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Menopause
“My
mom never talked to me about
menopause. She says her
mother never talked about it
either.”
“I’m
not sad I’m past
menopause. I’m glad those
monthly periods are over.”
“Is
it hot in here, or is it
me?”
Menopause,
or the “change of life,”
is different for each woman.
For example, hot flashes and
sleep problems may trouble
your sister. Meanwhile, you
could have a new sense of
freedom and energy. Your
best friend might hardly be
aware of a change at all.
What
is Menopause?
Menopause
is a normal part of life,
just like puberty. It is the
time of your last period,
but symptoms can begin
several years before that.
And these symptoms can last
for months or years after.
Some time around 40, you
might notice that your
period is different—how
long it lasts, how much you
bleed, or how often it
happens may not be the same.
Or, without warning, you
might find yourself feeling
very warm during the day or
in the middle of the night.
Changing levels of estrogen
and progesterone, which are
two female hormones made in
your ovaries, might lead to
these symptoms.
This
time of change, called perimenopause
by many women and their
doctors, often begins
several years before your
last menstrual period. It
lasts for 1 year after your
last period, the point in
time known as menopause.
A full year without a period
is needed before you can say
you have been “through
menopause.” Postmenopause
follows menopause and lasts
the rest of your life.
Menopause
doesn’t usually happen
before you are 40, but it
can happen any time from
your 30s to your mid 50s or
later. The average age is
51. Smoking can lead to
early menopause. Some types
of surgery can bring on
menopause. For example,
removing your uterus
(hysterectomy) before
menopause will make your
periods stop, but your
ovaries will still make
hormones. That means you
could still have symptoms of
menopause like hot flashes
when your ovaries start to
make less estrogen. But,
when both ovaries are also
removed (oophorectomy),
menopause symptoms can start
right away, no matter what
your age is, because your
body has lost its main
supply of estrogen.
What
Are the Signs of Menopause?
Women
may have different signs or
symptoms at menopause.
That’s because estrogen is
used by many parts of your
body. So, changes in how
much estrogen you have can
cause assorted symptoms.
But, that doesn’t mean you
will have all, or even most,
of them. In fact, some of
the signs that happen around
the time of menopause may
really be a result of
growing older, not changes
in estrogen.
Changes
in your period.
This might be what you
notice first. Your period
may no longer be regular.
How much you bleed could
change. It could be lighter
than normal. Or, you could
have a heavier flow. Periods
may be shorter or last
longer. These are all normal
results of changes in your
reproductive system as you
grow older. But, just to
make sure there isn’t a
problem, see your doctor if:
- your
periods are coming very
close together,
- you
have heavy bleeding,
- you
have spotting,
- your
periods are lasting more
than a week.
Hot
flashes. These are
very common around the time
of menopause because they
are related to changing
estrogen levels. They may
last a few years after
menopause. A hot flash
is a sudden feeling of 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 hot
flashes last between 30
seconds and 10 minutes.
Problems
with the vagina and bladder.
Changing estrogen levels can
cause your genital area to
get drier and thinner. This
could make sexual
intercourse uncomfortable.
You could have more vaginal
or urinary infections. You
might find it hard to hold
urine long enough to get to
the bathroom. Sometimes your
urine might leak during
exercise, sneezing,
coughing, laughing, or
running.
Sex.
Around the time of menopause
you may find that your
feelings about sex have
changed. You could be less
interested. Or, you could
feel freer and sexier after
menopause. You can stop
worrying about becoming
pregnant after one full year
without a period. But,
remember you can’t ever
stop worrying about
sexually-transmitted
diseases (STDs), such as
HIV/AIDS or gonorrhea. If
you think you might be at
risk for an STD, make sure
your partner uses a condom
each time you have sex.
Sleep
problems. You might
start having trouble getting
a good night’s sleep.
Maybe you can’t fall
asleep easily, or you wake
too early. Night sweats
might wake you up. You might
have trouble falling back to
sleep if you wake during the
night.
Mood
changes. You might
find yourself more moody,
irritable, or depressed
around the time of
menopause. It’s not clear
why this happens—is there
is a connection between
changes in estrogen levels
and emotions or not? It’s
possible that stress, family
changes such as growing
children or aging parents,
or always feeling tired
could be causing these mood
changes.
Changes
in your body. You
might think your body is
changing. Your waist could
get larger. You could lose
muscle and gain fat. Your
skin could get thinner. You
might have memory problems,
and your joints and muscles
could feel stiff and achy.
Are these a result of having
less estrogen or just
related to growing older? We
don’t know.
What
About My Heart and Bones?
Two
common health problems can
start to happen at
menopause, and you might not
even notice.
Osteoporosis.
Day in and day out your body
is busy breaking down old
bone and replacing it with
new healthy bone. Estrogen
helps control bone loss. So
losing estrogen around the
time of menopause causes
women to begin to lose more
bone than is replaced. In
time, bones can become weak
and break easily. This
condition is called
osteoporosis. Talk to your
doctor to see if you should
have a bone density test to
find out if you are at risk
for this problem. Your
doctor can also suggest ways
to prevent or treat
osteoporosis.
Heart
disease. After
menopause, women are more
likely to have heart
disease. Changes in estrogen
levels may be part of the
cause. But, so is getting
older. As you age, you may
develop other problems, like
high blood pressure or
weight gain, that put you at
greater risk for heart
disease. Be sure to have
your blood pressure and
levels of triglycerides,
fasting blood glucose, and
LDL, HDL, and total
cholesterol checked
regularly. Talk to your
health care provider to find
out what you should do to
protect your heart.
How
Can I Stay Healthy After
Menopause?
Staying
healthy after menopause may
mean making some changes in
the way you live.
- Don’t
smoke. If you do use any
type of tobacco,
stop—it’s never too
late to benefit from
quitting smoking.
- Eat
a healthy diet—one low
in fat, high in fiber,
with plenty of fruits,
vegetables, and
whole-grain foods, as
well as all the
important vitamins and
minerals.
- Make
sure you get enough
calcium and vitamin
D—in your diet or in
vitamin/mineral
supplements.
- Learn
what your healthy weight
is, and try to stay
there.
- Do
weight-bearing exercise,
such as walking,
jogging, or dancing, at
least 3 days each week
for healthy bones. But
try to be physically
active in other ways for
your general health.
Other
things to remember:
- Take
medicine to lower your
blood pressure if your
doctor prescribes it for
you.
- Use
a water-based vaginal
lubricant (not
petroleum jelly) or a
vaginal estrogen cream
or tablet to help with
vaginal discomfort.
- Get
regular pelvic and
breast exams, Pap tests,
and mammograms. You
should also be checked
for colon and rectal
cancer and for skin
cancer. Contact your
doctor right away if you
notice a lump in your
breast or a mole that
has changed.
Are
you bothered by hot flashes?
Menopause is not a disease
that has to be treated. But
you might need help with
symptoms like hot flashes.
Here are some ideas that
have helped some women:
- Try
to keep track of when
hot flashes happen—a
diary can help. You
might be able to use
this information to find
out what triggers your
flashes and then avoid
it.
- When
a hot flash starts, go
somewhere cool.
- If
night sweats wake you,
try sleeping in a cool
room or with a fan on.
- Dress
in layers that you can
take off if you get too
warm.
- Use
sheets and clothing that
let your skin
“breathe.”
- Have
a cold drink (water or
juice) when a flash is
starting.
You
could also talk to your
doctor about whether there
are any medicines to manage
hot flashes. Gabapentin,
megestrol acetate, and
certain antidepressants seem
to be helpful to some women.
What
About Those Lost Hormones?
These
days you hear a lot about
whether you should use
hormones to help relieve
some menopause symptoms.
It’s hard to know what to
do.
During
perimenopause, some doctors
suggest birth control pills
to help with very heavy,
frequent, or unpredictable
menstrual periods. These
pills might also help with
symptoms like hot flashes,
as well as prevent
pregnancy.
As
you get closer to menopause,
you might be bothered more
by symptoms like hot
flashes, night sweats, or
vaginal dryness. Your doctor
might then suggest taking
estrogen (as well as
progesterone, if you still
have a uterus). This is
known as menopausal
hormone therapy (MHT).
Some people still call it
hormone replacement therapy
or HRT. Taking these
hormones will probably help
with menopause symptoms and
prevent the bone loss that
can happen at menopause.
However, there is a chance
your symptoms will come back
when you stop MHT.
Also,
menopausal hormone therapy
has risks. That is why the
U.S. Food and Drug
Administration suggests that
women who want to try MHT to
manage their hot flashes or
vaginal dryness use the
lowest dose that works for
the shortest time it’s
needed.
Right
now, there is a lot that is
unknown about taking
hormones around menopause.
Use the resource listing at
the end of this Age Page if
you would like to learn more
about menopause or if you
want the latest information
on menopausal hormone
therapy.
Do
Phytoestrogens Help?
Phytoestrogens
are estrogen-like substances
found in some cereals,
vegetables, legumes (beans),
and herbs. They might work
in the body like a weak form
of estrogen. They might
relieve some symptoms of
menopause, but they could
also carry risks like
estrogen. We don’t know.
Be sure to tell your doctor
if you decide to try eating
a lot more foods that
contain phytoestrogens or to
try using an herbal
supplement. Any food or
over-the-counter product
that you use for its
drug-like effects could
change how other prescribed
drugs work or cause an
overdose.
How
Do I Decide What to Do?
Talk
to your health care provider
for help deciding how to
best manage menopause. You
can see a gynecologist,
geriatrician, general
practitioner, or internist.
Talk about your symptoms and
whether they bother you.
Make sure the doctor knows
your medical history and
your family medical history.
This includes whether you
are at risk for heart
disease, osteoporosis, and
breast cancer. Remember that
your decision is never
final. You can—and
should—review it with your
doctor during a checkup.
Your needs may change, and
so might what we know about
menopause.
A
hundred years ago life
expectancy was a lot
shorter. Reaching menopause
then often meant that a
woman’s life was nearing
its end. Not so now. Women
are living much longer.
Today, a woman turning 50
can expect to live, on
average, almost 32 more
years. You have the time and
freedom to make them active,
busy years. Follow a healthy
life- style and plan to make
the most of those years
ahead of you!
For
More Information
Other
resources with information
on menopause include:
National
Institutes of Health
Menopausal Hormone Therapy
Information
www.nih.gov/PHTindex.htm
National
Library of Medicine
MedlinePlus
In Health Topics, go to:
“Menopause”
www.medlineplus.gov
American
College of Obstetricians and
Gynecologists
409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
1-202-638-5577
www.acog.org
North
American Menopause Society
P.O. Box 94527
Cleveland, OH 44101
1-440-442-7550
www.menopause.org
For
more information on health
and aging, including
osteoporosis and the latest
on menopausal hormone
therapy, contact:
National Institute
on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225
(TTY/toll-free)
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