Q & A about Menopause

Menopause is the permanent cessation of menstruation. It can occur as early as age 40 or as late as early 60s and usually spans 1-2 years. It is normally diagnosed in females after 1 year of absent menstrual periods. Menopause occurring before age 40 is termed premature and may need medical evaluation for the cause. Menopause does not occur suddenly. Perimenopause usually begins a few years before the last menstrual cycle.

Physical changes that occur during menopause are menstrual cycle irregularities; hot flashes or flushes, which are sensations of heat spreading from the waist or chest toward the neck, face, and upper arms; headaches; dizziness; rapid or irregular heartbeat; vaginal itching; burning or discomfort during intercourse, which occurs a few years after menopause; bloating in the upper abdomen; bladder irritability; mood changes; sleeping difficulty; and depression or fatigue.

These symptoms are caused by a normal decline in ovarian function, resulting in decreased levels of the female hormones, estrogen and progesterone. Other causes could also be due to surgical removal of both ovaries and medical treatment of endometriosis or cancer. Menopause is a natural part of the aging process for women. Smoking and hysterectomy are risks for premature menopause. This process cannot be avoided, but its effects may be controlled or moderated. It is not an illness, and most women make an easy transition without crisis.

There are some complications that occur during menopause. Urinary incontinence can worsen after menopause. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing, or lifting (stress incontinence). You may have urinary tract infections more often. Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help relieve symptoms of incontinence.

Other symptoms such as vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also decreased sensation may reduce your desire for sexual activity (libido). Water-based vaginal moisturizers and lubricants may help.

Many women gain weight during the menopausal transition and after menopause because their metabolism slows. You may need to eat less and exercise more, just to maintain your current weight. As the estrogen levels decline, the risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. So it’s important to get regular exercise, eat a healthy diet, and maintain a normal weight. Ask your doctor for advice on how to protect your heart, such as how to reduce your cholesterol or blood pressure if it’s too high.                           

Osteoporosis is also a condition that increases with menopause. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips, and wrists.

For treating menopausal symptoms, there are both medical and non-medical remedies. For the medical therapy, one can use hormone replacement therapy (HRT) or estrogen replacement therapy (ERT). These options both have benefits and risks associated with them. These medications come in pill form, patch form, and vaginal ring form and are considered on a patient-by-patient basis. Herbal preparations that are over-the-counter may also help with milder symptoms of menopause as well as increasing your soy intake. There are also medications that help prevent and/or treat bone loss. Non-medical remedies include quitting smoking. Women who smoke start menopause about two years earlier than nonsmokers. Also smoking is linked to a decline in estrogen.         

Reducing stress in your life as much as possible can help reduce menopausal symptoms. Acupuncture and relaxation techniques are all harmless ways to reduce the stress. Active exercising and weight-bearing activities are helpful to improve bone strength. Eating a well balanced diet and increasing your calcium intake will help with menopausal symptoms, as well as bone strength. Women who think that they may be in menopause and are suffering from any of these above-mentioned symptoms should see their doctor for treatment options. Women who are not suffering from any of these symptoms should also see their doctor to discuss ways of preventing complications and maintaining a healthy body.

Melissa Waddell, WHNP. is a nurse practitioner at Atlantic Ob/Gyn located in Va. Beach and Chesapeake. Please call 757-463-1234 or visit www.atlanticobgyn.com.

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