My mom never talked to me about menopause though. She says her mother never talked about it either."

I’m not sad I’m past menopause. I’m just glad those monthly periods are over."

"Is it hot in here, or is it me?"

Menopause or the "change of life" affects each woman in a different way. Maybe hot flashes and sleep problems troubled your sister during menopause. You, however, might be feeling a new sense of freedom and energy. Your best friend may hardly be aware of a change at all.

Just like puberty, menopause is a normal part of life. It is really the end of a long, slow process. When you are in your mid-30’s, your ovaries begin to change how much estrogen and progesterone, two female hormones, they make. These are both important for normal menstrual cycles and successful pregnancy. Estrogen helps to keep bones healthy. It may also have an effect on cholesterol levels in your blood, help keep skin and arteries more elastic, and possibly help memory.

Although very rare before the age of 40, menopause can happen anytime from your 30’s to your mid-50’s or even later. Smokers often begin menopause earlier than non-smokers. If you have both ovaries removed (bilateral oophorectomy) during a hysterectomy (removal of the uterus), you may have the symptoms of menopause right away, no matter your age. Once your uterus is removed, your periods will stop.

Some of the hormone-related stages in your life are:

Puberty. This is the age when body changes begin and breasts develop. A young girl begins to have a monthly period, often around 12-1/2 years of age.

Perimenopause. This probably begins about 3 to 5 years before your last menstrual period. It lasts until 12 months after your final period. Some signs or symptoms of menopause may appear during this time.

Menopause. The event that marks menopause is your final menstrual period. You will know for sure that you have experienced menopause when you have not had a period in a year. Only then can you be sure that you are no longer able to get pregnant.

Postmenopause. Because this time follows menopause, it begins with your final period and lasts the rest of your life. Like menopause, you do not know you are there until 1 year later. The signs of menopause usually go away in a few years. You no longer have to worry about periods or getting pregnant. You are, however, at greater risk for some health problems.

Changing levels of estrogen and progesterone can cause a variety of symptoms. You may have little or no trouble with hot flashes or other signs of menopause. Some women, however, have slight discomfort or worse. Common changes you might have are:

Irregular periods. One of the first signs is a change in your periods. They may become less regular. They could be lighter. Some women have short times of heavy bleeding. These are all fairly common. Very heavy bleeding for many days, periods less than 3 weeks apart, periods that last longer than 10 days, or spotting between periods may also happen. Check with your doctor if you find any of this troublesome.

Hot flashes. A hot flash or flush is common in perimenopause. Possibly 80 % of American women have them. Suddenly you feel heat in the upper part or all of your body. Your face and neck become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Flashes can be as mild as a light blush or severe enough to wake you from a sound sleep (called night sweats). Most flashes last 30 seconds to 5 minutes. They should disappear within a few years after menopause.

Problems with the vagina and bladder. Body tissue in the genital area becomes drier and thinner as estrogen levels change. Sexual intercourse might become painful for you because of this dryness. You might also be more likely to have an infection in your vagina. As you get older, you may begin to have urinary tract problems. These could be more infections, trouble holding urine when you feel the need to go to the bathroom (urge incontinence), or problems holding urine when you sneeze, cough, laugh, run, or step down (stress incontinence). If you have any of these problems, see your doctor.

Sex. Until you have gone 1 year without a period, you should still use birth control if you do not want to become pregnant. Around the time of menopause, your feelings about sex might change. You might have trouble becoming sexually aroused because of hormone changes, discomfort due to changes in the vagina, or medicines you are taking. Or, you might feel freer and sexier after menopause---relieved that pregnancy is no longer a worry. Remember that after menopause you can still get sexually-transmitted diseases, such as HIV/AIDS (acquired immunodeficiency syndrome).

Fatigue and sleep problems. Feeling tired is another common symptom. You might have trouble getting to sleep, waking early, or getting back to sleep after waking up in the middle of the night. Women may be awakened by night sweats or the need to go to the bathroom.

Mood changes. Some people think that women may be more moody, irritable, or depressed around the time of menopause. There might be a connection between changes in the estrogen level and your emotions. Other causes for these mood shifts might be stress, family changes such as children leaving home, and feeling tired.

Changes in your body. Visible changes with menopause may include a thickening at the waist, loss of muscle mass and increase in fat tissue, or thinning and loss of stretchiness in the skin.

Other possible signs. Some women may experience headaches, memory problems, and joint and muscle stiffness or pain.

You may not even notice two important aspects of menopause. These are a loss of bone tissue, which can weaken bones and cause osteoporosis, and higher cholesterol levels, which may lead to cardiovascular (heart) disease.

Osteoporosis. Many people do not know they have weak bones until they break a hip, wrist, or vertebrae (bones in the spine). Osteoporosis develops as people age because their bones grow thinner and become less dense. With time bones may become weak and may break. For women, the loss of estrogen around the time of menopause means that they may lose bone strength faster.

The good news is that the risk of osteoporosis can be lowered. First, get plenty of calcium and vitamin D, both before and after menopause. Second, exercising often may also help keep muscles and bones strong and lessen the chance of falls and broken bones. Aim for 30 minutes of weight-bearing exercises like walking, jogging, or weight lifting 3 days a week or more. Third, taking estrogen or one of several other drugs available will also prevent further loss of bone. Drugs approved for osteoporosis by the Food and Drug Administration (FDA) include raloxifene, alendronate, and calcitonin.

Heart disease. Young women have a lower risk of heart disease than do men. This changes with age. Falling estrogen levels during menopause may lead to higher cholesterol levels in older women. This, in turn, increases the chance of heart disease, stroke, and other diseases that affect the heart and blood vessels. After menopause, a woman’s risk of heart disease grows to almost equal the risk for a man. In fact, heart disease kills more women than lung or breast cancer.

You can lower your chance of heart disease by eating low-fat foods, fruits, vegetables, and whole-grain foods; not smoking; losing weight; and exercising regularly. Some experts believe that using estrogen or estrogen/progesterone supplements may also lower the risk of heart disease in women after menopause.

You may first try to make some changes in the way you live. Start with a nutritious diet. Contact the National Heart, Lung, and Blood Institute for more information about reducing your risk of heart disease (See Resources). Also, be careful in your use of alcohol and caffeine, and try to avoid stress. For vaginal discomfort, use a water-based lubricant, but not petroleum jelly. Be sure to get a Pap test, mammogram, and pelvic and breast examinations every year.

If you are having hot flashes, try making a diary of when they happen and what may start them. This may help you find out what to avoid. Otherwise:

• When a hot flash starts, go somewhere that is cool.
• Sleeping in a cool room may keep hot flashes from waking you up during the night.
• Dress in layers that you can take off if you get warm.
• Use sheets and clothing that let your skin "breathe."
• Try having a cold drink (water or juice) at the beginning of a flash.

In perimenopause, your doctor might suggest birth control pills. These will provide birth control, make your periods more regular, and lower your chance of cancer of the uterus and ovaries. It may also help with symptoms like hot flashes. However, the pill hides the arrival of menopause. When you think you might have reached menopause, you could stop taking the pill for several months to see if you still have a regular period.

Once you have reached menopause, your doctor might suggest estrogen and progesterone, known as hormone replacement therapy or HRT. For women without a uterus, the doctor will recommend estrogen alone. This is called estrogen replacement therapy or ERT. The hormones are usually taken as pills, but can be given as skin patches, creams, or vaginal inserts, depending on a woman’s particular needs.

Taking hormones for a short time (less than 5 years) may help relieve any symptoms of menopause. Taking HRT/ERT for more than 5 years will also help delay osteoporosis and may protect against heart disease. It should improve your cholesterol levels and may also help your memory.

However, there are side effects and possibly health risks. This is particularly true if you have liver problems, high levels of triglycerides (a type of fat in the blood), or a history of blood clots. Blood clots and an increase in your chance of developing breast cancer are two risks of HRT/ERT. For more information on HRT/ERT, see the NIA Age Page on hormone replacement therapy.

Phytoestrogens are estrogen-like materials found in cereals, vegetables, legumes (beans), and some herbs. They may work in the body like a weak form of estrogen. Some may lower cholesterol levels. Soy, wild yams, and herbs such as black cohosh, dong quai, and valerian root have been suggested to relieve the symptoms of menopause. If you decide to eat a lot more foods with phytoestrogens, be sure to tell your doctor. Any food or over-the-counter product that you use for its drug-like effects could interact with other prescribed drugs or cause an overdose.

The effectiveness of these "natural" estrogens has not been proved. Some plant estrogens are under study now. Scientists want to know whether they can have the same helpful effects as the estrogen doctors now prescribe. Also, just as important, are they safe? Do they have the same risks as estrogen or different ones? Unlike prescription drugs, herbal medicines are not supervised by the FDA. They do not have to be proven safe or effective. In addition, their strength may vary between batches or manufacturers.

The decision about how to handle menopause is best made by talking with your doctor. First, decide how bothersome your symptoms are. Then think about your own medical history and risk of heart disease, osteoporosis, and breast cancer and your family history of these illnesses.

Remember any decision is not final. You can, and should, review it with your doctor every year during your annual checkup. You can see a gynecologist, or a general practitioner or internist. It is important you have routine breast and vaginal exams and a Pap test. Be sure to contact your doctor right away if you notice spotting, a lump in your breast, or a sense of fullness or bloating in your abdomen.

For your grandmother or great-grandmother, life expectancy was shorter and reaching menopause did mean that their life was nearing its end. Not so for you because today we are all living longer—on average, until 78. Make the most of the 20, 30, or more years you have ahead.

For information on menopause contact:

American College of Obstetricians and Gynecologists (ACOG)
409 12^th Street, SW
Box 96920
Washington, DC 20090
202-484-8748
Internet website: http://www.acog.org

North American Menopause Society
Box 94527
Cleveland, OH 44101
216-844-8748
Internet website: http://www.menopause.org

Planned Parenthood Federation of America, Inc.
810 Seventh Avenue
New York, NY 10019
800-230-PLAN
Internet website: http://www.plannedparenthood.org

The National Heart, Lung, and Blood Institute has information on heart disease in women:

NHLBI Information Center
Box 30105
Bethesda, MD 20824
301-592-8573
Internet website: http://www.nhlbi.nih.gov

For materials on osteoporosis contact:

Osteoporosis and Related Bone Disease National Resource Center
1232 22^nd Street, NW
Washington, DC 20037
800-624-BONE
Internet website: http://www.osteo.org/

The National Institute on Aging (NIA) offers free information on health and aging. For a complete list of publications write:

NIA Information Center
PO Box 8057
Gaithersburg, MD 20898-8057
Internet website: http://www.nih.gov/nia

1999

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