HEALTH TALK: Menopause

Today we are going to focus on our precious women. The topic is one which is not widely discussed because everybody, doctors included, often think of menopause and its symptoms and consequences as just one of those things which women unfortunately have to go through, like childbirth.  But I want to tell our women that they do not just have to grin and bear it.  Yes, it is a natural step in the process of aging, but it does not have to make your life miserable.

GENERAL INTRODUCTION

Today, medical advances have resulted in a wide range of health care choices that can enhance quality of life during menopause and the decades afterwards.  It is vital for women to know that menopause itself caries no serious health risks.  However, the chance for heart disease and osteoporosis (thinning of the bone) rises after menopause.  They must also understand the menopause and the range of treatment options to make the best health decisions, and to remember that menopause is a perfectly natural occurrence.

THE FACTS ABOUT MENOPAUSE

It simply means that a woman has stopped having her menstrual periods.  It occurs when the ovaries have packed it in and stopped making hormones called estrogens.  It usually happens between the ages of 45 and 60 but it can occur earlier.  If the ovaries are surgically removed or stop functioning for any reason, the same thing will happen.

Low estrogen levels cause some uncomfortable symptoms in many women.  The most common is hot flashes – sudden intense waves of heat and sweating.  They may disrupt sleep, drench pillows and bed linen, and cause many a husband to sleep in another room.  Other symptoms are mood changes, irregular periods, vaginal and urinary tract infections, urinary incontinence (leakage of urine or inability to control urine flow), and inflammation of the vagina.  Because of the genital changes, some women have
discomfort or pain during sexual intercourse.  Men need to be gentle and patient.  Some women notice changes in their skin, digestive tract, and hair during menopause.  Long term, remember we mentioned heart disease and osteoporosis.  Bones break easier and some women actually get shorter because of repated fractures of the bones of the vertical column.

WHAT ARE ESTROGEN AND PROGESTERONE?

Estrogen is the female hormone which plays a key role in shaping the female body and preparing it for female functions such as pregnancy.  The breasts, hips, vagina, uterus and other female organs need it to mature.

Progesterone is also made by the ovaries, and with estrogen regulates the changes that occur with each menses and prepare the uterus for pregnancy.  Before menopause, more than 90% of estrogen is made by the ovaries.  The adrenal glands, liver and kidneys also make a small amount, so a woman can at least have some after menopause.  Fat cells are also in on the act, so overweight women may have fewer problems with hot flashes and osteoporosis. Don’t start heaping up your plates though; I’m sure you know about overweight and obese problems.

Estrogen stimulates skeletal growth, and helps maintain healthy bones.  It protects the heart by promoting “good cholesterol” (HDL) and lowering “bad cholesterol” (LDL).  Estrogen may also affect a woman’s sexual desire.  Ah ha, wouldn’t you love to know which way?

Progesterone is the second female hormone, mostly made by the ovaries, but to a lesser extent by the adrenal glands.  Progesterone stimulates the growth of a cushiony lining in the uterus where the fertilized egg can grow and develop into a baby; helps the breast make milk, and generally maintain pregnancy.

SYMPTOMS

75% of women report some troublesome symptoms but severity and frequency of them vary from woman to woman.  Again hot flashes are the most common with vaginal atrophy running a close second – the vaginal tissue becomes thinner, drier, more delicate, and begins to shrink.

IRREGULAR BLEEDING

Irregular periods are characteristic leading up to menopause.  Periods may be shorter or longer, heavier or lighter, and the interval between them can just be all over the place.  See your doctor, though if: bleeding lasts more that 21 days; your period lasts longer than 8 days or is very heavy; your period occurs after 6 months or more after the last one..

HOT FLASHES

These are the classic sign of menopause.  A flash produces a sudden sensation of warmth or even intense heat that spreads over various parts of the body, especially the chest, face, and head.  Flushing and sweating usually occur, followed by a chill.  Some women feel their heart beating very fast and feel anxious.  They last from a few seconds to several minutes.  If you have had your womb removed, you are likely to have more hot flashes.  Many women will find their flashes decreasing after two years into menopause.  Some may have them for 10, 20, 40 years or longer after menopause.

VAGINAL THINNING

The importance of estrogen in maintaining healthy vaginal and other tissues below has already been mentioned.  Up to 50% of all women over 60 have some degree of vaginal dryness.  Regular sexual intercourse can help to keep the vagina moist and toned.  See, not only can they do it, they need to do it.  Age matters not.

LINKS BETWEEN MOOD, MENOPAUSE, AND SEXUAL FUNCTION

The brain also responds to estrogen.  It is thought to be important in memory and maintaining healthy nerve cells. Depression may be more likely right before menopause, but other things may be contributing – kids, career, marriage pressures, aging parents, etc…

DIAGNOSIS

The doctor will review a woman’s medical history and perform an examination.  He may order blood tests to make sure there isn’t another diagnosis and to decide what treatment, if any, is necessary.

HEALTH CHANGES AFTER MENOPAUSE

OESTEOPOROSIS

This is thinning of the bones, which weaken and break easily.  Most prone are those in the spine, wrists and hip.  Bones naturally weaken with age in both sexes after 40, but menopause is an added risk. Estrogen replacement can help in some selected cases but adequate intake of calcium and regular exercise, like walking, can do wonders.

HEART DISEASE

This has been touched on before.  But it may surprise you to know that heart disease is one of the leading cause of death among women; it is not a “man’s problem.”  Risk factors for heart disease in women (and men) include obesity, high blood pressure, diabetes, cigarette smoking, high levels of “bad” cholesterol and a low level of activity.

Estrogen replacement has been shown to play an important role in counteracting all the factors that lead to heart disease in women.

Now, women, I’m sure, you have a lot of questions. Let me anticipate some and try to answer them briefly.

WILL THESE SYMPTOMS LAST FOR THE REST OF MY LIFE?

For most, they last for a relatively short time.  However, because a woman’s estrogen level naturally remains low after menopause, the effect of estrogen deficiency will always be present.  But replacement therapy, eating right, exercise, and making lifestyle changes will all help.

IS A CHANGE IN SEXUAL DESIRE NORMAL AFTER MENOPAUSE?

Not really, the problems are essentially physical which cause women then to refrain.  But some women do view themselves differently, and for this counseling and support groups may help.

WHAT CAN BE DONE TO RELIEVEN PAIN DURING SEX?

Again, have sex often to decrease dryness and increase tone.  Also lubricants, when necessary, like K-Y Jelly, can assist.  There’s no shame in doing that.  Estrogen creams are also available.

WHAT ABOUT HORMONE REPLACEMENT THERAPY?

Replacing estrogen – hormone replacement therapy (HRT) – has done wonders for many women.  It is not for everybody, depending on various factors to do with your uterus, breasts and other considerations.  The best thing to do is talk with your doctor.

But please, do not suffer in silence.  Don’t grin and bear it.  There is help, there is counseling, and there is genuine concern on the part of us doctors, male or female.  We understand and we want to spare you the discomfort and the consequences.

See you next week.

Dr. Victor Emanuel has been an educator of medical professionals in training, and the public, for over 20 years in Dominica. The contents of his articles are based on facts and research conducted, and not of his opinion.