Thread: Menopause: Symptoms & Treatment

Menopause: Symptoms & Treatment

Menopause is not a disease or an illness. It is a transition between two phases of a woman's life. Menopause occurs when a woman permanently stops menstruating (having periods).

Many women experience a variety of symptoms as a result of the hormonal changes associated with the transition through menopause. Around the time of menopause, women often lose bone density and their cholesterol may worsen, increasing their risk of heart disease.

• • Premature menopause: The average age of US women in whom menopause occurs is 51 years. The most common age range at which women experience menopause is 48-55 years. If menopause occurs in a woman younger than 40 years, it is considered premature. Menopause is considered late if it occurs in a woman older than 55 years. For most women, menopause is a normal occurrence.
• ---• Menopause is more likely to occur at a slightly earlier age in women who smoke, have never been pregnant, or live at high altitudes.
• ---• If premature menopause occurs, a health care provider will check for other medical problems. About 1% of women experience premature menopause.
• • Perimenopause: The hormonal changes associated with menopause actually begin prior to the last menstrual period, during a 3- to 5-year period called perimenopause. During this transition, women may begin to experience menopausal symptoms and may lose bone density, even though they are still menstruating.
• • Surgical menopause: Surgical menopause is the removal of the ovaries. Women who have had surgical menopause have an increased risk of early heart disease and often experience menopausal symptoms, unless they are given medication.

Menopause Causes

Menopause occurs when a woman's ovaries run out of functioning eggs. At the time of birth, most females have about 1-3 million eggs, which are gradually lost throughout a woman's life. By the time of a girl's first menstrual period, she has an average of about 400,000 eggs. By the time of menopause, a woman may have fewer than 10,000 eggs. A small percentage of these eggs are lost through normal ovulation (the monthly cycle). Most eggs die off through a process called atresia.

• • Normally, FSH, or follicle-stimulating hormone (a reproductive hormone), is the substance responsible for the growth of ovarian follicles (eggs) during the first half of a woman's menstrual cycle. As menopause approaches, the remaining eggs become more resistant to FSH, and the ovaries dramatically reduce their production of a hormone called estrogen.
• • Estrogen affects many parts of the body, including the blood vessels, heart, bone, breasts, uterus, urinary system, skin, and brain. Loss of estrogen is believed to be the cause of many of the symptoms associated with menopause. At the time of menopause, the ovaries also decrease their production of testosterone-a hormone involved in the libido, or sexual drive.

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Menopause

Etiology/Endocrinology


• Menopause occurs due to programmed loss of ovarian follicles
• During perimenopause inhibin B falls due to decline in follicular number and FSH rises, estradiol preserved, low progesterone
• In late menopausal transition, FSH and estradiol fluctuate
• After menopause, ovary no longer secretes estradiol, however produces androgens under the stimulation of LH



Definition


• Stages of Reproductive Aging Workshop ( STRAW) Staging System 2001
• Menopausal transition: a) Variation in menstrual cycle ( > 7 d different from normal) and ≥2 skipped cycles and >=60 d amenorrhea; b) é FSH
• Perimenopause: Starts at the time of the menopausal transition ( see above) and ends 12 months after last menstrual period
• Menopause: 12 months of amenorrhea after final menses
• Postmenopause: Stage 1 is the first 5 years after menopause – women have bone loss and hot flashes. Stage 2 is 5 yrs after the last menstrual period until death.


Epidemiology


• Average age of menopause is app. 51.4 years; menopause prior to age 40 is premature ovarian failure
• Age of menopause reduced in smokers
• Ethnicity and race may influence menopause, earlier age among Hispanic women and later in Japanese-American women when c/w Caucasian
• Important to assess family history of early menopause


Clinical Manifestations

• Irregular bleeding patterns- if heavy bleeding should perform endometrial surveillance given period of unopposed estrogen exposure
• Hot flashes- Etiology unknown. Thermoregulatory dysfunction. Self limited to 1-5 yrs. Variable among cultures – 75% US women complain of hot flashes, 20% seek therapy.
• Sleep disturbance – Hot flashes can arouse from sleep and primary sleep disorders more common
• Vaginal dryness – Estrogen deficiency leads to thinning of epithelium - > vaginal atrophy ( loss of rugae, pale, pH inc to > 6.0)
• Sexual dysfunction – decrease in blood flow to vagina/vulva -> decreased lubrication; dyspareunia
• Urinary sx – low estrogen results in atrophy of urethral epithelium and predispose to stress/urge urinary incontinence
• Depression – Overall studies support an association between menopause and mood changes such as irritability/nervousness; controversial if related to true depression
• Bone loss – secondary to estrogen def
• Breast pain – Common in early menopausal transition
• Skin changes – estrogen def -> reduced collagen content of the skin/bones


Therapies

Tx moderate/severe vasomotor sx only
• Estrogen – most effective; po or transdermal; if women has uterus give in conjunction with progesterone; short term therapy; taper to end
• Behavioral changes – keeping temp cool, regular exercise, relaxation therapy
• SSRIs – One of first choices if not taking HRT. RCT’s have shown benefit
• Gabapentin- suggested for nocturnal hot flashes
• Progestins – Megestrol acetate, norethindrone acetate, high dose DMPA shown to be effective
• Clonidine – effective in some trials; try transdermal; may be good in women with HTN
• Phytoestrogens – NO more effective than placebo; concern is that they are SERMS
• Herbal/Black Cohosh – No more effective than placebo; may have estrogenic effect on breast

I am thankful to every one of you in explaining the early menopause symptoms in such an exemplary method. I wish we have some one who have witnessed menopause in their early age of 20-30.

informative post ..tfs..

Awesome information on perimenopause symptoms. May I know some experiences to fight against it. What are the natural remedies to get rid of it. Thank you so much in advance. Keep writing the updated information regarding it.