What You Need to Know About Menopause

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What is menopause?

Menopause is a stage in life when a woman stops having her monthly period. It is a normal part of aging and marks the end of a woman's reproductive years. Menopause typically occurs in a woman's late 40s to early 50s. However, women who have their ovaries surgically removed undergo "sudden" menopause.

The traditional changes we think of as "menopause" happen when the ovaries begin to stop functioning. The ovaries are the reproductive glands that store eggs and release them into the fallopian tubes. They also produce the female hormones estrogen and progesterone as well as testosterone. Together, estrogen and progesterone control menstruation. Estrogen also influences how the body uses calcium and maintains cholesterol levels in the blood.

As menopause nears, the ovaries slowly begin to run out of eggs. Eventually, the ovaries no longer release eggs into the fallopian tubes and the woman has her last menstrual cycle.

The ovaries also stop most of their production of estrogen and progesterone. Low estrogen levels may cause menopause symptoms and lead to more long-term changes in a woman's overall health. However, not all women develop low-estrogen symptoms, and not all women lose bone.

What are the symptoms of menopause?

Early symptoms of menopause include:

  • Irregular periods or skipping periods
  • Periods that are heavier or lighter than usual
  • Hot flashes (a sudden feeling of warmth that spreads over the upper body)

These symptoms are a sign that the ovaries are producing less estrogen. Menopause may also cause:

  • Vaginal dryness (the vagina may also become thinner and less flexible), which can cause painful intercourse
  • Bladder irritability and worsening of bladder control (incontinence)
  • Dry skin, eyes or mouth
  • Emotional changes (irritability, mood swings, mild depression)
  • Sleeplessness

How can I relieve menopause symptoms?

Many women are choosing hormone therapy (HT) to relieve menopause symptoms. HT is a treatment program in which a woman takes estrogen alone or with progestin (a synthetic form of progesterone). By supplementing with low-dose estrogen, HT can relieve:

  • Hot flashes
  • Vaginal dryness, which can result in painful intercourse
  • Some skin and hair changes
  • Bladder irritability
  • Mood and sleep disturbances

More importantly, HT may reduce a woman's risk for osteoporosis and other illnesses linked with the decrease of estrogen, such as colon cancer and possibly Alzheimer's disease.

Pre-existing health conditions may make HT unsafe for some women. Discuss HT with your health care provider. HT does not prevent heart disease and can increase the risk of blood clots. Prolonged use of estrogen-progestin can increase the risk of being diagnosed with breast cancer. HT may reduce the risk of diabetes.

What else can I do to relieve symptoms?

There are many other ways you can ease menopause symptoms and ensure your health. Tips are provided in the Coping With the Symptoms of Menopause brochure. In general, these tips include:

  • Taking steps to stay cool during hot flashes, such as wearing loose cotton clothing
  • Keeping your bedroom cool to prevent night sweats and disturbed sleep
  • Seeking emotional support from friends, family members or a professional counselor when needed
  • Taking medications, vitamins and minerals as prescribed by your doctor
  • Eating well and exercising regularly

What are the long-term health risks associated with menopause?

Osteoporosis

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Osteoporosis, a "brittle-bone" disease, occurs when the inside of bones become less dense, making them more fragile and likely to fracture. Estrogen plays an important role in preserving bone mass. Estrogen signals cells in the bones to stop breaking down.

Women lose an average of 25 percent of their bone mass from the time of menopause to age 60, due in large part to the loss of estrogen. Over time, this loss of bone can lead to bone fractures. There are other options besides estrogen to treat brittle bones.

Coronary artery disease

Coronary artery disease is the narrowing or blockage of arteries that surround the heart muscle. It results when fatty plaque builds up in the artery walls (known as atherosclerosis). This buildup is associated with high levels of cholesterol in the blood.

After menopause, a woman's risk for coronary artery disease increases. This increase may be linked to the loss of estrogen in women who have had premature menopause without benefit of estrogen.

Estrogen helps maintain healthy levels of cholesterol in the blood. It may also improve blood flow to the heart muscle and reduce blood clotting factors. However, it has not been shown to prevent heart disease in the average postmenopausal woman and can increase the risk of blood clots and stroke.

A healthy diet, not smoking, and getting regular exercise are your best options to prevent heart disease. Treating elevated blood pressure, diabetes and maintaining cholesterol levels with "statin" medications and aspirin therapy for selected at-risk persons are the standards of care.

Can menopause be a positive time of life?

Most certainly, menopause can be a positive time of life. Too often, myths foster misconceptions about this normal process of aging. Although menopause can cause some noticeable and uncomfortable changes, these can be effectively managed.

Menopause also does not harm a woman's overall mental health. Many times, long-term emotional problems are related to other factors, such as pre-existing illness, poor coping strategies and lifestyle stressors.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health This document was last reviewed on: 4/3/2003

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