Menopause is a natural process that all women will go through at some point in their life. It marks the end of natural fertility and although its symptoms can at times be tricky to navigate, it does not mark the end of your heath, vitality or wellbeing.
What is Menopause?
Menopause (infographic) can mean different things to different women but officially a woman is defined as being in menopause 12 months after her last menstrual period. The process leading up to menopause called peri-menopause is a time when many women can first start to experience the symptoms of menopause.
The average age of menopause in the United states is 51 [1] but there are cases of women starting menopause as early as their late 30’s or well into their late 50’s.
In simple terms menopause is really just a process where the body stops producing specific hormones. Throughout a womans adult life (up to the point of menopause) she will produce two key hormones known as Estrogen and Progesterone. Both of these hormones help regulate the menstrual cycle and play an important role in childbirth. Once a woman reaches her late 30’s the production of these hormones begins to slow down which is why fertility also begins to decline at this point.
The reduced production of Estrogen and Progesterone has the effect of causing irregular menstrual cycles. Around the age of 40 women may notice that their periods become longer or shorter, lighter or heavier, very infrequent or more frequent. This cycle continues up until the point where periods stop all together and menopause begins. The whole process takes longer than most people realize and peri-menopause can last for a few years.
Symptoms of Menopause
Women going through menopause may experience some or all of these symptoms in the months or years leading up to menopause (or just after it starts) [2]:
- Irregular periods
- Vaginal dryness and low sexual desire
- Hot flashes
- Night sweats
- Sleep problems
- Mood changes
- Weight gain and slowed metabolism
- Thinning hair and dry skin
Diagnosis
The diagnosis of menopause is usually a straightforward one for doctors to make. A history of your symptoms and a blood test is usually all that is required. In the majority of cases a blood test is only used if the diagnosis is unclear or if some doubt exists about whether a women is in true menopause or not.
Hormone Replacement Therapy (HRT)
Menopause is a natural process. It is not a medical condition that requires treatment or therapy but some of the symptoms of menopause like hot flashes, night sweats, difficulty sleeping, mood changes or vaginal dryness may become very uncomfortable or unpleasant to the point where they start to affect your daily activities or quality of life. In these cases doctors might recommend the use of creams or medications to help alleviate the symptoms.
Hormone therapy continues to be one of the most popular methods of treating the symptoms of menopause. As the name suggests hormone replacement therapy uses synthetic hormones (hormones that mimic naturally occurring estrogen) to replace the estrogen that the body is no longer making. Estrogen (usually given at a low dose) is used by itself or in combination with Progesterone to help relieve the symptoms of menopause.
Hormone replacement therapy is a catch-all phrase that is given to the process of delivering a specific amount of Estrogen to the bloodstream. Women can take HRT in many different formulations such as tablets, skin patches, gels, nasal spray or a vaginal ring. The choice usually depends on your lifestyle and personal preference.
Risks and Benefits of HRT
HRT is widely used for the treatment of menopause symptoms and can help improve night sweats, hot flushes and muscles aches and pains [6]. It can also help with vaginal dryness, sexual function, sleep and generally improve the quality of life of women that have prolonged and significant symptoms [6]. Research has also shown that HRT can also protect against Osteoporosis [3].
Although the benefits of HRT are significant, recent studies have shown that HRT can also increase the risk of breast cancer, blood clots and strokes [7]. It is important to keep in mind however that every womans own individual risks for developing complications are specific to her own medical history and that risks can vary greatly depending upon personal history and lifestyle. For this reason HRT is also usually prescribed at the lowest dose possible for the shortest period of time required to treat symptoms. Overall, most new research shows that the benefits of HRT usually outweigh the risks [5] but women should always discuss the pros and cons with their doctor.
Hormone replacement therapy can be used as an effective method for alleviating some of the more severe symptoms of menopause but it may not be suitable for all women particularly those with a medical history of blood clots, cancer, heart disease or strokes. For all other women, studies show that the benefits of HRT outweigh the risks but this should always be discussed with your doctor prior to use.
References
[1,2] Mayo Clinic. Menopause. January 2015
http://www.mayoclinic.org/diseases-conditions/menopause/basics/definition/con-20019726
[3] Medline Plus. Hormone replacement therapy. Page last updated July 2016.
https://medlineplus.gov/hormonereplacementtherapy.html
[5] Bassuk SS, Manson JE; Oral contraceptives and menopausal hormone therapy: relative and attributable risks of cardiovascular disease, cancer, and other health outcomes. Ann Epidemiol. 2015 Mar;25(3):193-200. doi: 10.1016/j.annepidem.2014.11.004. Epub 2014 Nov 13.
http://www.ncbi.nlm.nih.gov/pubmed/25534509?dopt=Abstract
[6] Patient.co.uk. Hormone Replacement Therapy (including Benefits and Risks). Last checked February 2016.
http://patient.info/doctor/hormone-replacement-therapy-including-benefits-and-risks
[7] Rossouw JE, Anderson GL, Prentice RL, et al; Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33.
http://www.ncbi.nlm.nih.gov/pubmed/12117397?dopt=Abstract
