Menopause

"Change of Life"

What is Menopause?

Menopause refers to the physical and psychological changes occurring from reduced estrogen production by the ovaries. This usually begins anywhere between the ages of 35 and 58. Menopause also marks the end of a woman's menstrual periods. "Premenopause" refers to the time when the menstrual cycle is likely to be irregular. There may be less and less blood flow each month until it stops completely, or the interval between periods may get longer and longer until it finally stops altogether. Menopause can also occur if the ovaries are surgically removed or if they stop functioning for any other reason.

How is it diagnosed?

Menopause signs and symptoms

Symptoms may last from a few months to several years and vary from hardly noticeable to severe.

  • Two-thirds of women complain of hot flashes and night sweats usually occurring over two to five years.
  • Twenty percent of menopausal women report vaginal dryness as their major symptom.
  • Sexual intercourse is often more difficult and painful.
  • There may be the need to urinate more frequently.
  • The skin becomes drier and thinner, and hair can become brittle and fall out easily.
  • Other symptoms include irregular menstrual periods with heavy or scant blood flow, disturbed sleep patterns, headaches, joint pain, and heart palpitations.
  • Psychological symptoms include dramatic mood swings, disturbances of memory or concentration, anxiety, depression, irritability, and decreased desire for sex.

Physical exam: Vaginal dryness and thinning of walls can be noted on physical exam.

Tests: An endometrial biopsy to evaluate any abnormal bleeding may be done. Other tests include blood estrogen levels, FSH levels, a Pap smear, and cholesterol and triglyceride levels.

How is Menopause treated?

Estrogen replacement therapy is usually recommended to relieve physical and psychological symptoms, and to reduce the risk of loss of bone density (osteoporosis) and heart disease. Another hormone, progesterone, will be included in the treatment, unless the woman has had a hysterectomy. Some women may not be able to take estrogen if they have had certain types of breast cancer, other cancers, or blood clots. Other medication may be substituted instead, such as beta-blockers and calcium supplements. Bone resorption inhibitors prevent bone loss but do not alleviate hot flashes. Severe psychological symptoms may warrant treatment with anti-depressant medication.

Medications

Information Brand Generic Label Rating
Order Neurontin Neurontin Gabapentin Off-Label
generic Venlafaxine Effexor Venlafaxine Off-Label
Premarin Conjugated Estrogens On-Label
May decrease hot flashes by up to 60 percent
Sertraline Zoloft Sertraline Off-Label
Paxil online Paxil Paroxetine Off-Label
Prozac Fluoxetine Off-Label
Celexa Citalopram Off-Label

What might complicate it?

As the estrogen level falls, the vaginal lining thins and its secretions diminish. The vagina itself shrinks, loses elasticity, and becomes prone to minor infections. If estrogen is taken without progesterone, it can slightly increase the risk of developing uterine cancer. Changes in the internal body chemistry (metabolism) may also occur during menopause, but the symptoms may not show up until later. Bones begin to lose calcium more rapidly after the first six months of menopause. Brittle bones (osteoporosis) may develop over the next ten to fifteen years. The risk of coronary heart disease increases after menopause, becoming similar to men's risk. Higher blood pressure increases the risk of stroke.

Predicted outcome

Symptoms of menopause may last only a month or persist for several years. Correcting the distressing symptoms can improve a woman's general well-being and help her pursue a more vigorous life. Reducing the risk of heart disease and osteoporosis during this time impacts future health. Hormone therapy for a woman who does not need it can cause unpleasant side effects or unnecessary health risks.

Alternatives

Other possibilities are pituitary gland dysfunction, anxiety, depression, and uterine cancer.

Appropriate specialists

Gynecologist, endocrinologist, psychiatrist or psychologist, and internist.

Notify your physician if

  • You or a family member has symptoms of menopause. Other causes should be ruled out.
  • You experience excessive bleeding, prolonged periods or spotting between your expected periods. These may be signs of other disorders.
  • Bleeding appears 6 months or more after your last period.
  • New unexplained symptoms develop. Hormones used in treatment may produce side effects.
  • Symptoms of menopause return while taking estrogen replacement therapy.

Last updated 20 December 2011


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