night
• Avoid exercising at night
• Have a warm milky drink before you go to sleep.

To help relieve skin dryness:
• Avoid using soap, which dries out your skin
• Avoid direct sunlight
Wear sunscreen
• Make sure your diet includes vitamins A, B, C, and E as well as potassium, zinc, magnesium, iron, calcium, and essential fatty acids

How to prevent osteoporosis
Osteoporosis is a greater risk in menopausal women.

To reduce your risk of fracture:
Stop smoking
• Keep your alcohol consumption within reasonable limits
• Do regular weight-bearing exercise, such as walking, running, and dancing
• Eat a well-balanced diet
• Eat foods that are rich in calcium and vitamin D
• Ask your doctor about taking supplements of calcium and vitamin D. It is recommended that menopausal women have 1200mg of calcium daily and 800-1000 IU of vitamin D.

How to prevent heart disease
Another health risk that increases after menopause is heart disease. To reduce this risk:
• Maintain a healthy body weight
• Eat a healthy diet that is low in saturated fats and rich in fruits and vegetables
• Take regular aerobic exercise, ideally every day, but at least three to four days a week for 30–40 minutes minimum
• Stop smoking
• Have the level of cholesterol in your blood checked. If your cholesterol level is very high, then you may need to take medication to lower it.
• Get your blood pressure checked regularly. You may need medication to lower it.

Page 5 of 5

Click here for more articles about menopause and women's health.

Excerpted from Women's Health For Life, copyright 2009 Donnica Moore, MD and DK Publishing. Used by permission of DK Publishing.

All Rights Reserved. No part of this excerpt may be reproduced except with permission in writing from the publisher.
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Prevention & Recovery

The ins and outs of menopause