Transition, menopause

Menopause: A woman can usually tell if she is approaching menopause because her menstrual periods starts changing.

The medical terms used to describe this time are the 'menopause transition' and 'perimenopause'.

The changes of the menopause transition (perimenopause) begin about 6 years before the natural menopause.

This is a time when the levels of hormones produced by the aging ovaries fluctuate leading to irregular menstrual patterns (irregularity in the length of the period, the time between periods, and the level of flow) and hot flashes (a sudden warm feeling with blushing).

Other changes associated with the perimenopause and menopause include night sweats, mood swings, vaginal dryness, fluctuations in sexual desire (libido), forgetfulness, trouble sleeping and fatigue, probably from loss of sleep.

(Conditions that have not been proved due to the menopause include headache, dizziness, palpitations of the heart and depression).

The menopause is the 'change of life', the time in a woman's life when menstrual periods permanently stop.

Menopause is the opposite of the menarche.

Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified.

It is the end of fertility, the end of the childbearing years.

(A woman may still, however, be able to become pregnant unless 12 consecutive months have passed without a period.) Natural menopause occurs when the ovaries naturally begin decreasing their production of the sex hormones estrogen and progesterone.

Induced menopause occurs if the ovaries are surgically removed (by bilateral oophorectomy) or damaged by radiation or drugs.

Due to the abrupt cutoff of ovarian hormones, induced menopause causes the sudden onset of hot flashes and other menopause-related symptoms such as a dry vagina and a decline in sex drive.

Early menopause (before age 40), whether natural or induced, carries a greater risk for heart disease and osteoporosis since there are more years spent beyond the protective cover of estrogen.

A 'simple' hysterectomy (when the uterus but not the ovaries are removed) before natural menopause should not affect the production of sex hormones and so not cause menopause (unless the nerves or blood supply to the ovaries is damaged during the hysterectomy).

The timing of natural menopause is variable.

In the western world the average age is now 51. Natural menopause can, however, be in a woman's 30s or 60s.

Factors influencing the time of menopause include heredity (genetics) and cigarette smoking.

Smokers (and ex-smokers) reach menopause an average of 2 years before women who have never smoked.

There is no relation between the time of a woman's first period and her age at menopause.

The age at menopause is not influenced by a woman's race, height, number of children or use of oral contraceptives.

Estrogen replacement therapy (ERT) is used to treat menopause.

It reduces or stops the short-term changes of menopause such as hot flashes, disturbed sleep, and vaginal dryness.

ERT can prevent osteoporosis, a consequence of lowered estrogen levels.

To keep bones strong, ERT should be taken from menopause throughout a woman's life.

Stopping ERT allows bone loss to resume.

ERT reduces the risk of heart disease up to 50%.

Vaginal ERT products help with vaginal dryness, more severe vaginal changes, and bladder effects but, since very little vaginal estrogen enters the circulation, it may not help with hot flashes or prevent osteoporosis and heart disease.

The use of unopposed ERT (ERT alone) is associated with an increase in the risk of endometrial cancer (cancer of the lining of the uterus).

However, by taking the hormone progestogen along with estrogen, the risk of endometrial cancer is reduced substantially.

Progestogen protects the uterus by keeping the endometrium from thickening (an effect caused by estrogen).

The combination therapy of estrogen plus progestogen is called hormone replacement therapy (HRT).