Definition

Menopause is the time in a womans life when her menstrual period stops. It is also called the the change of life. Menopause is a natural biological process that affects each woman differently. It involves a series of changes that happen in a womans body as early as the age of 40 and can last well into her fifties. Perimenopause is the time when women begin to feel the changes of menopause, and may last for several years. Women are post-menopause when they have not had a period for 12 months.

What causes menopause?

During menopause a womans ovaries make less of the hormones estrogen and progesterone (natural chemicals found in the body), causing other changes. Women in their late 30s may begin to experience irregular menstrual cycles, unpredictable or heavy bleeding. The remaining eggs in her body are less likely to be fertilized by a sperm, the ovaries release fewer eggs and she is less likely to become pregnant. Around the age of 50 to 55 she stops getting her period.

Pathophysiology of Ovulation
FSH (Follicle Stimulating Hormone) tells the ovary to recruit eggs Estrogen is made by the developing eggs

LH (Luteinizing hormone) peaks at midcycle (with estrogen and FSH) resulting in ovulation Post-ovulation, the corpus luteum makes progesterone until lack of pregnancy results in lowered progesterone and menses

Pathophysiology of Menopause
Fewer and fewer follicles are recruited until no follicles develop at all FSH and LH levels become persistantly Elevated

Estrodiol levels stabilize at 10-20 pg/ml

Testosterone levels stable, but ovarian production increases - androstenedione decreases by half so have relative androgen deficiency

Premature (early) menopause

Premature menopause is menopause that happens before the age of 40. For some women, menopause occurs early due to family history (genes), medical treatments like surgery to remove the ovaries, total hysterectomy (removal of the uterus and the ovaries), some cancer treatments, like chemotherapy or radiation, or other hormonal reasons.

Symptoms of menopause
Every woman experiences menopause in a different way at different times. Some women have very few symptoms, however most women experience some of these physical and emotional changes:

Hot Flashes
Also called hot flushes

or vasomotor events Sudden onset of feeling of intense heat with reddening of face/chest/head skin followed by profuse perspiration Lasts a few seconds - several minutes Frequency is variable - from one per week to several per hour - changes as woman goes through menopause Cause sleep disturbances - may be the etiology of emotional liability in menopause Triggered by stress Embarrassing - happens when women at peak of careers, causes feeling of loss of control

Irregular Cycles
90%

of women have irregular cycles prior to cessation of menses Cycle length shortens, as short as 21 days, followed by skipped periods Occasionally see longer cycle length Flow may be lighter or heavier When to Worry If bleeding closer than every 21 days If bleeding lasts longer than 10 days If bleeding heavy enough to soak a maxipad in 1 hour or less for several hours in a row If any of the above, the patient needs further evaluation

What to do:
EMB (endometrial biopsy)

D&C (rare now) Ultrasound evaluation of uterus with possible saline infused sonohysterogram (SIS) Hormonal treatments such as progesterone, GnRH agonists Surgical treatments such as endometrial ablation or hysterectomy

Vaginal Dryness
Woman often describes dryness or irritation Due to atrophy of mucosal surfaces Causes vaginitis, pruritus, dyspareunia, stenosis of vaginal opening and incontinence Symptoms vary with sexual activity, size of vaginal opening prior to menopause, patient tolerance. Many patients with atrophic appearing vaginas are asymptomatic

Vaginal Dryness - Treatment

Lubrication - KY jelly, Vaginal moisturizers (Replens) Estrogen replacement - topical or oral Encourage maintenance of sexual activity - can improve blood flow to area and maintain vaginal caliber, reducing symptoms

Is there a treatment for menopause?

Menopause is not a disease or disorder and usually does not require medical treatment. For some women, the symptoms of menopause will go away over time without treatment. Other women may seek treatment for relief from the symptoms of menopause. Medications used to treat these are called Hormone Replacement Therapy (HRT), and there are other non-hormonal treatments as well. These medications can be effective in treating hot flashes, bone loss (osteoporosis), insomnia and vaginal dryness. However, some women cannot take these medications if they have certain other medical conditions. Others also choose to deal with menopause symptoms with herbal treatments, diet changes and alternative medicines. Before making any decisions about medical treatment women are advised to consult with their doctor and weigh the positives and negatives of each. She should tell her doctor about ALL herbal treatments, vitamins and medicines that she is taking.

Can a woman become pregnant if she is having symptoms of menopause?

Yes, it is possible to become pregnant if the woman has had a period within the past year, even if it is irregular. It is recommended that women continue using a form of birth control to avoid becoming pregnant until at least one year has passed without having a period.