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National
Women's Health Resource Center The
change of life. The end of fertility. The beginning of freedom.
Whatever people call it, menopause is a unique and personal experience
for every woman. It's a natural event that marks the end of fertility
and childbearing years. Technically, menopause results when the
ovaries no longer release eggs and decrease production of the sex
hormones estrogen, progesterone and, to a lesser extent, androgen.
During
the reproductive years, a gland in the brain generates hormones
that cause a new egg from the ovaries to be released from its follicle
each month. As the follicle develops, it produces the sex hormones
estrogen and after ovulation, progesterone, which results in a thickened
uterine lining. This enriched lining is prepared to receive and
nourish a fertilized egg, which could develop into a fetus. If fertilization
does not occur, estrogen and progesterone levels drop, the lining
of the uterus breaks down, and menstruation occurs. For reasons unknown, your ovaries gradually begin to change in hormone production during your mid-30s. In your late 40s, the process accelerates and hormones fluctuate more, and usually causes irregular menstrual cycles and unpredictable episodes of menstrual bleeding. By
your early to mid-50s, periods finally end altogether. However,
estrogen production does not completely stop. The ovaries decrease
their output significantly, but a few women may still produce a
small amount of estrogen. Progesterone,
the other female hormone, works during the second half of the menstrual
cycle to prepare the uterine lining as a viable home for an fertilized
egg, and to shed the lining if the egg is not fertilized. If you
skip a period, your body may not make enough progesterone to break
down the uterine lining. However, your estrogen levels may remain
high even though you are not menstruating. At menopause, hormone
levels don't always decline uniformly. Production of estrogen and
progesterone is erratic and unpredictable at this time. Most
women can tell if they are approaching menopause because their menstrual
periods start changing. The "menopause transition" is
a term used to describe this time. Perimenopause is another term
used by some to describe as starting the menopausal process. But
menopause itself - as defined by health care professionals - is
only one day in a woman's life - the day after she has not had a
menstrual period for 12 consecutive months, and no other biological
or physiological cause can be identified. Until 12 consecutive months
have passed without a menstrual period, a woman in her late 40s
or 50s may still be able to get pregnant, despite irregular periods.
Although
the majority of women experience "natural" or spontaneous
menopause, some women may experience menopause due to one of a number
of medical interventions. Surgically removing both ovaries, a procedure
known as bilateral oophorectomy, will trigger menopause, at any
age. Induced menopause can also occur if the ovaries are damaged
by radiation, chemotherapy or by certain drugs. Certain medical
conditions also may cause menopause to occur earlier. Just
as every woman's body is unique, your menopause experience will
be a highly personal one. For example, 15 to 20 percent of women
experience no physical symptoms at all, except the end of their
menstrual periods. Some
women go through menopause before age 51 and some experience it
a bit later. Early menopause is defined as occurring at any age
younger than age 40 or 45. Early menopause can occur naturally,
but premature menopausal symptoms may signal an underlying condition,
so it is important to discuss any symptoms with your health care
professional. Menopause can occur as early as your 30s and, rarely,
as late as in your 60s. However, there is no correlation between
the time of a woman's first period and her age at menopause. In
addition, age at menopause is not influenced by race, height, the
number of children a woman has had or whether she took oral contraceptives
for birth control. What
does influence the time of menopause? Genetics are a key factor.
The age at which your mother stopped her periods may be similar
to when you stop your menstrual periods. And, women who smoke cigarettes
experience menopause two years earlier, on average, than nonsmoking
women. About
six years prior to natural menopause, typically in a woman's late
40s, menopause-related changes begin. Physical changes triggered
by hormonal fluctuations during this time frame include: *
Irregular menstrual patterns. One of the most common and annoying
symptoms you may notice during your 40s is that your periods become
irregular. They may be heavy one month and then very light the next.
They may get shorter or last longer. You may even begin to skip
your period every few months or lose track of when your periods
should start and end. These symptoms are caused by irregular estrogen
and progesterone levels. Levels of hormones vary erratically and
may be higher or lower than normal during any cycle. For example,
if you don't ovulate one month-which is common for women in their
late 40s-progesterone isn't produced to stimulate menstruation and
estrogen levels continue to rise. This can cause spotting throughout
your cycle or heavy bleeding when menstruation does start. One
note of caution: although irregular menstrual periods are common
as you get closer to menopause, they can also be a symptom of uterine
abnormalities or uterine cancer. If your periods stop for several
months and then start again with heavy bleeding or if you start
bleeding after menopause, consult with your health care professional
as soon as possible for an evaluation. Be sure to mention any menstrual
irregularities during regular check-ups. A uterine biopsy or vaginal
ultrasound are the only ways to evaluate if irregular symptoms are
abnormal. Irregular spotting can also be a symptom of cervical cancer
which may be picked up by a Pap test (see screening recommendations
below). Other
changes and signs of menopause include: *
hot flashes (sudden warm feeling, sometimes with blushing) *
night sweats (hot flashes that occur at night, often disrupting
sleep) *
fatigue (probably from disrupted sleep patterns) *
mood swings *
vaginal dryness *
fluctuations in sexual desire or response *
difficulty sleeping Although
there is a wide range of possible menopause-related conditions,
most women going through natural menopause have only mild disturbances
during the perimenopausal years. However, you should be aware that
there are at least two major health conditions that can develop
in the years: coronary artery disease and osteoporosis. Estrogen
helps protect against plaque buildup in your arteries. It does this
by helping to raise HDL cholesterol (good cholesterol), which helps
remove LDL-cholesterol (the type that contributes to the accumulation
of fat deposits called plaque along artery walls). As you age, your
risk for developing coronary artery disease (CAD) - a condition
in which the veins and arteries that take blood to the heart become
narrowed or blocked by plaque - increases steadily. Heart attack
and stroke are caused by atherosclerotic disease, in most cases.
Your
body's own estrogen helps prevent bone loss and works together with
calcium and other hormones and minerals to help build bones. Your
body constantly builds and remodels bone through a process called
resorption and deposition. Up until around age 30, the body makes
more new bone than it breaks down. But, once estrogen levels start
to decline, this process also slows down. By menopause, your body
breaks down more bone than it rebuilds. In the years immediately
after menopause, some women risk losing as much as 20 percent of
their bone mass. Although bone loss eventually levels out in your
late 50s, in the years ahead, keeping bone structures strong and
healthy to prevent osteoporosis becomes more of a challenge. Osteoporosis
occurs when bones become too weak and brittle to support normal
activities. Not
all women develop heart disease or osteoporosis. Many more things
affect your heart and your bones than estrogen alone. For example,
exercise improves your cardiovascular system - your heart, lungs
and blood vessels - at any age. It can help decrease high blood
pressure, a concern for one out of every three women over age 60.
It can also help reduce weight gain, a major risk factor for heart
disease, diabetes and many other health conditions common to older
women. You are never too old to begin or continue exercising. A
simple walking routine for 30 minutes three to five days a week
can provide health benefits. There are other exercise options. Talk
to your health care professional about which ones fit your lifestyle
and medical needs. If
your bones are strong and healthy as you enter menopause, you'll
have better bone structure to sustain you as you age. Bone loss
varies from woman to woman. You can also improve bone strength as
you age by exercising regularly and making sure you get enough calcium
in your diet or from supplements. Exercise also helps improve balance,
muscle tone and flexibility, which can diminish with aging. Weakness
in these areas can lead to more frequent falls, broken bones and
longer healing periods. Women today can expect to live as much as one-third of their lives beyond menopause. In the next decade, more women than ever before - as many as 52 million - will be age 50 or older. The years following menopause can be healthy years, depending on how you take care of yourself.
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