While some women sail through menopause, happily dancing and enjoying themselves without significant problems, some women have a more difficult time.
There are many treatment options for the various symptoms associated with menopause, and for most, the benefits of the treatment outweigh the risks.
The average age of menopause is between the ages of 50-52, though there are typically several years of peri-menopause when a woman will skip one, two, or more months between cycles. In fact, ovarian follicles (underdeveloped eggs) start to decline more rapidly in the mid-thirties, which is the process leading up to menopause (this actually takes many years to naturally conclude). The main symptoms of menopause include hot flushes and sweats. During a woman’s 30s and 40s, she can maintain adequate estrogen levels even if her ovaries are starting to weaken. In the year prior to menopause however, the body starts to sense the decreasing estrogen levels, which precipitates these hot flushes and sweats; the lack of estrogen can also affect physical changes in the body.
Estrogen depletion has been associated with loss of skin thickness and increasing wrinkles. In the vagina, the decreased estrogen can lead to dryness, itching, burning or pain with intercourse and narrowing of the vaginal canal. Thinning tissue around the urethra can lead to urinary symptoms, such as painful urination, incontinence and recurrent UTIs.
The bone is an active organ and estrogen plays a role in maintaining bone mass. When estrogen decreases, the cells that break down bone, exceed the ability of other cells to absorb calcium, Vitamin D, and building factors needed to rebuild bone. Women have compression factors in their spine, leading to shorter height – a fall or accident can increase the risk of fractures to other bones. Forearm fractures and hip fractures are most common which can be debilitating; decreased estrogen has been affiliated with declining muscle strength, which can adversely affect activity levels and subsequently increase sedentary lifestyle and weight gain.
Lifestyle changes can be helpful for menopausal women. For starters, eating healthy, increasing activity levels, and stopping tobacco have been associated with prolonged ovarian function. Weight bearing exercises, calcium and vitamin D supplements can be helpful for slowing bone loss. Medications such as estrogen, estrogen-like products, biophosphates and calcitonin have been used for bone health and to reverse certain amounts of bone loss.
Estrogen has traditionally been the mainstay of treatment for many of these menopausal symptoms, though it carries risks such as blood clots, strokes or heart attacks. Estrogen/Progesterone combination therapy has been associated with a small risk of breast cancer as well. There are also non-hormonal treatments for hot flushes and vaginal symptoms. For those women looking to avoid estrogens, a new CO2 laser treats vaginal symptoms like dryness, burning and painful sex.
There is a belief that menopause causes depression or mood changes but this has never been proven to be true. Other factors such as fatigue, insomnia, medical problems, death of or divorce from a partner and other common life stressors are more likely to impact the psychological state of menopausal women.
By adopting a healthy lifestyle and managing hot flushes and insomnia, menopausal women can improve some of the stress-causing factors, subsequently improving their mental status.
Women entering the menopausal years should talk to their doctor about healthy practices and management options so that the years following menopause can be as enjoyable and productive as possible.
By: Eric B Grossman, MD, FACOG