Information About Menopause

Biology 103
2002 First Paper
On Serendip

Information About Menopause

Diana DiMuro

While many people may find the topic humorous, or even frightening, the subject of Menopause is one I had many questions about. My interest and curiosity in this subject stems from my first-hand experience with it: my mom. After much suspicion that she was going through "the change," my sisters and I recently discovered that she had stopped having her period for the last four years. Much to our surprise, we realized that many of our hunches (such as "Hot Flashes" and "Mood Swings") were correct; they were indeed some of the symptoms associated with the periods before and during menopause. I learned that she was taking progestin, a hormone supplement, as well as certain vitamins, to help against the symptoms associated with menopause. Suddenly her violent mood swings and recent irritability began to make more sense. My mom explained that for the first time in her life she had feelings of "blueness" or depression. Despite the realization that my mother was menopausal, I still did not understand what menopause actually is. What are some of its symptoms? Are they treatable? If so, how? Are there any dangers associated with menopause? If so, how can they be prevented or treated? Through my research I would like to take a closer look at these questions to gain a greater understanding of my mom's situation and help others who might also come across it with their own families and friends.

Many of the symptoms and effects of menopause are not actually a result of menopause but are associated with the period of change leading into menopause. The changes and effects are broken down into three stages: perimenopause, menopause, and post menopause:

Perimenopause:
Perimenopause is the period of gradual changes that lead into menopause. They often affect a woman's hormones, body, and feelings. They can actually stop and start again anywhere between a few months or a few years. This period is also known as the "climacteric" period. During this process, the ovaries' production of the hormone estrogen slows down. The hormone levels in a woman's body fluctuate, causing changes, which are often similar (although much more intense) to the changes associated with adolescence.

Menopause:
Menopause occurs when a woman has her last period. A woman's ovaries stop releasing eggs. This is usually a gradual process; however, it can happen all at once.

Post Menopause:
Post Menopause is simply the time after menopause. Women often have many health concerns, which result from menopause (2).

I would like to focus mostly on the period known as perimenopause because of its many symptoms, which often serve as metonymies for menopause on the whole. After looking at many of these symptoms I will take a more focused look at one of menopause's most well known symptoms and how it can be treated. I will also examine some of the other methods of treatment for menopause, as well as some of the dangers associated with menopause and its treatment.

Perimenopause can begin as early as age thirty, however, the average age is fifty-one. Some of the symptoms associated with perimenopause are as follows:
-Irregular menstrual periods
-Achy joints
- Hot flashes
-Temporary and minor decrease in ability to concentrate or recall information
- Changes or loss in sexual desire
- Extreme sweating
- Headaches
- Frequent urination
- Early wakening
- Vaginal dryness
- Mood changes or "swings"
- Insomnia
- Night sweats
- Symptoms/conditions commonly associated with pre-menstrual stress (PMS)

Perimenopause can be any one or a combination of the above symptoms. The symptoms are often very unpredictable and disturbing, especially if a woman does not know they are related to menopause (2). These symptoms usually last between two and three years, though in some cases they can last between ten and twelve years. It is highly important to note that women in perimenopause have reduced fertility but are not yet infertile. There is still a chance of pregnancy during perimenopause, even if a woman's menstruation is highly sporadic (1).

One of the symptoms most commonly associated with perimenopause are "hot flashes." Hot flashes are sudden or mild waves of upper body heat that can last anywhere from thirty seconds up to five minutes. They are caused by rapid changes in hormone levels in the blood (2). The part of the brain that controls body temperature is the hypothalamus. During perimenopause, the hypothalamus can often mistake a woman's body temperature as too warm. This starts a chain reaction to cool her body down. Blood vessels near the surface of the skin begin to dilate and blood rushes to the surface of the skin in an attempt to cool down the body's temperature. This often causes sweating, as well as producing a flushed red look to the woman's face and cheeks (1). Some women experience a rapid heartbeat, tingling in their fingers, or a cold chill after the hot flash. Seventy-five out of one hundred women have hot flashes. Half of them have at least one hot flash a day, while twenty have more than one a day. Most women experience hot flashes from three to five years before they taper off. Although some women may never have a hot flash, or only have them for a few months, others may experience them for years. There is no way to tell when they will stop. Many women suggest keeping a journal to record what triggers a hot flash so that an attempt to prevent the next one can be made (2). Some suggestions by the North American Menopause Society to help combat hot flashes include: trying to wear light layers of clothing, sleeping in a cool room, deep breathing and/or meditation, and regular exercise to fight stress and promote healthy sleep (1). However, prescription hormone treatment is the most common treatment for hot flashes. Replacement of estrogen that is lost during menopause is the most effective treatment against hot flashes. Hormone replacement therapy is also common treatment for many other symptoms of menopause (1).

Hormone Replacement Therapy (HRT) can come in the form of pills, patches, implants or vaginal creams, to restore estrogen and other hormones that decrease during perimenopause and menopause in a woman's body. While many women find HRT extremely helpful, there are still many side effects to its use. Some women experience pre-menstrual stress (PMS), others experience vaginal bleeding, bloating, nausea, hair loss, headaches, weight gain, itching, increased vaginal mucus, or even corneal changes which may affect a woman's ability to wear contact lenses. Some more serious side effects put women at higher risk for breast cancer and heart disease. Some women use progestin a hormone without estrogen, which is a better replacement therapy for women at risk of blood clots. Progestin is however, a less effective means of birth control.
Many women prefer to use non-hormone therapies to reduce the symptoms of perimenopause and menopause. Regular exercise is a strong recommendation to combat stress and help promote healthy sleeping patterns. A diet high in fruits and vegetables and low in saturated fats is also recommended. Many women try eating soy products to help combat hot flashes(3). Soy contains phytoestrogens, a plant chemical that produces similar effects to estrogen. Others suggest reducing caffeine, alcohol, spicy foods, and even hot beverages(2). Herbal remedies and homeopathy are also quite common solutions to women against using hormones to treat menopause. There are many over-the-counter vaginal creams as well. Menopause Online suggests in increase in the amounts of vitamins E and B6. Research on Vitamin E shows that it can help prevent heart attacks, Alzheimer's disease, and cancer. Vitamin B6 is involved in the production of brain hormones (neurotransmitters). It is often low in people with depression or those taking estrogen in the form of birth control or hormone replacement therapy. Lack of B6, and folic acid has been associated with osteoporosis. An increase in B6 has been shown to help fight heart disease and reduce the symptoms of PMS (3).

Breast Cancer and Heart Disease:
The risk of developing breast cancer increases with age. By the time a woman turns 60, one out of twenty-eight women develop breast cancer. Studies have shown that hormone treatment for ten-fifteen years may slightly increase a woman's chances of developing breast cancer.
Before the age of fifty, women are three times less likely to have a stroke or heart attack then men. Ten years after menopause, women are at the same kind of risk as men. Whether this directly correlates to hormone replacement therapy is not clear (2).

Osteoporosis:
Loss of estrogen can lead to osteoporosis or loss of bone mass. Women may lose between two to five percent of their bone mass per year for up to five years after menopause. Bones can become brittle, more susceptible to breaking. Bone loss begins at age thirty that is why it is important for women to build bone mass early with weight bearing exercise like walking, running, or weight lifting. It is also important to take a calcium supplement to help aid in developing bone mass. At least 1,000 mg of calcium are recommended per woman per day, and 1,200 mg are recommended after menopause. Estrogen replacement therapy can also help in developing and retaining bone mass. There are currently newer non-hormonal medications that are effective as well (2).

What then is the best way to treat the symptoms of menopause? I am not sure whether there is enough conclusive evidence to determine how harmful the use of hormone replacement therapy is. It is currently found to be an effective treatment with varying degrees of side effects. Loss of hormones like estrogen can result in loss of bone mass, as well as leaving a woman's body more susceptible to diseases like breast cancer and heart disease. How much of an affect does hormone replacement therapy have on these diseases and how helpful or harmful is it? This is something I would like to conduct further research on before I give a "better" hypothesis. Before concluding, I'd like to take a closer look at one more aspect of menopause that is often overlooked or misjudged: psychological changes.

Psychological Changes:
Although there is no scientific study to support that menopause contributes to true clinical depression, many women do suffer from "feeling blue" or being discouraged. During perimenopause, a woman's hormonal rhythm changes. These hormonal changes contribute often to mood swings. For many women, the hormone changes of menopause coincide with other stresses during midlife. In addition, many women experience changes in their self-esteem and body image. Many women can react to menopause by feeling overwhelmed, angry, out of control, or even numb. It takes someone in the medical profession to determine whether a woman is clinically depressed or just feeling the effects of menopause. Often women can combat their feelings of sadness with herbal remedies like Saint John's Wort, or by changes in their lifestyle to reduce stress. Often times, irritability is closely linked to disturbances in a woman's sleeping pattern, which can be treated by treating hot flashes among other things. Stress-reducing techniques like meditation and deep-breathing are effective for some, while regular exercise and a healthy diet, getting enough sleep, and pampering yourself are all positive ways to help combat stress and sadness. Many women recommend talking to friends and family about menopause. Some even take this a step further and form self-help groups where women can speak to each other about their common experiences with menopause. Often realizing there is another woman out there who understands what you are going through is beneficial to feeling less depressed and overwhelmed by menopause (1).

I think menopause, like depression is something which has a lot of pre-conceived notions by the public and is not necessarily well understood. I think it deserves more research and acknowledgement as a legitimate and substantial occurrence in a woman's life that deserves more respect and understanding, as well as more open acknowledgement. It should not be something which needs to be hid or made the butt of a joke. There is still much research to be done concerning menopause and its treatment. I think once women feel they can openly address menopause they will feel less stress and anxiety towards it.