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Menopause, which marks the end of a woman’s reproductive life, is something roughly half of the world’s population will go through if they live long enough. But this stage like so much surrounding women’s health is poorly understood. A drop in hormones, primarily estrogen, is the driving force behind menopause’s signature event:The reduction and eventual end of fertility. Yet women experience a long list of other symptoms during perimenopause…..Continue reading…
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Menopause, also known as the climacteric, is the time when menstrual periods permanently cease, marking the end of reproduction. It typically occurs between the ages of 45 and 55, although the exact timing can vary. Menopause is usually a natural change. It can occur earlier in those who smoke tobacco. Other causes include surgery that removes both ovaries or some types of chemotherapy.
At the physiological level, menopause happens because of a decrease in the ovaries’ production of the hormones estrogen and progesterone.While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine. Menopause is the opposite of menarche, the time when a girl’s periods start.
In the years before menopause, a woman’s periods typically become irregular, which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow. During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, night sweats, and reddening of the skin. Hot flashes can recur for four to five years.
Other symptoms may include vaginal dryness, trouble sleeping, and mood changes. The severity of symptoms varies between women. Menopause before the age of 45 years is considered to be “early menopause” and when ovarian failure/surgical removal of the ovaries occurs before the age of 40 years this is termed “premature ovarian insufficiency“.
In addition to symptoms (hot flushes/flashes, night sweats, mood changes, arthralgia and vaginal dryness), the physical consequences of menopause include bone loss, increased central abdominal fat, and adverse changes in a woman’s cholesterol profile and vascular function. These changes predispose postmenopausal women to increased risks of osteoporosis and bone fracture, and of cardio-metabolic disease (diabetes and cardiovascular disease).
Medical professionals often define menopause as having occurred when a woman has not had any menstrual bleeding for a year. It may also be defined by a decrease in hormone production by the ovaries. In those who have had surgery to remove their uterus but still have functioning ovaries, menopause is not considered to have yet occurred. Following the removal of the uterus, symptoms of menopause typically occur earlier. Iatrogenic menopause occurs when both ovaries are surgically removed along with uterus for medical reasons.
The primary indications for treatment of menopause are symptoms and prevention of bone loss. Mild symptoms may be improved with treatment. With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended; sleeping naked in a cool room and using a fan may help. The most effective treatment for menopausal symptoms is menopausal hormone therapy (MHT).
Non hormonal therapies for hot flashes include cognitive-behavioral therapy, clinical hypnosis, gabapentin, fezolinetant or selective serotonin reuptake inhibitors. These will not improve symptoms such as joint pain or vaginal dryness which affect over 55% of women.Exercise may help with sleeping problems. Many of the concerns about the use of MHT raised by older studies are no longer considered barriers to MHT in healthy women. High-quality evidence for the effectiveness of alternative medicine has not been found.
During early menopause transition, the menstrual cycles remain regular but the interval between cycles begins to lengthen. Hormone levels begin to fluctuate. Ovulation may not occur with each cycle. The term menopause refers to a point in time that follows one year after the last menstruation.During the menopausal transition and after menopause, women can experience a wide range of symptoms.
However, for women who enter the menopause transition without having regular menstrual cycles (due to prior surgery, other medical conditions or ongoing hormonal contraception) the menopause cannot be identified by bleeding patterns and is defined as the permanent loss of ovarian function. During the transition to menopause, menstrual patterns can show shorter cycling (by 2–7 days); longer cycles remain possible.
There may be irregular bleeding (lighter, heavier, spotting). Dysfunctional uterine bleeding is often experienced by women approaching menopause due to the hormonal changes that accompany the menopause transition. Spotting or bleeding may simply be related to vaginal atrophy, a benign sore (polyp or lesion), or may be a functional endometrial response.
The European Menopause and Andropause Society has released guidelines for assessment of the endometrium, which is usually the main source of spotting or bleeding. In post-menopausal women, however, any unscheduled vaginal bleeding is of concern and requires an appropriate investigation to rule out the possibility of malignant diseases. Urogenital symptoms that may appear during menopause and continue through postmenopause include:
- painful intercourse
- vaginal dryness
- atrophic vaginitis – thinning of the membranes of the vulva, the vagina, the cervix, and the outer urinary tract, along with considerable shrinking and loss in elasticity of all of the outer and inner genital areas.
The most common physical symptoms of menopause are heavy night sweats, and hot flashes (also known as vasomotor symptoms).Sleeping problems and insomnia are also common. Other physical symptoms may be reported that are not specific to menopause but may be exacerbated by it, such as lack of energy, joint soreness, stiffness, back pain, breast enlargement, breast pain, heart palpitations, headache, dizziness, dry, itchy skin, thinning, tingling skin, rosacea, weight gain, urinary incontinence, urinary urgency.
Psychological symptoms are often reported but they are not specific to menopause and can be caused by other factors.They include anxiety, poor memory, inability to concentrate, depressive mood, irritability, mood swings, and less interest in sexual activity. Menopause-related cognitive impairment can be confused with the mild cognitive impairment that precedes dementia.
There is evidence of small decreases in verbal memory, on average, which may be caused by the effects of declining estrogen levels on the brain, or perhaps by reduced blood flow to the brain during hot flashes. However, these tend to resolve for most women during the postmenopause. Subjective reports of memory and concentration problems are associated with several factors, such as lack of sleep, and stress…
Irish women fear menopause symptoms are damaging their relationships The Irish Independent
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