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Written By: Abier Hamami. RPH. CPHQ
Abstract: Menopause is not a disease or an illness. It is a transition between two natural phases of a woman’s life. Gaining the right knowledge about menopause will make this transition less stressful and help you in living a healthier life.
What is Menopause?
At what age does it occur?
What is the cause of Menopause?
What are the stages of Menopause?
What are the symptoms of Menopause?
How is Menopause diagnosed?
What are the complications of Menopause?
Is their a need to regularly visit the doctor?
Is there a medical treatment for Menopause?
Are their herbal or alternative products used for Menopause symptoms?
Can life-style changes help in staying healthy after Menopause?
What is Menopause?
Menopause (also known as the "Change of life" or climacteric) is a normal part of any woman’s life, just like puberty. Literally, we can define menopause as "ceasing of menses (monthly periods)".
Even though it is usually a natural process, but certain surgical or medical treatments can bring on menopause earlier than expected. These include: hysterectomy, chemotherapy and radiation therapy, and premature ovarian failure.
It is interesting to know that also men can experience some physical and emotional changes that Researchers now suggest these men were probably experiencing a male version of menopause, or more specifically called "Andropause". Andropause is characterized by decreased testosterone levels associated with the normal male aging process.
At what age does it occur?
Menopause occurs around the age of 50. However, some women can experience menopause as early as 40 or as late as 60. If menopause occurs prior to age 40 this is thought to be abnormal and is called premature menopause, which could be either natural due to family genes, or brought on by medical and surgical means as explained above.
What is the cause of Menopause?
Menopause is the result of depletion of egg cells from the ovaries and the reduction of female hormones. These hormones regulate your monthly cycles of ovulation and menstruation. In your late 30s, the amount of progesterone your body produces diminishes, and the remaining eggs from your ovaries are less likely to be fertilized. Eventually your menstrual periods stop, and you can no longer become pregnant
What are the stages of Menopause?
Menopause is not a sudden event but it is rather a three- stages process. These stages are:
· Peri-Menopause Stage:
§ May begin 3 to 5 years before your last menstrual period
§ Lasts until 1 year after your last menstrual period
§ Signs and symptoms may appear during this phase
· Menopause Stage:
§ Complete cessation of menstrual periods
§ You have had no menstrual periods for 1 year
§ Child-bearing is no longer naturally possible
· Post-Menopause Stage:
§ Begins 1 year after your last menstrual period
§ You no longer menstruate
§ Risk of certain health problems increases (such as osteoporosis and cardiovascular disease)
What are the symptoms of Menopause?
Every woman experiences menopause differently, your signs and symptoms also are likely to be very individual. You may breeze through menopause with few signs and symptoms. Or you may experience a number of physical and emotional changes, including:
· Irregular periods: periods could be lighter or heavier than normal. Also they may be shorter or last longer.
· Hot flashes of the face and neck that last for 30 sec to five min. They are the most common symptom of menopause. According to some studies, hot flashes occur in as many as 75% of perimenopausal women.
· Vaginal problems as dryness, infection, and painful intercourse
· Urinary incontinence and burning on urination
· Sex changes such as diminished interest in sex, or difficult arousal.
· Fatigue and sleep disturbance
· Mood changes as irritability, anxiety, or depression
· Changes in appearance. The fat that once was concentrated in your hips and thighs may settle above your waist and in your abdomen. You may notice a loss of fullness in your breasts, thinning hair and wrinkles in your skin.
· Other symptoms as Headaches, Memory problems, Joint and muscle stiffness or pain , and Difficulty concentrating
How is Menopause diagnosed?
Menopause is often diagnosed based on the presence of symptoms, and in some cases, changes in hormone levels. Your doctor will also consider whether there are any other possible causes for your symptoms.
To determine hormone levels changes, a blood test that measures the level of follicle-stimulating hormone (FSH) in your blood is usually used for diagnosis. FSH is produced by your pituitary gland and stimulates your ovaries to produce estrogen. As your estrogen levels decline, your pituitary gland produces more FSH into your blood in an attempt to stimulate more estrogen. When blood levels of FSH consistently rise to certain levels (usually >40) , it is likely that you have reached menopause. More than one FSH test will be needed to confirm menopause. You should not be taking birth control pills when you have an FSH test, because birth control pills contain hormones that will affect the test results.
Generally speaking, menopause is usually diagnosed when a woman has not had a menstrual period for 12 consecutive months.
What are the complications of Menopause?
Several chronic medical conditions tend to appear after menopause including:
· Cardiovascular disease. At the same time your estrogen levels decline, your risk of cardiovascular disease increases.
· Osteoporosis. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis.
· Urinary incontinence. As the tissues of your vagina and urethra lose their elasticity, you may experience a frequent, sudden, strong urge to urinate (urge incontinence) or incontinence with coughing, laughing or lifting (stress incontinence).
· Weight gain. Many women gain weight during the menopausal transition.
Is their a need to regularly visit the doctor?
Yes, all perimenopausal and postmenopausal women should see their doctor annually for a full physical exam. This exam should include a breast exam, pelvic exam, and mammogram. Also since menopause increase the risk of heart diseases and osteoporosis, therefore your doctor may request a cholesterol test and a bone density test to assure close monitor and early diagnosis of these diseases.
Is there a medical treatment for menopause?
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 prescription medications and nonprescription medications.
Prescription Medications:
Hormone Replacement Therapy (HRT).
Is a treatment that is used to supplement the body with either estrogen alone or estrogen and progesterone in combination.
HRT has been widely used in recent decades to relieve the signs and symptoms of menopause as hot flashes, and vaginal discomfort. However, one large study called the Women's Health Initiative (WHI),funded by the National Institutes of Health, was halted early when researchers found that women given a certain type of combined estrogen and progesterone were at increased risk of heart attack, stroke and breast cancer. Later results from the WHI study showed that estrogen alone also increased stroke risk, but did not increase breast cancer or heart disease risk. The study results suggest that benefits of HRT use must be outweighed by the risks; therefore, your physician will discuss your personal and family medical history with you before it is prescribed.
Generally women who have the following conditions should not be started on HRT:
- Pregnanacy.
- Vaginal bleeding.
- Certain kinds of cancers (such as breast and uterine cancer).
- Stroke or heart attack.
- Blood clots.
- Liver disease.
- Heart disease.
Androgen
Androgen is a hormone produced by both males and females. In women, the ovaries secrete androgen as testosterone and androstenedione. Androgen, which must be taken with estrogen, may help improve sex drive in some women. Possible side effects include:
- Restlessness
- Depression
- Growth of facial and body hair
- Acne
- An enlarged clitoris
- Increased muscle mass
- A lowered voice
- Increased cardiovascular risks
Bisphosphonates
These agents effectively reduce both bone loss and your risk of fractures. Therefore, they are used in osteoporosis treatment. Among them are Alendronate (Fosamax) and Risedronate (Actonel)
Selective Estrogen Receptor Modulators (SERMs)
SERMs such as Raloxifene (Evista), have some of the beneficial effects of estrogen, especially improved bone strength, but no increased risk of breast cancer or uterine bleeding. However, these medications tend to cause, rather than relieve, hot flashes and increase your risk of blood clots and gallstones.
Low-dose antidepressants. Venlafaxine (Effexor), an antidepressant related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), may decrease hot flashes by up to 60 percent. Other drugs in the SSRI class that can be helpful include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalpram (Celexa) and sertraline (Zoloft). These medications may cause side effects including nausea, dizziness or sexual dysfunction.
Gabapentin (Neurontin). This drug is approved to treat seizures and is commonly used to manage chronic, nerve-related pain, but it also has been shown to significantly reduce hot flashes. Side effects may include drowsiness, dizziness, nausea and swelling.
Clonidine (Catapres, others). a pill or patch typically used to treat high blood pressure, may significantly reduce the frequency of hot flashes, but side effects such as dizziness, drowsiness, dry mouth and constipation are common.
Nonprescription Medications:
Are their herbal or alternative products for Menopause symptoms?
Many herbal or alternative products have been promoted as aids in managing the symptoms of menopause. Such as:
· Black cohosh (Remifemin ®) is a commonly used herbal supplement that is believed to reduce hot flashes. However, small German studies that tested black cohosh only followed women over a short time period. The German agency that regulates herbs does not recommend using black cohosh for longer than 6 months. Side effects can include nausea, vomiting, dizziness, visual problems, slow heartbeat, and excessive sweating. Recently the European Medicines Agency EMEA and the Committee on Herbal Medicinal Products (HMPC) have been made aware of a number of case reports of hepatotoxicity (liver injuries) in patients using black cohosh, and recommended to stop taking it, and consult their doctor immediately if they develop signs and symptoms suggestive of liver injury (tiredness, loss of appetite, yellowing of the skin and eyes or severe upper stomach pain with nausea and vomiting or dark urine).Also black cohosh is not regulated by the U.S. Food and Drug Administration, so women must be careful about the safety and purity of this supplement.
· Inconclusive and conflicting studies indicate that other herbals, such as dong quai, red clover (Promensil), chasteberry (Vitex), yam cream, Chinese medicinal herbs, and evening primrose oil, should be avoided or taken with care under the supervision of a health care provider to avoid unwanted and dangerous side effects and interactions
Important Note: Be sure to consult your doctor before taking any herbal treatments or dietary supplements for signs and symptoms of menopause. Herbal products can interfere or interact with other medications you may be taking.
Can life-style changes help in staying healthy after Menopause?
Yes some life style changes can help in alleviating some menopausal symptoms and also help in staying healthy. These changes are:
· Stop smoking.
· Stay cool, as wear less layers, sleep in cold room, use a fan, and avoid hot food or drinks.
· Increase your intake of Phytoestrogens (naturally occurring estrogens) There are two main types of phytoestrogens — isoflavones and lignans. Isoflavones are found in soybeans, chickpeas and other legumes. Lignans occur in flaxseeds, whole grains and some fruits and vegetables. Although some women find that adding these foods to their daily diets seems to help hot flashes, studies have mostly found them ineffective. In addition, some studies indicate that phytoestrogens may increase breast cancer growth. If you have had breast cancer, talk to your doctor before supplementing your diet with them.
· Eat a healthy diet- one low in fat, high in fiber, with plenty of fruits, vegetables, and whole grain foods, as well as all the important vitamins and minerals. Also minimize your intake of caffeine.
· Make sure to get enough calcium and vitamin D in your diet or take a supplement.
· Avoid weight gain.
· Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. Also do some exercises to strengthen your pelvic floor muscle, as Kegel exercises, to improve some forms of urinary incontinence.
· Schedule regular check up.
· Optimize your sleep. If you have trouble sleeping, avoid caffeinated beverages and exercise right before bedtime. Practicing relaxation techniques, such as deep breathing, guided imagery and progressive muscle relaxation, can be very helpful.
References:
· http://www.thirdage.com/healthgate/files/19829.html
· http://www.niapublications.org/agepages/menopause.asp
· http://www.mayoclinic.com/health/menopause/DS00119
· http://womenshealth.gov/faq/menopaus.htm
· http://www.nlm.nih.gov/medlineplus/menopause.html
· http://www.emedicinehealth.com/menopause/article_em.htm
· http://www.infoforyourhealth.com/Womens%27%20Health/Menopause.htm
· http://www.webmd.com/content/article/51/40613
· http://www.medicinenet.com/menopause/article.htm
· http://consumerhealthdigest.com/malemenopause.htm?source=google/MaleMenopause
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