Menopause and Its Symptoms
By Roland Larrabee, MD
Menopause is the time in a woman's life when menstruation stops permanently. Menopause is usually a gradual process, but it can occur suddenly in some cases.
The ovaries begin to produce less estrogen hormone. The reduced amount of hormone causes menstrual periods to become irregular. Eventually they stop completely. Menopause can also suddenly occur when the ovaries are surgically removed, e.g., as might occur with a hysterectomy.
Most women go through menopause between ages 45 and 55. In the US, the average age for menstrual periods to stop completely is 51.
Hormonal changes can cause physical and psychological symptoms before and during menopause. Symptoms may occur for a few weeks, a few months, several years, or not at all. The symptoms may come and go, or they may occur regularly.
These physical signs and symptoms are common during menopause:
- irregular or no menstrual periods
- hot flashes
- night sweats
- changes in your sleep patterns
- dizziness, headaches
- muscle and joint pain
- dry skin
- palpitations (awareness of a fast or irregular heartbeat)
- tiredness
- vaginal dryness, sometimes causing discomfort or pain during sex
- grayish vaginal discharge with a bad odor
- more frequent need to urinate, or leakage of urine
- more frequent minor vaginal and urinary infections
- loss of desire to have sex.
Menopause usually occurs at a time in your life when other dramatic changes take place. Some of these changes may include loss of parents, adjustment to children growing up and leaving home, becoming a grandparent, retirement, or career changes. These changes, in addition to the changes in your body, may result in psychological or emotional stress. Psychological symptoms of menopause may include: anxiety, depression, tearfulness and irritability, sleeplessness, less desire for sex, lack of concentration and more trouble remembering things.
Menopause is a natural part of a woman's life. It is not a disease and does not necessarily require any treatment. However, some health problems, such as osteoporosis, are associated with low estrogen. To treat menopause symptoms and help prevent osteoporosis (a thinning and weakening of bones), your health care provider may recommend lifestyle changes and possibly also drug treatment.
Treatment of menopause symptoms should start with a healthy lifestyle. This would include not smoking, regular exercise, weight loss, a balanced healthy diet and a program to reduce stress (if exercise is not enough). Be sure to take 1200 to 1500 mg of calcium along with 400 to 800 U of vitamin D.
The treatment of choice to relieve symptoms is hormone replacement therapy (HRT). Unfortunately, this strategy has been associated with undesirable consequences, such as cardiovascular disease. Your physician can help with determining if you are a candidate for HRT.
Many other medications have been used to help relieve menopausal symptoms, despite not being FDA approved for that purpose. These include Effexor, Proxac, Paxil, Clonidine, and gabapentin. Belladonna products have not been found to be helpful.
There are many over-the-counter “natural” products that have been touted to be beneficial. The evidence best supports the use of black cohosh. Soy products, vitamins (B, C and E), evening primrose oil, ginseng, wild yam extract, mai quan and flaxseed have not been found to be consistently helpful.
Dr. Larrabee is Associate Director of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.
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