Susan L. Grant MD and Margaret Klugman RPA
Obstetics and Gynecology Board Certified




8 East 83rd Street
New York, New York 10028
Phone: 212.769.0755
Fax: 212.769.4728
info@grantklugmanobgyn.com

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Understanding Menopause

What Is Menopause?

Menopause simply means the end of menstruation. As a woman ages, there is a gradual decline in the function of her ovaries and the production of estrogen. Around the time a woman turns 40, this process speeds up. This menopause transition is known as perimenopause.

Menopause is the time in a woman's life when her period stops. It usually occurs naturally, most often after age 45. Menopause happens because the woman's ovary stops producing the hormones estrogen and progesterone.

A woman has reached menopause when she has not had a period for one year. Changes and symptoms can start several years earlier. They include:

  • A change in periods - shorter or longer, lighter or heavier, with more or less time in between
  • Hot flashes and/or night sweats
  • Trouble sleeping
  • Vaginal dryness
  • Mood swings
  • Trouble focusing
  • Less hair on head, more on face

Some symptoms require treatment. Talk to your doctor about how to best manage menopause. Make sure the doctor knows your medical history and your family medical history. This includes whether you are at risk for heart disease, osteoporosis, or breast cancer.

Women typically menstruate for the last time at about 50 years of age. A few stop menstruating as young as 40, and a very small percentage as late as 60. Women who smoke tend to go through menopause a few years earlier than nonsmokers. Most women notice some menstrual changes -- such as a shortening of cycle length (periods occurring closer together), skipped menstrual periods, and occasional heavy periods -- up to a few years before menstruation ceases.

There is great variation in experience of menopause among women. About 75% of women have hot flashes. Nighttime hot flashes are more common and may result in chronic sleep deprivation. Mood changes aren't as well understood, but some women report an obvious change in mood. In addition, women may experience vaginal dryness, painful intercourse, and urinary symptoms. These symptoms are often temporary and pass as your body adjusts. Hormone replacement therapy can help relieve the symptoms in the meantime.

However, menopause does increase your risk of osteoporosis (thinning of the bones) and heart disease. Talk with your doctor about how you can decrease these risks.

Treatment

Hormone Replacement Therapy

Menopause is the time in a woman's life when her period stops. It is a normal part of aging. In the years before and during menopause, the levels of female hormones can go up and down. This can cause symptoms such as hot flashes and vaginal dryness. Some women take hormone replacement therapy (HRT) to relieve these symptoms. HRT may also protect against osteoporosis.

However, HRT also has risks. It can increase your risk of breast cancer, heart disease and stroke. Certain types of HRT have a higher risk, and each woman's own risks can vary depending upon her health history and lifestyle. You and your health care provider need to discuss the risks and benefits for you. If you do decide to take HRT, it should be the lowest dose that helps and for the shortest time needed. Taking hormones should be re-evaluated every six months.

Natural Treatments/Alternative Therapies

You may want to consider alternatives to menopausal hormone therapy to ease menopausal symptoms. Some women decide to take herbal, natural, or plant-based products to help their symptoms. But there is not enough evidence to know if treatments like these are helpful. Tell your doctor if you are taking any of these treatments. They may have side effects or make another drug not work as well. Some of the most common ones are:

  • Soy. This contains phytoestrogens (estrogen-like substances from a plant). Some research has shown that soy food products can help with mild hot flashes. Other research suggests that women who have been diagnosed with estrogen-dependent breast cancer should be cautious with their soy intake. Eating large amounts of soy products could be harmful for women with this type of breast cancer.
  • Other sources of phytoestrogens. The active ingredients in most dietary supplements for menopause are phytoestrogens - chemicals found in plants that may act like the estrogen produced naturally in the body. These include herbs, such as black cohosh, wild yam, dong quai, and valerian root.
  • Bioidentical hormone therapy. Bioidentical hormones are custom-mixed formulas containing various hormones that are chemically identical to those naturally made by your body. These over-the-counter products are marketed as being tailored to a woman's individual hormone needs. There are two main types of Bioidentical hormones:
    1. Those that are FDA-approved and commercially available with a prescription
    2. Those that are mixed on an individual basis for women in compounding pharmacies, which are NOT FDA-approved

It is important to know that alternative therapies can affect medical care by introducing personal belief systems that are not typically a part of the doctor-patient relationship.

sources:
http://www.nlm.nih.gov
http://www.webmd.com
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