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The transition period in a woman's life when the ovaries stop producing eggs, menstrual activity decreases and eventually ceases, and the body decreases the production of the female hormones, estrogen and progesterone, is known as menopause. Known as the "change of life," menopause is the last stage of a gradual biological process. It begins about 3 to 5 years before the final menstrual period, and is also known as climacteric, or perimenopause. It is considered complete when a woman has been without periods for 1 year. On average, this occurs at about age 50, but like the beginning of menstruation in adolescence, timing varies from person to person. Surgical menopause occurs if the ovaries are removed or damaged - as in a radical hysterectomy or chemotherapy. In this case, menopause begins immediately, with no perimenopause. Temporary "stress menopause" occurs when women in their late 30s or older have no periods for long stretches of time. It can be caused by stress, chemotherapy, grief, illness, bulimia, anemia, or excessive exercise. With an average life span of 80 years, most women must live with the effects of menopause for a third of their lives.
Symptoms
Low estrogen levels are linked to some uncomfortable symptoms in many women with about 75% of women complaining of these symptoms during menopause. However, the severity and frequency of symptoms varies from woman to woman. Following is a list of symptoms experienced during menopause:
- Achy joints
- Difficulty in concentrating
- Headaches
- Hot flashes
- Insomnia
- Early wakening
- Mood changes
- Night sweats
- Conditions commonly associated with PMS
- Changes in sexual desire
- Extreme sweating
- Frequent urination
- Vaginal dryness
(Hot flashes, mood swing, and vaginal dryness are the most noticeable symptoms).
Hot flashes
Hot flashes are sudden explosions or mild waves of upper body heat that last from 30 seconds to five minutes. Hot flashes appear to be a direct result of decreasing estrogen levels. In response to falling estrogen levels, your glands release higher amounts of other hormones that affect the brain's thermostat, causing body temperatures to fluctuate. They often start with a tingling sensation in the fingers. The tingling is followed by fast rises in skin temperature from the chest to the face and rapid heart palpitations. Profuse sweating and then cold shivering often follow this, as body temperature readjusts.
Women who have hot flashes generally weigh less than women who do not have hot flashes. Women who have had a hysterectomy are more likely to have hot flashes.
Seventy-five percent of women have hot flashes during perimenopause. Fifty percent of women have one each day. Twenty percent have more than one a day. Ten percent have them up to five years after menopause. They are very uncommon after that.
Following events can sometimes trigger a hot flash:
- Confining spaces
- Hot, humid weather
- Caffeine
- Alcohol
- Hot drinks
- Spicy foods
- Stressful or frightening events
However, avoiding these triggers will not necessarily prevent all episodes.
The symptoms of hot flashes can be adjusted by the following:
- Dress in layers so you can remove them at the first sign of a flash.
- Drink a glass of cold water or juice at the onset of a flash.
- At night keep a thermos of ice water or an ice pack by your bed.
- Use cotton sheets, lingerie and clothing to let your skin "breathe".
- Try regular exercise, biofeedback, cold showers, decreased stress, and cooler rooms.
- Reduce intake of tea, alcohol, hot beverages, and spicy foods.
- Wear thin layers of all-cotton clothes that can be removed.
- Keep a hot-flash diary to learn what triggers them.
Mood swings
The brain also responds to estrogen. In fact, estrogen is now thought to be important in memory and the healthy functioning of nerve cells in the brain. Depression may also be more likely in the years right before menopause.
Many women also notice changes in their skin, digestive tract, and hair during menopause. In the long term, some women experience problems linked to the low levels of estrogen found after menopause including osteoporosis and increased risk for heart disease.
Vaginal dryness
Vaginal or urinary tract infections, urinary incontinence (leakage of urine or inability to control urine flow), and inflammation of the vagina are experienced due to a reduction in estrogen levels. Estrogen plays a key role in maintaining the function of a woman’s vagina and surrounding tissues, uterus, urinary bladder, and urethra (the organ through which urine is passed from the bladder) that might atrophy due to the lower estrogen levels. Because of the changes in the urinary tract and vagina, some women may have discomfort or pain during sexual intercourse as a result of a thinning of the tissue lining the vagina. Vaginal dryness can also occur, as would itching or irritation. Although few women experience serious problems with vaginal dryness and thinning right after menopause, both dryness and thinning continue to occur over time. Some doctors estimate that at least half of all women older than 60 years have some degree of vaginal dryness. Regular sexual intercourse can help to keep the vagina moist and toned.
Prevention
Menopause is a natural and expected part of a woman's development and does not need to be prevented.
Causes
During the reproductive years, the pituitary gland in the brain generates hormones that cause a new egg to be released from its follicle each month. The follicle also increases production of the sex hormones estrogen and progesterone, which thicken the lining of the uterus. This enriched lining is prepared to receive and nourish a fertilized egg following conception. If fertilization does not occur, estrogen and progesterone levels drop, the lining of the uterus breaks down, and menstruation occurs. For unknown reasons, the ovaries begin to decline in estrogen and progesterone production during the mid-thirties. In the late forties, the process accelerates and hormones fluctuate more, causing irregular menstrual cycles and unpredictable episodes of heavy bleeding. By the early to mid-fifties, periods finally end altogether. However, estrogen production does not completely stop. None estrogenic material produced by the adrenal glands is converted to estrogen, and once in a while this will cause post-menopausal bleeding. This is usually nothing to worry about, but since postmenopausal bleeding may be an early indication of other problems (including cancer) it should always be checked by a physician. This form of estrogen is weaker than that produced by the ovaries and increases with age and with the amount of fat tissue At menopause, hormone levels do not always decline uniformly. They alternately rise and fall again. Changing ovarian hormone levels affect the other glands in the body, which together make up the endocrine system. The endocrine system controls growth, metabolism and reproduction. This system must constantly readjust itself to work effectively. Ovarian hormones also affect all other tissues, including the breasts, vagina, bones, blood vessels, gastrointestinal tract, urinary tract, and skin.
Diagnosis
For a woman in her late 40s or early 50s, the diagnosis of menopause is pretty easy. Her periods stop, and she has hot flashes. However it can be difficult in young women, women with unusual symptoms, or women who have had a hysterectomy. Since thermal abnormalities that could be construed as hot flashes, are symptoms of some diseases (thyroid problems and some cancers), the presence or absence of these conditions should be sought. There is a simple blood test, which measures circulating follicle-stimulating hormone (FSH) levels. As the ovaries lose the ability to produce estrogen, the pituitary gland increases production of other hormones (called "gonadotropin") to stimulate the ovary to do better. One stimulating hormone is FSH. It is generally accepted that a woman has reached menopause when her FSH blood level rises above 30 to 40 MIU/ml (depending on the testing laboratory). Estrogen is also sometimes measured, but obtaining a reliable diagnosis of menopause may be difficult by measuring estrogen alone.
Dietary Guidelines
- A diet high in raw food and low in red meat and sugar is good.
- Include the following foods in your diet. Whole grain, sesame seeds, sunflower seeds, almond, fresh vegetable and fruits, garlic, beans and whole grain pastas.
- Add soybean-based foods, like tofu, which have estrogenic properties to the diet.
- Eating light meals is preferable to heavy meals as it discourages hot flashes.
- Avoid rich dairy products, sugar, fatty greasy foods, red meats, coffee, tea, and nicotine.
- Avoid alcohol and caffeine as they can aggravate nicotine.
Home Care Suggestions
- Relaxing techniques such as yoga or breathing exercises can help combat anxiety or nervousness.
- Drink plenty of water and wear light cotton clothes fabrics at night as a remedy for hot flashes.
- Occasionally wipe off your face with premoistened towelettes.
- Always carry a packet with you.
- Do not smoke. Smoking when combined with hormone replacement therapy can increase the risk of stroke, high blood pressure and heart disease.
- Regular aerobic exercises are very helpful in combating both the physical and psychological symptoms of menopause. Regular exercises can increase the secretion of certain brain chemicals, which can elevate moods and counteract depression.
- Discussing your menopause with an understanding partner can also be very helpful. Knowing that certain symptoms are perfectly normal and temporary can be extremely valuable.
- Regular sexual intercourse seems to discourage both vaginal dryness and hot flashes.
Menopause is not a tragic end to your youth and sexuality but a natural transaction. Try viewing it that way.
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