Health Care and Menopause

Menopause is a universal and irreversible part of the overall aging process involving a woman's reproductive system, after which she no longer menstruates, according to MedScape. The menopausal transition (MT) is characterized by hormonal changes and clinical symptoms that occur over a period leading up to and immediately post menopause. This period is frequently termed the climacteric, and/or perimenopause, but mostly recently is coined the menopausal transition.

Menopause is the permanent end of menstruation and fertility, defined as occurring 12 months after your last menstrual period, according to the Mayo Clinic. Menopause is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss. Even though menopause is not a disease, women shouldn't hesitate to seek treatment for severe symptoms. Many effective treatments are available, from lifestyle adjustments to hormone therapy.

Technically, women don't actually "hit" menopause until it's been one year since their final menstrual period, according to the Mayo Clinic. In the United States, that happens at about age 51, on average. But in the months or years leading up to that point, women might experience these signs and symptoms:

• Irregular periods
• Decreased fertility
• Vaginal dryness
• Hot flashes
• Sleep disturbances
• Mood swings
• Increased abdominal fat
• Thinning hair
• Loss of breast fullness

The Mayo Clinic has lots of additional information about menopause, located at this site: http://www.mayoclinic.com/health/menopause/DS00119.

According to the North American Menopause Society (NAMS), physical signs of menopause begin many years before the final menstrual period. Perimenopause (literally meaning “around menopause”), can last 6 years or more, and by definition, ends 1 year after the final menstrual period. Perimenopausal changes are brought on by changing levels of ovarian hormones such as estrogen. During this transition time, estrogen levels gradually decline, but they do so in an erratic fashion. Sometimes they can even be higher than during the reproductive years. During perimenopause, a woman may be able to conceive, although fertility is very low. If pregnancy is not desired, contraception is necessary until menopause is reached.

When a woman suspects she is experiencing perimenopause, it is an excellent time to have a complete medical examination by a qualified health professional. According to NAMS, the diagnosis of perimenopause can usually be made by reviewing a woman’s medical history, her menstrual history, and her signs and symptoms. In most cases, testing hormonal blood levels is not recommended because in menstruating women hormone levels are changing all the time. However, in younger women (below 40) menstrual irregularity is infrequently a sign of menopause, so hormone testing may be a useful tool to test whether menopause has occurred.Testing blood hormone levels can also be helpful in assessing a woman’s fertility and potential for pregnancy. Results can help women make decisions about beginning or adjusting medications and help them understand their personal biological clock. For some women, it may make sense to test for other causes of symptoms that can mimic perimenopause, such as thyroid disease.

What about testing for follicle-stimulating hormone (FSH)? Sometimes, elevated FSH levels are used to confirm menopause. FSH is a hormone produced by the pituitary gland that triggers the ovaries to secrete estrogen. As the ovaries’ production of estrogen declines around menopause, the pituitary gland releases more FSH into the blood to try to stimulate estrogen production. So, when a woman’s FSH blood level is consistently elevated, and she is no longer having menstrual periods, it is generally accepted that she has reached menopause. However, a single FSH level can be misleading in perimenopause because estrogen production doesn’t fall at a steady rate from day to day. Instead, both estrogen and FSH levels fluctuate from fairly high to fairly low during perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid. Some healthcare practitioners recommend testing a woman’s saliva for estrogen levels, but there is no conclusive evidence that this test provides useful information around menopause. Much more information can be found at their website: http://www.menopause.org/.

What are the complications and effects of menopause on chronic medical conditions? According to MedicineNet.com, one of them is the increased risk of osteoporosis. Osteoporosis is the deterioration of the quantity and quality of bone that causes an increased risk of fracture. The density of the bone (bone mineral density) normally begins to decrease in women during the fourth decade of life. However, that normal decline in bone density is accelerated during the menopausal transition. As a consequence, both age and the hormonal changes due to the menopause transition act together to cause osteoporosis. The process leading to osteoporosis can operate silently for decades. Women may not be aware of their osteoporosis until suffering a painful fracture. The symptoms are then related to the location and severity of the fractures.

The second health risk is cardiovascular disease, according to MedicineNet. Prior to menopause, women have a decreased risk of heart disease and stroke when compared with men. Around the time of menopause, however, a women's risk of cardiovascular disease increases. Heart disease is the leading cause of death in both men and women in the U.S. Coronary heart disease rates in postmenopausal women are two to three times higher than in women of the same age who have not reached menopause. This increased risk for cardiovascular disease may be related to declining estrogen levels, but in light of other factors, postmenopausal women are not advised to take hormone therapy simply as a preventive measure to decrease their risk of heart attack or stroke. A significant amount of material on this health care topic concerning menopause can be found at this site: http://www.medicinenet.com/menopause/article.htm .

According to the National Institute on Aging (NIA), as a woman, staying healthy after menopause may mean making some changes in the way you live:

• Don't smoke. If you do use any type of tobacco, stop—it's never too late to benefit from quitting smoking.
• Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals.
• Make sure you get enough calcium and vitamin D—in your diet or with vitamin/mineral supplements.
• Learn what your healthy weight is, and try to stay there.
• Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health.

Here are some other things to remember, according to the NIA:

• Take medicine if your doctor prescribes it for you, especially if it is for health problems you cannot see or feel—for example, high blood pressure, high cholesterol, or osteoporosis.
• Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort.
• Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed.

Menopause is not a disease that has to be treated, according to the NIA. But you might need help if symptoms like hot flashes bother you. Here are some ideas that have helped some women:

• Try to keep track of when hot flashes happen—a diary can help. You might be able to use this information to find out what triggers your flashes and then avoid those triggers.
• When a hot flash starts, try to go somewhere cool.
• If night sweats wake you, sleep in a cool room or with a fan on.
• Dress in layers that you can take off if you get too warm.
• Use sheets and clothing that let your skin "breathe."
• Have a cold drink (water or juice) when a flash is starting.

You could also talk to your doctor about whether there are any medicines to manage hot flashes. A few drugs that are approved for other uses, for example, certain anti-depressants, seem to be helpful to some women. Much more info can be located at this website: http://www.nia.nih.gov/health/publication/menopause .

Menopause can be treated, and it makes sense to see a primary care doctor if the symptoms appear to be troublesome. The condition can get worse in some women. Find out about available information and resources to deal with this health care issue. What you learn can help you through the emotional and physical trauma.

Until next time.