by Dr. Jay Sprong
As women enter the later stage of their life, they begin the natural process called menopause. Menopause is the permanent stopping of all ovary functions, including monthly periods. This also signifies the end of their reproductive years, as they no longer are able to become pregnant. Menopause typically occurs in mid-life, around 42-58, with the average just short of 52 years. Menopause is caused by a major reduction in female hormones, as the woman’s ovarian early eggs are depleted and is just part of the normal aging process.
How do you know? Why does menopause happen?
It is generally agreed that a woman has begun menopause when her periods have stopped for a full year. Additional signs that happen in the beginning include longer or shorter cycles, lighter or heavier menstrual flow, stopped menses and prolonged time with no bleeding. The effects of menopause are non-disruptive to most, thought it can possibly make a woman’s life more difficult or stressful.
Once menopause has begun, there are many signs that the process is occurring: irregular menses, night sweats, hot flashes, sleep disturbance, vaginal dryness with intercourse, bladder urgency and incontinence, mood changes, forgetfulness, and possibly the gradual development of osteoporosis and heart disease. Every woman’s experiences are different but the ceasing of menses is always present.
In some cases, menopause can be brought on earlier than usual by various body issues, such as prolonged cigarette smoking, illness, chemotherapy, radiation, racial and ethnic factors and body mass index (overweight or underweight). However hysterectomy, which is the removal of the uterus surgically does not cause menopause, as it does not include removal of the ovaries.
Menopause is caused by a depletion of ovarian early eggs, called follicles, with a decrease in the three primary ovarian hormones: estradiol, progesterone and testosterone. Studies show that estrogen and progesterone levels fall sharply with menopause and testosterone is a slow decline with age, indirectly related to menopause.
Hormone Replacement Therapy
Hormone Replacement Therapy (HRT), has been available for decades but recent studies have noted an increased risk with breast cancer and heart disease, and yet there are women whose symptoms warrant discussion of this option. It is advised for women with severe symptoms to discuss their individual situation with their doctor. HRT is a dosage of estrogen plus progestin for women with their uterus, or estrogen alone, for women who have had a hysterectomy. The therapy can provide relief from her stressful symptoms and the therapeutic plan is to use the lowest dose possible to treat the symptoms for the shortest time necessary in each individual case. If treatment is necessary it is best to start it early after the development of symptoms rather than later, and to taper off when able.
Education is the Best “Treatment”
The best “treatment” for menopause is basic education. Menopause is sometimes a taboo subject in the United States, and many women do not know what to expect when menopause begins. It can be scary and confusing. Women who do not want HRT may get some relief from signs of menopause in other ways, such as lubricants and moisturizers or low-dose prescriptions of vaginal estrogen products for vaginal dryness, staying in cool rooms and avoiding hot flash triggers (i.e. spicy food, hot drinks, etc), counseling sessions, and medication that can help in reducing osteoporosis issues.
Talk to your doctor or healthcare provider if you are having bothersome or worrisome symptoms associated with menopause. Together, you can identify options that will work well for you.
Dr. Jay Sprong is an obstetrician-gynecologist with Hampshire OG/GYN Associates.
Cooley Dickinson Hospital • 30 Locust St. (Route 9), Northampton, Mass. • (413) 582-2000