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.

What are the symptoms of menopause?

It is important to remember that each woman's experience is highly individual. Some women may experience few or no symptoms of menopause, while others experience multiple physical and psychological symptoms. The extent and severity of symptoms varies significantly among women. These symptoms of menopause and perimenopause are discussed in detail below.

Irregular vaginal bleeding

Irregular vaginal bleeding may occur during menopause. Some women have minimal problems with abnormal bleeding during perimenopause whereas others have unpredictable, excessive bleeding. Menstrual periods (menses) may occur more frequently (meaning the cycle shortens in duration), or they may get farther and farther apart (meaning the cycle lengthens in duration) before stopping. There is no "normal" pattern of bleeding during the perimenopause, and patterns vary from woman to woman. It is common for women in perimenopause to get a period after going for several months without one. There is also no set length of time it takes for a woman to complete the menopausal transition. It is important to remember that all women who develop irregular menses should be evaluated by her doctor to confirm that the irregular menses are due to perimenopause and not as a sign of another medical illness.

The menstrual abnormalities that begin in the perimenopause are also associated with a decrease in fertility, since ovulation has become irregular. However, women who are in perimenopause may still become pregnant until they have reached true menopause (the absence of periods for one year).

Hot flashes & night sweats

Hot flashes are common among women undergoing menopause. A hot flash is a feeling of warmth that spreads over the body and is often most pronounced in the head and chest A hot flash is sometimes associated with flushing and is sometimes followed by perspiration. Hot flashes usually last from 30 seconds to several minutes. Although the exact cause of hot flashes is not fully understood, hot flashes are likely due to a combination of hormonal and biochemical fluctuations brought on by declining estrogen levels.

There is currently no method to predict when hot flashes will begin and how long they will last. Hot flashes occur in up to 40% of regularly menstruating women in their forties, so they may begin before the menstrual irregularities characteristic of menopause even begin. About 80% of women will be finished having hot flashes after five years. Sometimes (in about 10% of women), hot flashes can last as long as 10 years. There is no way to predict when hot flashes will cease, though they tend to decrease in frequency over time. On average, hot flashes last about five years.

Sometimes hot flashes are accompanied by night sweats (episodes of drenching sweats at nighttime). This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.

Vaginal symptoms

Vaginal symptoms occur as a result of the lining tissues of the vagina becoming thinner, drier, and less elastic as estrogen levels fall. Symptoms may include vaginal dryness, itching, or irritation and/or pain with sexual intercourse (dyspareunia). The vaginal changes also lead to an increased risk of vaginal infections.

Urinary symptoms

The lining of the urethra (the transport tube leading from the bladder to discharge urine outside the body) also undergoes changes similar to the tissues of the vagina, and becomes dryer, thinner, and less elastic with declining estrogen levels. This can lead to an increased risk of urinary tract infection , feeling the need to urinate more frequently, or leakage of urine (urinary incontinence). The incontinence can result from a strong, sudden urge to urinate or may occur during straining when coughing, laughing, or lifting heavy objects.

Emotional and cognitive symptoms

Women in perimenopause often report a variety of cognitive (thinking) and/or emotional symptoms, including fatigue, memory problems, irritability, and rapid changes in mood. It is difficult to precisely determine exactly which behavioral symptoms are due directly to the hormonal changes of menopause. Research in this area has been difficult for many reasons. Emotional and cognitive symptoms are so common that it is sometimes difficult in a given woman to know if they are due to menopause. The night sweats that may occur during perimenopause can also contribute to feelings of tiredness and fatigue, which can have an effect on mood and cognitive performance. Finally, many women may be experiencing other life changes during the time of perimenopause or after menopause, such as stressful life events, that may also cause emotional symptoms.

Other physical changes

Many women report some degree of weight gain along with menopause. The distribution of body fat may change, with body fat being deposited more in the waist and abdominal area than in the hips and thighs. Changes in skin texture, including wrinkles, may develop along with worsening of adult acne in those affected by this condition. Since the body continues to produce small levels of the male hormone testosterone, some women may experience some hair growth on the chin, upper lip, chest, or abdomen.

TYPE OF MENOPAUSE

Premature menopause

Menopause is called "premature" if it happens at or before the age of 40--whether it is natural or brought on by medical means (induced). Some women have premature menopause because of:

* Family history (genes)
* Medical treatments, such as surgery to remove the ovaries
* Cancer treatments, such as chemotherapy or radiation to the pelvic area that damage the ovaries-- although menopause does not always occur

Having premature menopause puts a woman at more risk for osteoporosis later in her life. For women who want to have children, premature menopause can be a source of great distress. Women who still want to become pregnant can talk with their doctors about other ways of having children, such as donor egg programs or adoption.

Post menopause

The postmenopausal phase of a woman's life begins at menopause, which is 1 year after her last menstrual period. While post-menopause usually begins around age 50, some women become postmenopausal in their mid-40s, and others do so in their later 50s.

In early post-menopause, a woman's estrogen stabilizes at a low level. Although low estrogen helps reduce the risk of various types of cancer, it also leads to bone thinning, which sometimes results in osteoporosis. A variety of hormonal and non-hormonal treatments are available for postmenopausal women who have menopausal symptoms. Women are generally encouraged to try non-hormonal treatment to avoid the cancer, heart, and dementia risks of hormone replacement therapy.

Post-menopause can begin early and suddenly after removal of the ovaries or after cancer treatment that damages the ovaries.

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