Definition of Menopause

Description

Menopause, or climacterium, marks the completion of a woman's childbearing years and the cessation of menses (menstrual cycles), as the ovaries slow down and, eventually, stop functioning. Women typically reach this phase in their lives between ages 45 and 55. As a result of hormonal changes due to this process, women undergoing menopause may experience feelings of irritability, as well as "hot flashes" on the neck, chest, face and arms. There are other less obvious physiological indications that indicate that menopause has begun.


Causes

As a woman enters menopause, the number of eggs in the ovaries decrease, which lowers ovary function and leads to a dramatic reduction in estrogen secretion. At the same time, the pituitary gland increases the secretion of a follicle-stimulating hormone (FSH), which makes the eggs grow faster and the periods shorter. Sometimes ovulation does not occur.


Symptoms

In the years preceding menopause, the menstrual cycle is shortened by an increase in FSH, ovulation becomes irregular, and there is less estrogen in the blood. The decrease in estrogen causes various climacterium symptoms such as hot flashes, depression, dryness of the vagina, and a decline in sexual function.

Hot flashes
Hot flashes are the most common early symptom when blood levels of estrogen decrease. When less estrogen is secreted, the capillaries expand irregularly, causing hot sensations in the face, neck, and chest. It becomes hard to sleep because of night sweats caused by hot flashes. In severe cases, these symptoms occur 40 times a day. Approximately 67% of women experience these symptoms for a year, and 25% of women experience them for more than 5 years. Impatience, irritation, anxiety, and worry may also occur in conjunction with hot flashes.

Urinary system changes
The decrease in estrogen also affects skin and epithelial cells. With less estrogen being secreted, epithelial cells in the vagina and urinary system become thin and dry, losing elasticity. This causes the muscles in the perineum, urethra and bladder neck to weaken. As a result, many women find it hard to control urine, and lose a little when they cough, sneeze, laugh or exercise. Menopausal women may also have an urgent need to urinate even when the bladder is not full.

The uterus and vagina become atrophic with lack of estrogen during menopause, so sometimes there is a sagging or slacking sensation when lifting heavy objects.


If dryness of the vagina, or colpoxerosis, is severe, it can cause pain and small tears during intercourse. A drier, menopausal vagina is also more susceptible to yeast infections.

Emotional changes and sexual function
Many women in menopause complain about anxiety, depression, sensitivity, fatigue, forgetfulness, and insomnia. These symptoms are partially caused by decreases in estrogen, luteinizing hormone, and male hormone. A lack of female and male hormones decreases sexual desire (libido) and causes the painful intercourse (from dryness) that some women experience during menopause. These symptoms can be improved with hormone replacement therapy.

Skin changes
After menopause, skin loses elasticity and stretches, causing more wrinkles. Although the lack of estrogen is not the main cause, hormone treatment will help the skin maintain elasticity.

Breast changes
The lack of estrogen affects the breasts' size, quality, and supporting tissue. Breasts stretch, decrease in size, and become soft because there is less connective tissue.




Diagnosis

Menopause is diagnosed by history of an absence of menstrual periods for at least 6 months and by a hormone level (FSH > 35 IU/L).

Menstruation before menopause is nonovulational and signals the beginning of climacterium. One way of determining whether or not ovulation occurs is to measure basal body temperature. Normally the basal body temperature is low for the first half of the menstrual cycle and high during the latter half. When ovulation does not occur, there is no change in body temperature.

When menstruation becomes irregular, a woman may also be experiencing early symptoms of menopause. When ovulation stops, the secretion of progesterone stops and without progesterone, the little estrogen that is secreted facilitates growth of the endometrium (endometrial hyperplasia). This growth cannot be sustained, and as it breaks down little by little, irregular bleeding occurs. Eventually, menopause commences as ovary function comes to a halt and the secretion of estrogen stops.


Treatment

Menopause signals the beginning of potentially new health issues for women. Hormone replacement therapy can improve and prevent many menopause-related symptoms and problems, including osteoporosis, a degenerative bone disease. Bone density decreases at the rate of 1-2% per year after menopause. For some women, osteoporosis progresses more severely.

The reduction of estrogen after menopause can increase a woman's risk for high blood pressure, heart attacks, cerebral hemorrhages, and other cardiovascular diseases. After menopause, the level of low-density lipoprotein (LDL) or "bad cholesterol" increases and the level of high-density lipoprotein (HDL) or "good cholesterol" decreases. HDL removes cholesterol from the arteries, reducing the risk of vascular diseases. High LDL levels are related to the occurrence of arteriosclerosis. Hormone replacement therapy may prevent coronary artery disease in postmenopausal women.

Premature menopause is menopause that has occurred before age 35, and treatment is necessary to prevent side effects. If menstruation continues after age 55, a uterine myoma (a benign tumor) may be present and a woman should seek a medical examination.

If both ovaries have been surgically removed, then menopause is "surgically induced" and severe estrogen deficiency symptoms will occur. Hormone replacement therapy is needed in cases of surgically induced menopause.