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Menopause
Menopause
by Helen Matthews, MD
Menopause is a fact that affects every woman around the world. However, the physical and mental impact of this physiologic inevitability varies both within and across all cultures. There is no universal menopause experience. But, for all women, menopause can mark the beginning of an exciting new time of life. A caring physician can help women manage any bothersome symptoms of menopause, and can help women approaching menopause to identify those health problem and lifestyle issues which should be addressed in order to reduce the risk of disease, and to achieve optimal health.
What is menopause?
Menopause is a normal, natural event—defined as the final menstrual period and usually confirmed when a woman has missed her periods for 12 consecutive months (in the absence of other obvious causes). In menopause, the aging ovaries' production of estrogen and other hormones declines. Menopause marks the permanent end of fertility. It occurs, on average, at age 51. The years between puberty (when periods start) and menopause are called premenopause.
Physical signs of menopause begin many years before the final menstrual period. This menopause transition phase is called perimenopause (literally meaning ’around menopause ’). It can last 6 years or more, and ends 1 year after the final menstrual period.
Induced menopause, which can occur at any age between the first and last periods, is when menstrual periods stop due to a medical intervention, such as the surgical removal of both ovaries, and cancer treatments.
What changes do women experience around menopause?
Many women who have natural menopause report no physical changes at all during the perimenopausal years except irregular menstrual periods that eventually stops when menopause is reached. In addition to irregular menstrual periods, some women experience symptoms of hot flashes, difficulty sleeping, and/or vaginal dryness. The severity of these changes varies from woman to woman, but for the most part, they are perfectly natural and normal.
The most common menopause-related discomfort is the hot flash (sometimes called a hot flush). Good news! Hot flashes typically stop on their own over time, and may not require any treatment. Menopause-related hot flashes usually follow a consistent pattern unique to each woman. Some hot flashes are easily tolerated, others are annoying or embarrassing, and still others can be debilitating. Most women experience hot flashes for 3 to 5 years before they taper off. If treatment is needed, hot flashes can usually be reduced or eliminated completely.
Many women experience increasing vaginal dryness during menopause. Decreases in estrogen levels - may cause tissues of the vulva and the lining of the vagina to become thin, dry, and less elastic—a condition known as atrophy. This condition can lead to daily discomfort, and when severe, can even interfere with a woman's sexual functioning.
Other changes, such as difficulty sleeping, moodiness, difficulty losing weight, decreased sexual desire, difficulty with memory, headaches, and urinary leakage, grow more common as women age, but may not be directly caused by menopause.
How can the symptoms of menopause be managed?
The best treatment for hot flashes depends on how the severity, how much they interfere with a woman's quality of life, her personal philosophy and preferences, and her health profile. Lifestyle modifications which may be effective in reducing hot flashes include regular exercise, avoidance of hot flash triggers, good sleep habits, and stress reduction techniques. Prescription medications have the potential to significantly reduce, or eliminate hot flashes. A wide variety of estrogen therapy and estrogen-progesterone therapy products are government approved in the United States and Canada for the treatment of moderate to severe hot flashes and vaginal atrophy. Use of hormone therapy should always be at the lowest effective dose and for the shortest amount of time consistent with treatment goals. This is to minimize exposure to the hormones, which have been associated with some serious risks. The recent Women's Health Initiative (WHI) study clarified the risks and benefits of long-term hormonal therapy. Many factors will be part of a woman's decision to use a particular hormone product—her age, her risks, her preferences, available treatment options, and the cost of the product. Each woman must decide if her potential benefits outweigh her potential risks. Only after examining and understanding her own situation and after a thorough consultation with her physician can a woman make the best treatment choice. A woman's decision about hormone therapy may also change as more is learned through clinical trials and as personal situations and risk factors change.
What other health issues are important for menopausal women?
In the postmenopausal years, all women experience the physical effects of aging, which can increase their risk of serious health conditions, such as heart disease, diabetes, osteoporosis, and cancer. Women can work with their physicians to identify risk factors for these diseases as early as possible, and to employ preventive strategies. Menopause presents an opportunity for a woman to make the changes necessary to achieving her optimal state of health and maximizing her quality of life. As women experience the physical, emotional, and social changes of approaching menopause, each woman faces a unique opportunity to identify her own strategies for midlife wellness. In fact, reaching menopause, whether natural or induced, is an ideal time to begin or reinforce a health promotion program that will provide benefits throughout the rest of a woman's life.
Dr. Helen Matthews is a board certified Obstetrician and Gynecologist who recently joined the practice of Dr. Marion Kramer. Dr. Matthews is on staff at St. Rose Hospital, Alta Bates Summit Medical Center and Eden Medical Center. Dr. Kramer and Dr. Matthews have an office in Hayward at 27255 Calaroga Avenue. Phone: (510) 783-0783
We welcome your questions!
Physicians on staff at St. Rose Hospital are interested in responding to your questions about health care and related topics such as health education and prevention.
Please send any questions to: TheDoctor@strosehospital.org