What Is Menopause?
Menopause is the general term used to describe the ‘change of life’ in women, when their sex hormones production decreases and often initiates a complex of symptoms called the ‘menopause syndrome’. Menopause refers to the one year without bleeding immediately following the last menstrual period. Menopause is preceded by a period known as the peri-menopause. Peri-menopause is the period of time, generally about three to five years before menopause, which has its own complex. The post-menopause is the time after the menopause when symptoms may or may not be present. The average age of menopause is 50 years, even though it can occur early in some women.
Normal Menstrual Cycle
The Hypothalamus (a special part of the brain) senses a lack of certain sex hormones in the blood stream and stimulates the pituitary gland, also located in the brain. It produces a hormone called follicle stimulating hormone. This hormone circulates to the ovaries and stimulates the follicles or potential eggs. One or more of the follicles are then selected to ovulate, and along with ovulation, produce estrogen, progesterone – female sex hormones and male hormones which go into the blood stream and stimulate the uterine lining (lining of the womb) to get ready to accept the egg. If no fertilized egg reaches the uterine lining, also called the endometrium, the hormone levels then decrease and the menstrual cycle starts all over again.
With menopause, the ovaries do not respond to the follicle stimulating hormone stimulation from the pituitary glad. The pituitary gland then produces more of the follicle stimulating hormone trying to force ovulation. This produces an increase in follicle stimulating hormone in the blood and this can be used as a diagnostic test for menopause.
Peri-Menopause and its symptoms may begin up to eight years before menopause. Usually the first manifestation is abnormal bleeding which is characterized by shorter menstrual intervals. If one’s regular cycle length is 28 days, in the peri-menopause the menses may shorten to 24-26 days. Later there are irregularities in the cycle length and longer intervals caused by missing periods. These are normal expected changes due to the inconsistent production of hormones made from the older less efficient ovaries. Bleeding between the periods, or inter-menstrual bleeding is not normal and often represent an anatomic cause for the bleeding rather than a hormonal one. Uterine fibroids (growth on the womb) or intra-uterine polyps are the most frequent causes of such bleeding.
Menopause is the transition in a woman’s life when the ovaries stop releasing eggs, menstrual activity decreases and eventually ceases, and the body decreases the production of the female hormones estrogen and progesterone.
Along with the inconsistent bleeding often come symptoms of hormonal irregularities. During the months when normal hormones are produced and bleeding is normal, there may not be any specific symptoms. In the months when ovulation does not occur, hormone secretion does not occur in a normal pattern. During these months one may have menopausal type syndrome like hot flashes, insomnia (inability to sleep at night) and irritability which may also seem a lot like peri-menopausal syndrome. These are secondary to estrogen deficiency. In some of the cycles, adequate estrogen is still present but without ovulation no progesterone is produced and similar peri-menopausal syndrome-like symptoms can be present from progesterone deficiency. The key to the peri-menopausal syndrome is therefore the inconsistency of both bleeding and symptoms.
What symptoms occur during menopause?
Hot flashes are the classically described most common symptoms during menopause. They are symptoms that last 10 to 15 minutes and are described as a feeling of warmth which starts in the mid-chest area and rises up to the face and head and is often accompanied by flushing and sweating. These really are flashes and flushes, the flashes are felt but are not visible to other people. Other symptoms attributed to menopause are night sweats and insomnia (inability to sleep at night) which is probably a night time manifestation of hot flashes. Irritability, fatigue, depression, joint pains, dry skin, memory problems and impatience are often also included in the menopausal syndrome. Certainly this is a general list of symptoms, each of which can be a symptom of something else. Many women, actually up to 30 percent of women, have none of these symptoms during the ‘change’. For 10 to 30 percent of women, the symptoms can be so severe that they can greatly affect their life style.
What Can Be Done to Decrease the Symptoms of Menopause?
The answer is best broken down to three categories:
Non-hormonal medicines and
Lifestyle changes both lessen menopause symptoms and allow women to live longer and healthier lives. Increasing exercise, quitting smoking and eating healthier food are very wise and helpful measures in general but also tend to lessen the symptoms of menopause.
The non-hormonal medicines used during menopause include vitamins, minerals, herbal products and the most recently recommended soy products to try to help alleviate the menopausal symptoms
Hormonal treatment may include estrogen therapy as recommended by your doctor, alone or in combination with progesterone with or without testosterone.
Dr. Lily M. Sanvee