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What Is Menopause?
Menopause represents the end of menstruation, usually diagnosed when a woman has not had a
menstrual period for 12 consecutive months, and there is no other obvious biologic or
physiologic cause. In the Western world, the majority of women experience a natural
menopause between the ages of 45 and 55 --on average at about age 51 --but it can occur as
early as in a woman's 30s and as late as in her 60s. Menopause is not a disease, but a
natural event --the end of fertility --resulting from the ovaries slowing down production
of two sex hormones: estrogen and progesterone. When the ovaries are removed surgically
("surgical menopause") or when the ovaries are damaged through drugs or x-rays,
"induced menopause" results. Menopause is considered to be "premature"
when it occurs either naturally or is induced before age 40.
Although menopause has been defined as a point time, in truth this is a process which
unfolds over many years. These years bring a variety of changes associated with decreasing
estrogen levels. These changes or "symptoms" most often start in a woman's 40s
and sometimes in her 30s. Many women are surprised by two things: the age at which
menopause-related symptoms can begin, and the range of symptoms. Other terms often used to
discuss menopause include "pre-menopause" (all the reproductive years leading to
menopause), "peri-menopause" includes the time immediately prior to the
menopause (when the endocrinological, biological, and clinical features of approaching
menopause commence) as well as the first years immediately after menopause, and
"post-menopause" (all the time beyond menopause).
Before menstruation stops completely, most women experience noticeable changes in their
periods. Some periods become shorter in length; others become longer. The flow may be
lighter or heavier --and some women have extensive bleeding with clots. The time between
periods often changes, with irregularity being very common.
Another change often experienced is the hot "flash" or "flush" --an
uncomfortable warm feeling and increased pulse rate often triggered by being too hot,
eating hot or spicy foods, hot drinks, alcohol, caffeine, or stress. There is usually a
consistent pattern for a woman's hot flashes; however, each woman's pattern is different.
Some hot flashes are easy to ignore, others are embarrassing, still others can be
debilitating. When hot flashes occur along with drenching perspiration while sleeping,
they are called "night sweats." Since they interfere with sleep, women who have
them become tired and sometimes irritable. Healthy sleep patterns are also disrupted by
falling estrogen levels.
Other changes associated with menopause can include mood changes, forgetfulness,
difficulty concentrating, dryness of the vagina, discomfort with intercourse, and lowered
sex drive. These are normal reactions to the body's withdrawal from sex hormones. Aging
changes which may or may not be related to menopause include incontinence (involuntary
leaking of urine), heart disease, and osteoporosis (thinning of bones). A woman's risk for
developing the more serious problems should be determined as early as possible.
Each woman's menopause experience is different, and most women have minimal symptoms.
Indeed, the majority continue to function well. Another piece of good news is that, for
most women, the symptoms do not last forever. Most or all diminish or disappear over time,
many can be reduced with certain lifestyle changes such as exercise and diet
modifications, and most or all decrease or disappear with treatment.
For some women, menopause brings a sense of freedom since the end of fertility means no
more birth control and dealing with periods. Menopause is a bridge to a part of life when
most women report feeling more confident, empowered, involved, and energized than in their
younger years. For some women, however, menopause --coupled with mid life psycho-social
crises - can contribute to serious health problems. So menopause is a signal to continue,
or start, a good health program.
Many women ask when they will go through menopause. Family history might provide clues,
since the time of menopause is determined genetically; however, recalled dates of a
mother's or grandmother's menopause may not be accurate. Contrary to previous opinion,
there is no correlation between the time of a woman's first period and her age at
menopause. In addition, in most studies, other factors that have no influence on age at
menopause include race, height, the number of children a woman has had, and whether she
took oral contraceptives. There is some evidence that a small percentage of women who have
had their uterus (but not ovaries) removed --called a "hysterectomy"
--experience menopause several years earlier than women of the same age without
hysterectomy. One factor that definitely influences the age of menopause is cigarette
smoking. Smokers, and even former smokers, can experience menopause up to three years
earlier than nonsmokers --providing another reason not to smoke. Although the time of the
initial menstrual period ("menarche") is typically experienced at an earlier age
than years ago --probably because of improvements in health, education, nutrition, and
living conditions --the average age at menopause (about 51 in the Western world) has not
changed much since ancient times.
Women who have had hysterectomies and who have not had their ovaries removed will ask when
they have gone through menopause. Following "hysterectomy" (the surgical removal
of the uterus or womb, but not the ovaries), there will be no more menstrual periods.
Therefore, a woman will not have the best marker for identifying menopause: stopping of
menstrual periods for 12 consecutive months. However, with the ovaries still intact,
estrogen will continue to be produced so that signs of approaching menopause that may
appear include the same ones that could appear with a uterus: hot flashes and night
sweats. These changes may continue to be xperienced or even worsen when the ovaries shut
down their production of estrogen at menopause.
Dr. Andrew Dott teaches advances hysteroscopic and laparoscopic surgical techniques,
is on the speaker's panels for several American pharmaceutical companies and is a
professional lecturer. Among his lecture topics are female and male menopause, menopause,
herbs and medications, endometriosis, and contraception.
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