Menopause
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Menopause
is a normal part of life. It is one step in a long, slow process of
reproductive aging. For most women this process begins silently somewhere
around age 40 when periods
may start to be less regular. Declining levels of the hormones estrogen
and progesterone cause changes in your periods. These hormones are important for keeping
the vagina and uterus healthy as well as for normal menstrual cycles and
for successful pregnancy. Estrogen also helps to keep bones healthy. It
helps women keep good cholesterol levels in their blood.
Some
types of surgery can bring on menopause. For instance, removal of your
uterus (hysterectomy) will make your periods stop. When both ovaries are
removed (oophorectomy), menopause symptoms may start right away, no matter
what your age.
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A
woman’s body changes throughout her lifetime. Many of those changes are
due to varying hormone levels that happen at different stages in life.
Puberty
often
starts when a girl is about 12 years old. Her body changes—breasts and
pubic hair develop, monthly periods begin.
Menopausal
transition ,
commonly called perimenopause, is the time when a woman’s body
is closer to menopause. At this time, a woman’s periods may become less
regular,
and she may start to feel menopause symptoms, such as hot
flashes and night sweats. Perimenopause usually begins about 2 to 4 years
before the last menstrual period. It lasts for about 1 year after your
last period.
Menopause
is marked by a woman’s last menstrual period. You cannot know for sure
what is your last period until you have been period free for 1 full year.
Postmenopause
follows menopause and lasts the rest of your life. Pregnancy is no longer
possible. There may be some symptoms, such as vaginal dryness, which may
continue long after you have passed through menopause.
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Changing
hormone levels can cause a variety of symptoms that may last from a few
months to a few years or longer. Some women have slight discomfort or
worse. Others have little or no trouble. If any of these changes bother
you, check with your doctor. The most common symptoms are:
Changes
in periods. One
of the first signs may be a change in a woman’s periods. Many women become
less regular; some have a lighter flow than normal; others have a heavier
flow and may bleed a lot for many days. Periods may come less than 3 weeks
apart or last more than a week. There may be spotting between periods.
Women who have had problems with heavy menstrual periods and cramps will
find relief from these symptoms
when menopause starts.
Hot
flashes. A
hot flash is a sudden feeling of heat in the upper part or all of
your body. Your face and neck become flushed. Red blotches may appear on
your chest, back, and
arms. Heavy sweating and cold shivering can
follow. Flashes can be as mild as a light blush or severe enough to wake
you from a sound sleep (called night sweats). Most flashes last
between 30 seconds and 5 minutes.
Problems
with the vagina and bladder.
The genital area can get drier and thinner as estrogen levels change. This
dryness may make sexual intercourse painful. Vaginal infections can become
more common. Some women have more urinary tract infections. Other problems
can make it hard to hold urine long enough to get to the bathroom. Some
women find that urine leaks during exercise, sneezing, coughing, laughing,
or running.
Sex.
Some
women find that their feelings about sex change with menopause.
Some have changes to the vagina, such as dryness, that makes sexual
intercourse painful. Others feel freer and sexier after menopause —
relieved that pregnancy is no longer a worry. Until you have had 1 full
year without a period, you should still use birth control if you do not
want to become pregnant. After menopause a woman can still get sexually
transmitted diseases (STDs), such as HIV/AIDS or gonorrhea. If you are
worried about STDs, make sure your partner uses a condom each time you
have sex.
Sleep
problems.
Some women find they have a hard time getting a good night’s sleep – they
may not fall asleep easily or may wake too early. They may need to go to
the bathroom in the middle of the night and then find they aren’t able to
fall back to sleep. Hot flashes also may cause some women to wake up.
Mood
changes. There
may be a relationship between changes in estrogen levels and a woman’s
mood. Shifts in mood may also be caused by stress, family changes such as
children leaving home, or feeling tired. Depression is NOT a symptom of
menopause.
Changes
in your body.
Some women find that their bodies change around the time of menopause.
With age, waists thicken, muscle mass is lost, fat tissue may increase,
skin may get thinner. Other women have memory problems, or joint and
muscle stiffness
and pain. With regular exercise and attention to diet,
many of these changes may be eased or prevented.
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You
may not even notice two important changes that happen with menopause.
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Loss
of bone tissue can weaken your bones and cause osteoporosis.
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Heart
disease risk may grow, due to age-related increases in weight, blood
pressure, and cholesterol levels.
Osteoporosis.
To
maintain strong bones, the body is always breaking down old bone and
replacing it with new healthy bone. For women, the loss of estrogen
around the time of menopause causes more bone to be lost than is replaced.
If too much bone is lost, bones become thin and weak and can break easily.
Many people do not know they have weak bones until they break a wrist,
hip, or spine bone (vertebrae). Doctors can test bone density (bone
densitometry) to find out if you are at risk of osteoporosis. You can
lower your risk of bone loss and osteoporosis by making changes to your
lifestyle — regular weight-bearing exercise and getting plenty of calcium
and vitamin D can help. There are also drugs available that prevent bone
loss. Talk to your doctor to find out what is best for you.
Heart
disease. Younger
women have a lower risk of heart disease than do men of the same age. But
after menopause, a woman’s risk of heart disease is almost the same
as
a man’s. In fact, heart disease is the major cause of death in
women, killing more women than lung or breast cancer. It’s important to
know your blood pressure, and levels of cholesterol, HDL, triglycerides,
and fasting blood glucose. You can lower your chance of heart disease by
eating a healthy diet, not smoking, losing weight, and exercising
regularly. There are also drugs that can help. Talk to your doctor to be
sure you are doing everything possible to protect your heart.
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To stay healthy you can make some changes in the way you live. For example:
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Don’t
smoke.
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Eat
a healthy diet that is low in fat and cholesterol and moderate in total
fat. Your diet should aim to be high in fiber and include fruits,
vegetables, and whole-grain foods. It should also be well balanced in
vitamins and minerals, including calcium.
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Lose
weight if you are overweight.
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Take
part in weight-bearing exercise, such as walking, jogging, running, or
dancing, at least 3 days each week.
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Take
medicine to lower your blood pressure if your doctor prescribes it for
you.
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For
vaginal discomfort, use a water-based vaginal lubricant (not
petroleum jelly) or an estrogen cream.
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If
you frequently feel an urgent need to urinate, ask your doctor
about techniques such as pelvic muscle exercises, biofeedback, and bladder
training that can help you improve muscle control.
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Be
sure to get regular pelvic and breast exams, Pap tests, and mammograms.
Contact
your doctor right away if you notice a lump in your breast.
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If
you are having hot flashes, keep a diary to track when they happen. You
may be able to use this information to help find out what triggers
them.
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Try
these tips to help manage hot flashes:
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When
a hot flash starts, go somewhere cool.
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If
hot flashes wake you at night, try sleeping in a cool room.
o
Dress
in layers that you can take off if you get too warm.
o
Use
sheets and clothing that let your skin “breathe.”
o
Have
a cold drink (water or juice) at the beginning of a flash.
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In
perimenopause, your doctor might suggest birth control pills especially
if you are having problems with very heavy, frequent or unpredictable
menstrual periods. This medication will make your periods more regular.
It may also help with symptoms like hot flashes. However, birth control
pills
can hide the arrival of menopause. If you think you might have reached
menopause, you can stop taking the pill for a while and see if you
start
having regular periods again. But if you were using birth control pills
to prevent pregnancy, you should remember to use another type of
contraceptive until you have
gone 12 months without a period.
In
menopause, your doctor might suggest taking estrogen and progesterone,
known as hormone replacement therapy or HRT. HRT involves taking estrogen
plus progestin. Estrogen alone, or ERT, is for women who have had the
uterus removed. Estrogen plus
progestin is for women with a uterus.
Progestin, when used with estrogen, helps reduce the risk of uterine
cancer. These hormones can be taken in a variety of forms such as pills,
skin patches, creams, or vaginal inserts, depending on a woman’s needs.
HRT
or ERT may relieve menopause-related symptoms, such as hot flashes,
and
reduce loss of bone. However, HRT has risks. It should not be used for
long-term prevention of heart disease. Taking HRT increases, rather
than
reduces, the risk for heart disease and stroke. It also increases the risk
of breast cancer and blood clots. But it appearsto decrease the risk
of colon cancer. Scientists are still studying the effects of HRT — the
final answers are not yet available. Talk to your doctor about taking
estrogen/progestinor about other treatments (for example, biofeedback)
that may ease menopausal symptoms.
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Phytoestrogens
are estrogen-like substances found in cereals, vegetables, legumes
(beans), and some herbs. They may work in the body like a weak form
of
estrogen. Some may lower cholesterol levels. Soy, wild yams, and herbs
such as black cohosh and dong quai, contain phytoestrogens and may
relieve
some symptoms of menopause. The government does not regulate
phytoestrogens. Scientists are studying some of these plant
estrogens
to find out if they really work and are safe.
Be
sure to tell your doctor if you decide to eat more foods with
phytoestrogens. Any food or over-the-counter product that you use for its
drug-like effects could interact with other prescribed drugs or cause an
overdose.
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Talk
to your doctor to decide how to best manage your menopause. Think about
your symptoms and how much they bother you. You also need to consider
your
medical history – your risk of heart disease, osteoporosis, and breast
cancer. Remember that your decisions are never final. You can, and
should, review them with your doctor every year during your checkup.
You can
see a
gynecologist, geriatrician, general practitioner, or internist.
For
your grandmother and great-grandmother, life expectancy was shorter.
Reaching menopause often meant that their life was nearing an end. But
this is no longer true. Today women are living longer — on average, until
age 78. By making wise decisions about menopause and a healthy lifestyle,
you can make the most of the 20, 30, or more years you have ahead!
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The National
Heart, Lung, and Blood Institute (NHLBI) Information Center
National Cancer Institute (NCI)
- Cancer Information Service (CIS)
NIH
Osteoporosis and Related Bone Diseases — National Resource Center
American
College of Obstetricians and Gynecologists (ACOG)
North
American Menopause Society
Planned
Parenthood Federation of America, Inc.
National
Institute on Aging (NIA)
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