Menopause is not a cause for panic and is considered a normal part of the aging process. It’s a gradual transition that generally begins in a woman’s 40s and once you get there, you’re there to stay.
The official definition of menopause is the lack of menstruation for one year and is generally accompanied by a variety of signs and symptoms from mild to severe, although none are life-threatening.
Ovaries start reducing their output of hormones – estrogen, progesterone, and testosterone – and this leads the pituitary to increase its production of FSH as it frantically tries to make the ovaries release more of these same hormones. However, the ovaries are worn out and can’t perform their usual tasks as menopause approaches. Usually, before this occurs, the menstrual cycles tend to change and become more erratic, sometimes heavier or with prolonged spotting, until they eventually stop altogether.
The range of age for menopause is 45-55 years, but approximately 5% of women experience it earlier such as 40-45 years. The age of onset is affected by genetics, smoking, exposure to radiation or chemotherapy, or surgically induced menopause.
During the period between menopause and age 80, women need to adapt to new biological, social, and psychological changes. Women must deal with hormonal, physical, and emotional shifts along with life transitions such as the ‘empty nest’ syndrome, loss of loved ones, job changes, divorce, caring for aging parents, different social roles, the loss of fertility, and the onset of chronic diseases such as hypertension.
One meta-analysis of menopause showed that there are six trends occurring in the menopause:
- Aging associated with menopause causes psychosocial events.
- Occurring physical and emotional changes affect women.
- Women perceive the period as both good and bad or associated with gains and losses.
- Coping strategies and resilience are improved so that they can optimize their physical and emotional well-being.
- Sex life is affected by health issues, family, and marital relations, and past history of whether the sexual experiences were pleasant or not.
- Women need to be prepared and educated so that their needs can be met based on expectations.
Signs and symptoms of menopause
The two terms – signs and symptoms – are often used interchangeably, but symptoms are subjective feelings that a patient experiences while signs are objective and measurable, such as pulse or blood pressure. The most common symptoms are vasomotors (affecting the dilation of blood vessels) in nature such as hot flashes, night sweats, mood changes, and vaginal dryness due to fluctuating and decreasing estrogen levels. Vaginal dryness can lead to painful sex which can adversely affect sex drive as does waning testosterone levels.
The following are many of the signs and symptoms of menopause:
- Vaginal changes - dryness, loss of collagen and blood vessels which causes the skin to thin out, leading to irritation, bladder symptoms, painful intercourse
- Skin wrinkles due to loss of estrogen that leads to loss of collagen
- Bladder droppage/urinary urgency/leakage due to the lack of estrogen that is essential to bladder health
- Dry skin, again lack of estrogen and loss of collagen and oil production
- Hair growth in unwanted places like the upper lip, chin, and lateral cheeks
- Muscle loss as testosterone level decreases/muscle soreness
- Increase in abdominal fat, elevated bad cholesterol, and lower good cholesterol
- Sagging skin/breasts due to gravity and lower estrogen levels
- Eye/vision changes/dry eyes — difficulty reading but generally maintain ability to see in a distance
- Brain shrinkage, mood, and memory issues
- Hot flashes or flushes that come on suddenly
- Night sweats
- Sleep disturbance
- Dyspareunia (painful sex) from vaginal dryness and low levels of lubrication
- Bone loss that can lead to osteoporosis
- Mood changes, anxiety, and depression
- Abdominal fat
- Brain fog – lack of focus and concentration
- Muscle loss
- Achy joints
- Low libido
- Hair growth in unwanted places and loss of hair in other places
- Dry mouth and dental problems
- Increase bad cholesterol
- Weight gain
Most of these symptoms are progressive, but often, the hot flashes go away within 5 years while vaginal dryness and bone loss increase as time goes on. Cardiovascular disease (CVD), like coronary artery disease and stroke, may affect women later on after the establishment of menopause and tend to be more severe than their male counterparts.
Treatment and disease prevention strategies during the menopause
So, what can you do about these signs and symptoms of menopause that doesn't involve drugs or hormones? Besides diet and exercise, is there anything else that can relieve some of these symptoms? While it is true that many symptoms will wane over time, it's still no fun when you are amid a tsunami of a hot flash with sweat in your eyes and cheeks on fire.
Let's review some options:
- Alternative and complementary therapies such as acupuncture have shown some promise
- Exercise regimens like yoga and low-impact aerobics in a well-air-conditioned room
- Herbal preparations like black cohosh and other phytoestrogens (plant-based) like soy and yams might prove useful
- Lifestyle modifications (smoking cessation, improving sleep)
- Over-the-counter preparations like RePlens for vaginal dryness
- Yoga, relaxation techniques like meditation
Hormone therapy in the form of pills, injections, and topicals is useful in many cases for a finite period of time. Long-term estrogen supplementation or estrogen started late in the menopausal period may have adverse consequences in the form of CV disease and breast cancer. Women who still have their uterus would need to take a progesterone with an estrogen supplement to prevent the risk of excess uterine growth that could lead to cancer of the lining. There are OTC and herbal remedies that may help symptoms of menopause.
Chinese Herbal Medicine has been used for centuries in other cultures for the management of menopause. The ingredients of many of these supplements are soy isoflavones, black cohosh, red clover and ginseng, chasteberry, licorice, and berberine. Kun Tai capsule and the most frequently prescribed Chinese herbal medicine herb was Bai shao (Paeoniae Radix Alba, Paeonia lactiflora Pall). It has been shown that black cohosh was more effective than primrose oil because it was able to reduce the frequency of hot flashes and improve the quality of life.
In addition, Passiflora incarnata L. can help vasomotor symptoms, insomnia, and depression. Studies of Saliva officinalis showed that it can decrease the severity of the menopausal symptoms in postmenopausal women, such as hot flashes, night sweats, panic, fatigue, and cognitive issues such as concentration.
Lifestyle changes, such as limiting alcohol intake, quitting smoking, doing weight-bearing exercises, and other healthy behaviors like mediation and yoga, can help mitigate symptoms and slow bone loss.
Screening mammograms, bone density tests, metabolic panels, and colonoscopies are common diagnostic tests performed in menopause. And now, there is Cologuard, a new non-invasive test that looks for DNA from cancer cells in a stool sample.
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