Menopause

The process is usually signaled by changes in the menstrual cycle: decreased bleeding, skipped periods, unusually heavy flow over a shorter than usual period, etc. The transition to menopause may take no more than six months or it may extend over two years. Since ovulation may still occur, even sporadically, contraception should be practiced until menstruation has stopped completely for four to six months, unless your doctor has determined there is no danger of an unwanted pregnancy.

Hormonal Changes

During the years of fertility, either of the ovaries may produce an egg each month (ovulation) and supply the hormones--especially estrogen but also progesterone--to prepare for the development of the fertilized egg. As menopause approaches, these functions gradually taper off until egg production stops altogether and hormone production is insignificant.

The resulting changes in hormonal balance cause the characteristic symptoms of menopause--hot flushes and night sweats, which are experienced by up to 85 percent of all women. Although the mechanism of these symptoms is not fully understood, they appear to result from a vasomotor (the body's temperature regulation system) instability related to changing hormonal levels. The hallmark is a sudden suffusion of heat affecting the face and upper part of the body. There may be a red blotching of the skin and excessive perspiration, followed by a chill. Their frequency and intensity varies considerably among women, ranging from the barely noticeable to the almost intolerable. Happily, the body almost always adjusts to the decreased levels of female hormones and the flushes lessen and disappear.

The hot flushes usually occur without warning and may be over in a flash or they may last for as long as a minute. Although many women experience discomfort from these flushes and are embarrassed because they fear they are obvious to those around them, the latter usually is not the case. Night sweats, another term for hot flushes that occur during sleep, are sometimes severe enough to disrupt sleep and, consequently, may give rise to the increased irritability, fatigue or feelings of depression often associated with menopause. It should be emphasized that mood changes are not menopausal symptoms per se, but instead may be consequences of concurrent factors in the woman's life, such as feeling unneeded as children move out on their own or as career and other roles change.

Vaginal dryness is another symptom directly related to the hormonal changes of menopause. This condition, which may lead to itching, infection and discomfort during sexual intercourse, is relieved by the use of lubricating cream. Since many women experience a strong resurgence of sexual desire at menopause, problems in this area should be frankly discussed with your doctor so that they can be resolved promptly.

Hormone Replacement

Hormone replacement therapy to make up for the body's diminished estrogen production will relieve the severity and frequency of hot flushes and the vaginal dryness. At one time, long-term estrogen replacement was widely recommended for all women. In recent years, however, there has been a shift in attitudes as more became known about possible risks of long-term estrogen therapy. Studies have linked estrogen replacement with an increased risk of gallbladder disease and cancer of the endometrium (the lining of the uterus). In the menstruating woman, fluctuating levels of estrogen and progesterone stimulate the endometrium to grow in readiness for a fertilized egg. If conception does not take place, the hormone levels drop and the lining is shed in the form of a menstrual period. During uninterrupted estrogen therapy, the endometrial tissue proliferates, but it is not shed. Some researchers feel this unopposed estrogen stimulation is a factor in the increased occurrence of endometrial cancer seen in women on long-term estrogen replacement. These risks can be minimized, many experts feel, by using the smallest possible dose of estrogen that effectively minimizes symptoms for as short a time as needed. Periodic endometrial biopsies also may be advised. Of course, the worry is moot for women who have undergone surgical removal of the uterus (hysterectomy), since they no longer have any risk of endometrial cancer.

In addition, a new approach has been developed that involves giving low doses of estrogen that are interrupted every month or two with a few days of pregesterone. This, in effect, mimics the natural menstrual cycle and prevents the buildup of endometrial tissue. Women on this regimen will bleed as during a menstrual period, even though the ovaries have ceased to function.

In any event, your doctor is the best judge of whether estrogen replacement is indicated for you. There are some women, such as those who have an estrogen-sensitive breast cancer, in whom estrogens are contraindicated. There are others for whom they may be recommended not only to relieve menopausal symptoms but also to help prevent the loss of bone tissue (osteoporosis) that is common among older women. Estrogen is not indicated for depression or other mood problems or insomnia, despite popular reports to this effect.

What's Ahead?

Although many women regard menopause as "the beginning of the end," it should be noted that the average American woman lives a third of her life after menopause. While menopause may involve particular discomforts, these can be minimized until eliminated by time. Self-fulfillment and attractiveness are by no means limited to the young. Honest introspection about the pleasures and comforts of the later years, heart-to-heart talks with emotionally supportive family members or a respected friend, reaching out for new experiences, work in the community or a career and commonsense counseling by your doctor are but a few of the avenues open to the woman experiencing menopause.