Menopause is defined as the time when a woman’s menses have stopped for a year or more. Menopause is caused by the ovaries running out of eggs, thus lowering production of the hormones estrogen and progesterone. Menopause, unless induced by surgery, is a natural process that takes several years. During this time, called the perimenopause, fertility decreases and a woman’s periods change in duration, frequency, and amount of blood flow. The average age of menopause occurs is 51, while perimenopause begins five or six years earlier.
Symptoms of Menopause
The symptoms of menopause can vary, with some women experiencing no symptoms at all and others experiencing multiple severe symptoms. The first phase of menopause often begins with irregular periods, and can include the following symptoms:
- Hot flashes
- Night sweats and disturbed sleep
- Discomfort during intercourse
- Vaginal dryness or itchiness
- Urinary tract infection
- Bladder control issues
- Weight gain
- Thinning hair
- Dry skin
Diagnosis Of Menopause
Menopause is easily diagnosed by symptoms: a fifty year-old woman with hot flashes who is 13 months from her last period is menopausal. In some cases, especially if the menopause seems early (before age 45) blood tests are used to make an accurate diagnosis and rule out any other conditions. Three tests are typically used.
A follicle-stimulating-hormone (FSH) test measures the level of follicle-stimulating hormone in the blood. When a woman’s estrogen levels decrease, the pituitary gland in the brain causes FSH to be increased, attempting to stimulate estrogen production by the ovaries. Since the ovaries cannot respond, FSH levels can go quite high.
An estradiol (E2) test measures the level of E2 in the blood. If the FSH is high and the E2 is low, ovarian insufficiency is proven. This is the hallmark of menopause.
A thyroid-stimulating-hormone (TSH) test determines whether hypothyroidism is responsible for certain symptoms similar to those of menopause. This would typically be done only if the patient’s history is not clear.
Treatment of Menopause
Treatment for menopause varies depending on the individual. Many women have no symptoms and require no therapy. Such women should be assessed regularly for silent symptoms such as increasing cholesterol levels and bone loss.
For patients with symptoms, one logical approach is to replace the missing hormones. Since this has certain drawbacks and risks, which vary between patients, one can also apply non-hormonal therapies to target specific symptoms.
Specific therapies for hot flashes include estrogens, certain antihypertensives, and several drugs, which were invented as anti-depressants but which, at low doses, block the flashes.
Sleep disruption is extremely distressing to menopausal women, with many secondary effects arising from this. It generally responds to estrogen replacement therapy or to a gentle sleeping pill.
Vulvovaginal dryness, if not treated, can lead to painful intercourse and loss of sexual pleasure. This can be very stressful within a marriage. Non estrogenic therapy with SERMs (selective estrogen receptor modulators) can be helpful. A new treatment, vaginal phototherapy, is uniquely effective for this problem.
Osteoporosis is generally silent in the early menopause, with most fractures occurring after age 60. This makes it important to address bone health during the 50s.
Women experiencing menopause are welcomed to consult with their Dr Howe for thorough assessments of their situation, effective treatment of symptoms, and recommendations for reducing the chances of complications.