What is it
Menopause is part of a gradual biological process (except when surgically induced), culminating in the cessation of ovulation and menstruation. In the three-to five-year period preceding a woman’s final menstrual period (known as the perimenopause), her ovaries produce less and less estrogen and progesterone, the two major female hormones. (Together with two other female hormones, known as follicle-stimulating hormone and luteinizing hormone, estrogen and progesterone orchestrate ovulation, menstruation, and if fertilization occurs, pregnancy.) Menstrual periods may become irregular or unusually light or heavy. Ovulation (the monthly release of an egg) becomes less frequent and eventually stops.
The cessation of menstruation usually occurs at approximately age 50. Menopause is complete when a woman has been without a period for a year. Some women reach this point in their early 40s, others not until their late 50s. Neither is abnormal. (If a woman ceases to menstruate before the age of 40, it’s not considered true menopause, but premature ovarian failure, though the results are the same.)
Although menopause is clearly associated with a number of physiological symptoms, it’s a myth that menopause causes clinical depression or psychosis. Some women do feel angry and depressed, of course, and do experience mood swings. Those suffering from night sweats and other troublesome symptoms may be irritable from lack of sleep. At midlife, too, women may be coping with professional and marital problems, may be dealing with adolescents, or may be assuming responsibility for the care of grandchildren or older relatives. All this might contribute to depression. But the influence of hormone deficiencies on emotions is a matter of debate. A number of studies suggest that women with young children are more likely to be depressed than menopausal women.
When it comes to health, more important than the immediate symptoms of menopause are its long-term consequences. Today, once a woman enters menopause, she can expect to live almost another 30 years that can be productive and rewarding. Yet once her supply of estrogen decreases markedly, her risk of two serious diseases increases dramatically. One of these is heart disease. Before menopause, few women die of heart attacks. After menopause, women begin to catch up with men in rates of heart disease; by age 75, rates become similar. At age 65 the same number of women die of heart disease as of cancer, and after age 75, heart disease is the chief cause of death among women.
Postmenopausal women also find themselves at increasing risk of osteoporosis, the bone-thinning disorder that can eventually result in disabling fractures. Women begin life with less bone mass than men, and after menopause, bone loss among women is more rapid than it is among men. That is why, after age 65, so many women suffer from osteoporosis. Women need to be aware of these increased risks and to take steps ideally, well before menopause to prevent them.
Symptoms
For many women the only sign of menopause is the end of menstrual periods, preceded by irregular periods and changes in the amount of blood flow. Other common signs or symptoms that some women experience include the following:
- Hot flashes, or hot flushes, often accompanied by profuse sweating.
- Vaginal dryness.
- Stress incontinence.
- Mood swings, depression, and sleep problems ore reported by some women, but there is widespread disagreement as to whether emotional changes and sleep disturbances are the result of menopause.
What causes it
Natural menopause is a normal biological shift that probably starts in a woman’s mid- to late 30s, when estrogen and progesterone levels begin a very gradual decline a process that accelerates at some point after age 40. (Estrogen production does not completely stop. The ovaries still produce a little, as do fat cells and the adrenal glands.)
Women who have never had children tend to reach menopause earlier. Ethnicity, marital status, genetics, and geography don’t seem to influence menopause. Smokers, however, experience menopause, on average, two years earlier than nonsmokers, though no one understands why.
Women who have hysterectomies (surgical removal of the uterus) experience an abrupt cessation of menstruation, though their ovaries continue to produce hormones. If their ovaries have also been removed, they experience an abrupt menopause, which may cause more-severe symptoms than a naturally occurring one.
What if you do nothing
Menopause is a natural transition in a woman’s life, not a medical condition or a health problem. But estrogen and progesterone play many roles in a woman’s body, affecting many tissues, including the breasts, skin, vagina, bones, blood vessels, and digestive system, in addition to the reproductive organs. When production of these important hormones declines, many changes, both short-and long-term, are to be expected. However, menopausal symptoms vary considerably from one woman to another. Many women have occasional and/or mild symptoms that are largely tolerable without any sort of intervention. Other women experience symptoms that are so severe that medical advice or treatment is required (though symptoms usually diminish over time).
About 75 percent of American women experience hot flashes sudden feelings of intense heat, accompanied by a flushed face and, often, sweating, and followed by a clammy feeling. Sometimes an aura precedes the flash you sense that you’re going to have one. Heart rate increases, and your body temperature fluctuates. All this is caused by a shortage of estrogen, which is somehow involved in regulating body temperature (though no one understands how).
By day, hot flashes can be embarrassing and disconcerting, and they can result in sweat soaked clothing. By night, hot flashes or night sweats (hot flashes accompanied by sudden sweating) can disrupt sleep. A woman may awaken several times a night in sweat-soaked sheets and feel exhausted the next day.
But even in one woman, hot flashes vary in intensity, frequency, and the span over which they occur because estrogen production fluctuates as it diminishes, hot flashes can come and go. Some women have them for a month and never again. It’s also possible to have hot flashes for months, then have them disappear for months, only to recur. But hot flashes do subside over time: only 20 percent of women experience them four years after menopause.
Another common consequence of menopause is vaginal dryness a reduction in vaginal lubrication (usually accompanied by thinning of the vaginal walls) that may lead to pain during sexual intercourse. This, not the decline in estrogen, is probably the chief reason for reduced sexual desire in menopause.
The decline in estrogen can cause the cells lining the urinary tract to thin and the muscles that control urine flow to weaken. Consequently, some women experience urinary incontinence. Some women are also more prone to urinary tract infections because of changes in urinary tract mucosa and vaginal bacteria.
Home remedies
If hot flashes are disrupting your life, you should certainly see a doctor. Hormone replacement therapy (HRT) can put a stop to hot flashes and night sweats, and can correct vaginal dryness. However, it isn’t appropriate for everyone. The following self-care measures may also prove helpful. Bear in mind that medical science knows little or nothing about nondrug or dietary remedies for hot flashes, vaginal dryness, and other menopausal symptoms. There is probably no harm in trying herbal remedies, but many are expensive and since herbal remedies are not regulated by the Food and Drug Administration (FDA) it’s hard to be sure whether a given product contains what it promises. Also, some products (such as ginseng or mega doses of vitamins) can have side effects.
Dress in layers
Start with a porous fabric like cotton next to your skin. Avoid woolens. If a flash starts, take off your top layer. Try drinking a glass of cold water or juice if a flash is beginning.
Sleep comfortably
Sleep on cotton sheets, and keep your bedroom cool. Layer your sheets and blankets so that you can remove a layer if you have a flash.
Monitor your diet
Highly spiced foods and alcoholic beverages appear to encourage hot flashes in certain females.
Exercise
Some women have discovered that frequent workout helps ease hot flashes. Workout may also help you sleep better.
Try tofu it can’t hurt
Plants also contain estrogenic compounds that resemble (but are not identical to) human estrogens. One estrogen “family,” called isoflavones, occurs in high concentration in soybeans and the soybean product tofu. Whether isoflavones in soy or plant estrogens in other foods are effective against hot flashes isn’t proved, but certainly tofu is a good addition to a healthy diet. If you wish to try it as a hot-flash cure, get real thing, than soy drinks, that are not as high in isoflavones.
Be patient
The problem won’t last forever. Hot flashes are inferior right at menopause. They normally diminish and may go away completely within three to five years.
Treat vaginal dryness
A seeming loss of sexual desire may in fact be due to this condition, which can make intercourse painful. Vaginal creams containing estrogen or non-estrogenic water-soluble lubricants can alleviate vaginal dryness. Many women, happy to be liberated from birth control and worries about pregnancy, report an increase in sexual pleasure in their 50s.
Although ovulation may occur less regularly as a woman approaches menopause, she may still be able to get pregnant. If you are certain you don’t want to become pregnant, it’s important to use a reliable method of contraception until you are clearly past menopause.
Prevention
Menopause is a normal consequence of aging. But some of the troubling symptoms and health consequences (such as osteoporosis) associated with menopause can be prevented or delayed with hormone replacement therapy.
