About Menopause

What is Menopause?

Very simply, menopause is the time in a woman’s life when she no longer has a menstrual period.   A woman’s body has a certain number of eggs contained in the ovaries, and, eventually, no more eggs will be released from the ovaries for fertilization. As we age, the female hormones estrogen and progesterone begin to decline.  These hormones are responsible for signaling to your body when it is time to ovulate and menstruate.   As they reach lower levels, your ovulation and menstruation (bleeding) will become irregular, eventually stopping altogether.  When you no menstruate you have entered the menopausal phase of your life.

Menopause occurs at a different time in every woman.   You are most likely to go through menopause around the same time that your grandmother, mother, or sister did.   Most women stop menstruating completely between the ages of 50 and 51, but in many cases the whole menopausal process can last several years.   In the U.S., most women begin perimenopause or “pre” menopause sometime between the ages of 45 and 55, but perimenopause can occur as early as 35 or as late as 60.

Usually, the normal aging of the body brings on menopause; this is called natural menopause.   However, many women enter menopause due to other reasons.  Surgical removal of the ovaries, certain medications or treatments can force a woman's body to enter menopause early.  These treatments are also commonly responsible for menopause in younger women, or Premature Menopause (menopause before age 40).   Damage to the ovaries or low levels of estrogen can also initiate early menopause. 

Menstruation, Hormones and Menopause

In order to understand what occurs at menopause, it is helpful to understand the role of hormones in our monthly cycle.   Hormones are substances in our bodies that travel throughout the body and can bind to specialized areas of cells in order to begin a specific chain of events.   The first half of the menstrual cycle is dominated by estrogen, which causes the lining of the uterus to be built in preparation for a potential pregnancy.   At approximately day 14 of the cycle, or two weeks prior to menstruation, an egg is released from the ovaries. This is referred to as ovulation. After ovulation the ovary begins producing progesterone.   It is during this second half of the cycle that progesterone is dominant.   Progesterone acts to stabilize the uterine lining to prepare for pregnancy, and to prevent further buildup of the lining by estrogen.   At the end of the cycle, if the egg is not fertilized, both estrogen and progesterone levels drop.  This causes the cells lining the uterus to slough off, in the process we call menstruation.   The body goes through this cycle every month to ensure a fresh uterine lining in preparation for a potential pregnancy.

If a woman fails to ovulate, however, she does not produce progesterone, and this may result in the experience of symptoms of hormonal imbalance.   At birth, a woman has close to a million eggs, half of which remain by the time puberty occurs.  Around 10 to 15 years prior to menopause, this loss begins to accelerate, and  eventually estrogen levels decrease to the point that the lining of the uterus no longer builds up and menstruation ceases.  The result is menopause.
 

Stages of Menopause

Although the entire process of menopause can take 15 years or longer, depending on your age and family history, a natural menopause occurs in three major stages.   The first stage of menopause is known as perimenopause.   Some of the first signs of menopause are irregular periods and spotting due to fluctuating hormone levels in your body.  Although it is still possible to get pregnant during perimenopause as eggs may be released from your ovaries, it is becoming less likely.  This stage usually lasts two to five years, but can be longer.  During this time, some symptoms of menopause may appear, such as hot flashes and irritability.

The second stage of menopause occurs when your period no longer arrives. This stage is simply called menopause and usually occurs around age 50 or 51. In order to be in menopause, your period must be absent for at least 12 consecutive months.  Gradually, your estrogen levels will decline and your body will stop producing progesterone.  Signs of menopause and symptoms of this hormone decline include hot flashes, night sweats, headaches, vaginal dryness and mood swings.

The final stage of menopause is called postmenopause. Your menopause symptoms should begin to decrease during this time.  However, drastically lower levels of estrogen and progesterone increase your risk of developing osteoporosis, heart disease and urinary tract infections.

Symptoms of Menopause

Since each woman’s experience with menopause is different, many symptoms have been associated with menopause.  Following are some of the most common symptoms reported.

Hot Flashes

These can occur at any time, day or night, and last from a few seconds to half an hour or more.   When you're having a hot flash, you might experience:

• A feeling of mild warmth to intense heat spreading through your upper body and face
• A flushed appearance with red, blotchy skin on your face, neck and upper chest
• A rapid heartbeat
• Perspiration, mostly on the upper body
• A chilled feeling as the hot flash subsides

Mood Swings

As estrogen and progesterone decline, some women describe themselves as “emotional.”   They may be more easily triggered into strong emotional responses such as sadness, anger, irritability or delight.   Often women don’t realize that this is associated with menopause and don’t seek help for this symptom.

Headaches

Both migraine and tension headaches may increase during menopause.   Migraine headaches are vascular in nature, and since the vascular system is more unstable during menopause, migraines can become more frequent and difficult to manage.

Insomnia

Many women report a greater tendency to be wakeful.   Sometimes this is due to night sweats and sometimes due to neurological excitability, both of which are more common during menopause.   Once awake, they find it difficult to go back to sleep and can suffer from sleep deprivation as a result.

Vaginal Dryness and Urinary Problems

 As estrogen levels decline, the walls of the bladder, urethra and vagina become drier and less flexible.  This makes the tissue more easily damaged and more prone to infections.  Medical help is readily available for these symptoms.

Memory Loss

Some loss of memory is normal with aging, such as word retrieval and short term memory.  However, if this symptom becomes severe enough to interfere with your everyday life, your healthcare provider should be consulted. 
 

Decreased Sexual Desire

Sometimes this is a result of hormone shifts, other times it is a reaction to other stressors or difficult life situations.  If this poses a problem in your life or relationship, talk to your physician or midwife about possible treatments.

Treating the Symptoms

If and when symptoms become severe enough to affect your quality of life, there are a number of different treatment options for you to consider.

• Lifestyle changes. A healthy diet and regular exercise program will go a long way towards minimizing the symptoms of menopause and helping to maintain overall good health. It is also a good idea to finally kick any old, unhealthy habits, such as smoking or drinking too much alcohol. Other interventions that may be helpful for hot flashes are to dress lightly and in layers and avoid potential triggers like caffeine and spicy foods.
  For vaginal dryness, moisturizers and nonestrogen lubricants are available. Remaining sexually active may also help to preserve the lining of the vagina.
• Prescription medication. Treatment with estrogen and progesterone, called combination hormone therapy (HT), or hormone replacement therapy (HRT), can be prescribed for women who still have their uterus to reduce the symptoms of menopause and help prevent osteoporosis. Estrogen alone is the prescribed regimen for women who have had a hysterectomy and no longer have their uterus.

Some women may not be candidates for  hormone therapy.   This includes women with current or past breast or uterine cancer,  blood clots, liver disease, or stroke.

If you are unable or do not want to take hormones, there are other medications that your doctor can prescribe to alleviate some of the symptoms of menopause.   These may include antidepressants for mood swings and difficulty sleeping.  Other medications can sometimes help to reduce hot flashes related to menopause.

Life after Menopause

Although menopause was once a life-stage dreaded by many women (“the change”), women today have an abundance of medical knowledge and resources available to her as she experiences menopause. The key to staying youthful and active is good nutrition and regular physical exercise.

Nutritional needs after menopause:

As a person ages, nutritional requirements change. A premenopausal woman should consume about 1,000 mg of calcium daily. Women after menopause should consume 1,200 mg of calcium per day.  In addition, Vitamin D is vital for calcium absorption and bone formation. 

Other nutritional guidelines include:

• Choose foods low in fat, saturated fat, and cholesterol. Fat intake should be less than 30 percent of daily calorie intake.
• Eat fruits, vegetables, and whole grain cereal products, especially those high in vitamin C and beta carotene.   Try to consume at least 20 to 30 grams of fiber daily.
• Avoid foods and drinks with processed sugar, as many of these products contain empty calories and promote weight gain.
• Avoid salt-cured and smoked foods such as sausages, smoked fish, ham, bacon, bologna, and hot dogs.   These foods are high in sodium, which can lead to high blood pressure.

The many benefits of exercise after menopause:

Menopausal women often experience weight gain, possibly because of declining estrogen levels.   In this case, exercise becomes particularly important as a woman ages.   Regular exercise benefits the heart and bones, helps regulate weight, and can be a mood enhancer, creating a better sense of well-being. Women who are physically inactive are more likely to suffer from coronary heart disease, obesity, high blood pressure, diabetes, and osteoporosis.   Sedentary women may also suffer from chronic back pain, insomnia, poor circulation, weak muscles, loss of bone mass, and depression.

Aerobic activities such as walking, jogging, swimming, biking, and dancing help prevent some of these problems and also help raise HDL cholesterol levels, commonly referred to as the "good" cholesterol. Weight-bearing exercises such as walking and running, as well as moderate weight training, help increase bone mass.  In postmenopausal women, moderate exercise helps preserve bone mass in the spine and prevent fractures. Exercise also has a mood-enhancing quality, due to hormones called endorphins, which are released in the brain.  This enhancement can last for several hours after exercise and also helps the body deal with stress.

Always consult your physician before starting an exercise program, particularly if you have been sedentary.

Remember

Menopause is a normal part of a woman’s life.  Being prepared  to manage the physical symptoms can make the transition much easier and even allow you to appreciate the natural changes in your body.