Menopause = “No more periods”, Yay!

The average age for menopause in our country is 51, but there is a wide range of “normal”, from age 40 to 60. So if you reach that age range, it is an inevitability. Starting early in life, the ovaries begin to activate and produce hormones. Then in the early teens, the hormones play a big part in a woman’s health and well-being, and control what we call the menstrual cycle. The most obvious symptom of the menstrual cycle is bleeding, but there are host of other effects as well.
The ovaries begin to start aging significantly in the 30s. There is more rapid decline over 40. Eventually they stopped working completely, at least as far as we can measure. We often refer to this gradual decline as the “pre-menopause.” The most common and obvious symptom of this stage is a change in the menstrual cycle. Eventually this bleeding completely stops. We officially define the condition of menopause as 12 months without any bleeding. Ovaries are probably still producing some hormones during that time, but just not enough or in the right proportions to cause any bleeding. It isn’t possible to pinpoint the exact moment in time when the ovaries have completely stopped producing hormones. Standard blood tests can measure estrogen levels, but when they are relatively low, as they are in menopause, their accuracy is not very good, therefore doing blood tests at this point is not very helpful in diagnosing or managing the situation.

The symptoms associated with this transition from functioning to non functioning ovaries, is variable in time for each individual woman. There is also a large range of what can be experienced.

In general, I think just about everybody is happy to be done with the bleeding, pelvic and breast discomfort. Women who were suffering from PMS or PMDD are feeling much better, since these conditions often resolve as hormone levels even out. Other women find losing her hormones creates a number of bothersome changes in how they feel.

About the symptoms of menopause, the primary sign is lack of bleeding. Other associated changes can be temperature issues, either just feeling much warmer in general, or actual hot flashes, where there is a short but intense feeling of heat, sometimes associated with sweating. This can either be during the day, or at night. There can also be some trouble sleeping. This can be associated with the hot flash, or night sweat, but doesn’t have to be. There may be a direct effect of hormones on your brain which can affect sleeping patterns.

Some women experience increased achiness in their joints and muscles. Some notice a significant change in mood. For those who previously suffered from PMS, which were mood swings just prior to the menses, moods may actually improve menopause. For other women, mood swings may become more problematic.
The major point to remember that this is a normal natural process. Given the fact that life expectancy for women is now into the 80s, this significant change comes at barely halfway through a lifetime. By definition then, women spend almost half of their lives in menopause. Most of the bothersome symptoms that occur during the transition years gradually decline in frequency and intensity with time. But it is impossible to predict for each individual woman how long t will take. It could be months to years, but the good news is that it usually goes in a positive direction.

The one thing that doesn’t typically get better, in fact usually gets worse, is that of vaginal dryness. This may start very early in menopause years, or 10–20 years later. Sometimes this is only an issue during vaginal intercourse. Sometimes, it progresses to a more significant stage, where the vaginal skin is not only dry, but very thin and inflamed. This may lead to discomfort in the vaginal area, even when doing daily activities such as emptying the bladder.

More good news is that there is often some type of treatment to alleviate any of the above symptoms if they are bothersome and interfering with quality of life. Nobody ever died from a hot flashes or vaginal dryness, but they can be a major source of discomfort, and in my opinion, there is no reason to suffer these problems, if they are very uncomfortable. For most women, hormone therapy safe to take, but there are also non hormonal treatments that have shown to be effective in alleviating a lot of the discomforts of menopause.
There is much written in newspapers, magazines and journals, and the Internet, regarding treatment options for menopausal women. There was a time, not too long ago, when all women were advised to start on hormone replacement as soon as menopause was reached, even if they did not have bothersome symptoms. It was felt to be protective of the cardiovascular system and have other health advantages, including bone health. Then a big study came out in 2002, the WHI, which changed all that. It suggested there was a significant risk to taking hormone replacement, particularly regarding the diagnosis of breast cancer and adverse cardiovascular. Then most all women were taken immediately off the hormone therapy and there was a lot of suffering at that time. Thankfully, many investigators continued to reevaluate the data of that study and found that hormone therapy was not as risky as initially thought, at least for certain subgroups of women. In fact the benefits, frequently outweigh the risks in a many women. Fortunately, many practitioners are still fearful of prescribing estrogen to menopause. Most of it out of ignorance as to the current medical information and/or fear of litigation.

Personally, I do not think all women need or should be taking estrogen, but there is a considerable number that would feel much better if they did. This could either be a systemic form, such as pills, patches, or creams, or even estrogen preparations for the vagina.
Many women choose to try over the counter oral herbal preparations or supplements. In theory, these products may make you feel better, but there are no big studies indicating that they are any better than placebo, and since they are not FDA approved, there are no quality controls in place to guarantee their safety either. The vaginal preparations may be helpful for the dryness issues, but nothing has been shown to be quite as good as prescription estrogen vaginal products if symptoms are more severe.
Here are a few helpful websites with reliable information: NAMS site, North American Menopause Society American College of Obstetrics and Gynecology very helpful site by Dr.Barbara Depree re: sexual issues of midlife