MOHD. RAZZI BIN ISMAIL

2002174647

INTRODUCTION OF MENOPAUSE

The term “menopause” comes from two Greek words that mean “month” and “to end.” It translates as “the end of the monthlies.”  The medical definition of menopause is the absence of menstruation for 12 months. In American women, the average age for menopause is 51. However, it can occur between a woman’s late thirties and her late 50s. Menopause also occurs when a woman’s uterus and ovaries are surgically removed. Menopause is an important time in a woman's life. Her body is going through changes that can affect her social life, her feelings about herself, and her functioning at work. Menopause is the medical term for the end of a woman's menstrual periods. It is a natural part of aging, and occurs when the ovaries stop making hormones called estrogens. This causes estrogen levels to drop, and leads to the end of monthly menstrual periods. This usually happens between the ages of 45 and 60, but it can happen earlier. Menopause can also occur when the ovaries are surgically removed or stop functioning for any other reason.

UNDERSTANDING ESTROGEN & PROGESTERONE

Estrogen is known as a 'female hormone' because it plays a key role in shaping the female body and preparing it for uniquely female functions such as pregnancy. Prior to menopause, more than 90% of the estrogen in a woman's body is made by the ovaries. Other organs (including the adrenal glands, liver, and kidneys) also make small amounts of estrogen. That's why women continue to have low levels of estrogen after menopause. Because fat cells can also make small amounts of estrogen, women who are overweight when they are going through menopause may have fewer problems with hot flashes and osteoporosis (both of which are related to lack of estrogen). Estrogen stimulates skeletal growth and helps maintain healthy bones. It also helps protect the heart and veins by increasing 'good cholesterol' (HDL or high-density lipoprotein) and lowering 'bad cholesterol' (LDL or low-density lipoprotein). Estrogen may also affect a woman’s sexual desire.

Progesterone is the second most important female hormone. Like estrogen, most progesterone is made by the ovaries, with a smaller amount made by the adrenal glands. The job of progesterone is to stimulate the growth of a cushiony lining in the uterus where the fertilized egg can grow and develop into a baby, help the breast make milk and generally maintain pregnancy.

SYMPTOMS OF MENOPAUSE

Irregular bleeding

The period of time leading up to menopause is often characterized by irregular periods. In fact, changes such as shorter or longer periods, heavier or lighter menstrual bleeding, and varying lengths of time between periods may be a sign that menopause is near. You should talk to a physician if:

• Bleeding occurs more often than 21 days
• Your period lasts longer than 8 days or is very heavy
• Your period occurs after 6 months or more without a period

Hot flashes

Hot flashes are the classic sign of menopause, as well as the most common reason for seeking treatment. A hot flash produces a sudden sensation of warmth or even intense heat that spreads over various parts of the body, especially the chest, face, and head. Flushing and sweating usually occur as well, followed by a chill. Some women feel their heart beating very fast or hard and feel anxious. Women who have had a hysterectomy are more likely to have hot flashes. Many women experience most of their hot flashes in the first 2 years after menopause, and find that the hot flashes gradually lessen. However, some women have hot flashes for several years before menopause, and some have them for 10, 20, or even 40 years or longer after menopause. Hot flashes can affect a woman's social life and work.

Vaginal thinning

After menopause, all of these organs may weaken or shrink. When these changes occur in the bladder and urethra, they can lead to the involuntary leakage of urine, infection, or painful urination. A thinning of the tissue lining the vagina may lead to pain during intercourse. Vaginal dryness can also occur, as may itching or irritation. Although few women experience serious problems with vaginal dryness and thinning right after menopause, both dryness and thinning continue to occur over time. Some doctors estimate that at least half of all women older than 60 years have some degree of vaginal dryness. Regular sexual intercourse can help to keep the vagina moist and toned.

DEALING ACTIVELY WITH MIDLIFE CHANGES

There are many choices in dealing with symptoms associated with approaching menopause. These include healthy lifestyle changes, hormone replacement therapy, other medications, social support and therapy. 

Healthy lifestyle changes

Regular exercise may decrease depression and irritability. Good muscle tone can also improve energy level and decrease aches and pains. Some forms of exercise may help decrease bone loss. Yoga or Tai Chi decrease stress and may reverse the decreased flexibility often associated with aging. Regular Tai Chi has been shown to decrease the incidence of hip fractures in older individuals. A diet high in complex carbohydrates, including multiple small meals may reduce irritability and improve one’s feeling of well-being.  

Social support

Many women experience menopause as a time of increased freedom and new possibilities. As their own children grow up, they may have more time and flexibility. However, some women experience the empty nest as the loss of their central role in life. Loss of a spouse through death or divorce can increase isolation. The physical changes associated with hormonal fluctuations can be confusing. Menopause may cause some women to start to think about the finite nature of life. Supportive friends and family can help a woman understand and cope with life changes. Reading about menopause or talking to one’s doctor can help make the changes less mystifying. A return to spirituality can spur growth at this phase of life.  

Hormone replacement therapy

Taking estrogen and progesterone can help some of the symptoms associated with approaching menopause. The decision to take hormones is an individual one. A woman considering HRT needs to consider the severity of her symptoms, her health history and her family history. She may also have personal preferences about taking medications. Estrogen is the hormone that seems to relieve many of the symptoms of approaching menopause. If a woman has already had her uterus removed, she may take estrogen by itself.  However, if a woman with an intact uterus takes estrogen without progesterone, the lining of the uterus may build up, and the woman may be at increased risk of uterine cancer. Thus HRT often requires a combination of estrogen and progesterone. The doses of estrogen and progesterone used for HRT are generally lower than the doses used for birth control pills. Often, women only need HRT for a limited number of years after menopause. There can be benefits and drawbacks to the use of HRT. Estrogen can relieve hot flashes, vaginal dryness, urinary problems, and sometimes insomnia. It can also promote a feeling of well-being. Some women feel that it improves memory and concentration. HRT can reduce the chance of osteoporosis. Estrogen may help prevent heart disease, but recent data has suggested that this effect may not be as dramatic as previously thought. For some women there may be drawbacks to HRT. Some studies have suggested a link between HRT and an increased incidence of breast cancer. Estrogen may elevate blood sugar, cause headaches, weight gain, or other side effects.

Psychological support

The death of loss of a spouse, heath changes and other stresses may cause stress. Depression and mood swings are more common during perimenopause than after menopause is well established. However, a woman with a history of anxiety or major depression may have a reoccurrence during either of these periods.  Counseling may help some women deal with losses. Counseling may also help a woman review her life and make decisions about new directions and interests. If a woman has a persistent depression or experiences sleep, appetite and energy changes, or has suicidal thoughts, she may want to consider a psychiatric consultation and antidepressant medication.  

BACK