A NATURAL APPROACH FOR A BRIGHTER FUTURE : A MENOPAUSE GUIDE FOR PATIENTS
What Is Menopause?
The term "menopause" really refers to the last period of menstruation that a woman has, but it has come to mean the stage of her life during which her ovaries (glands which produce eggs and sex hormones) gradually cease to function and her body slowly gets used to lower hormone levels. Doctors sometimes call this time of change 'the climacteric'.
The changes are not sudden, but take place over a few years. They usually start when a woman reaches her middle or late 40's, but may begin as early as the late 30's. Periods usually become irregular or infrequent before they eventually stop altogether. On the average, women have their last period when they are about 50.
The section above mentions that during the menopause the body gets used to lower hormone levels, but what are these hormones and what was their importance before you reached menopause?
The Importance Of Hormones
Hormones are special chemicals that regulate the way our bodies work. The ovaries produce the female hormone, estrogen, responsible for the change from childhood to womanhood. It causes the breasts to develop, and produces the characteristic feminine shape. Estrogen also stimulates the reproductive organs to grow and mature so that a woman is able to have children. Together with another ovarian hormone, progesterone, it builds up the lining of the womb during each monthly cycle. An egg is released from one of the ovaries each month, and if it is fertilized it settles into the womb lining and grows into a baby. If pregnancy does not occur, the womb lining breaks down and is shed as the monthly period (menstruation).
Estrogen is also important in keeping a woman fit and well. It contributes to the healthy condition of her skin and many other organs of the body and to her mental alertness.
As you approach menopause, the production of hormones by the ovaries begins to slow down, and in some months no egg is released. This often results in irregular periods, since the womb lining is not built up and shed as regularly as it used to be. A woman may rarely notice any change in her periods at all until they suddenly stop, and menopause itself has been reached. Some women, however, are troubled by excessively heavy periods at this stage. If these continue, a doctor should be consulted because they may be easily treated and because they are sometimes due to causes other than menopause.
Even when a woman thinks she has stopped menstruating, she should continue to use contraceptive precautions for some time, because it is quite possible that her periods have just become irregular. Her doctor will tell her when it is safe to stop using contraception.
Symptoms Of The Change Of Life
During her young adult life, a woman's body is used to the high levels of circulating estrogen. When she approaches menopause, and the ovaries slow down their production of hormones, it can take some time for her body to adapt. In some ways, it never does, and the loss of estrogen has permanent effects. She may have symptoms that are a consequence of this change from higher levels of estrogen to lower levels. Some of these symptoms are likely to begin while she is still having periods. Other changes develop over a longer time, and might not be noticeable for some years until after the periods have stopped.
The earliest symptoms (in addition to the menstrual change already mentioned) almost always start some considerable time before periods cease. They are usually more noticeable after periods have stopped, and may continue for several years. However, we can call them short-symptoms, because they always stop eventually.
The most common of these short-term symptoms are hot flushes and sweats, which can be most embarrassing if they happen in public. A feeling of heat spreads up from the chest and neck to the face, which flushes red. This flushing is often accompanied by heavy sweating, particularly at night, which can lead to disturbed sleep. While some women are lucky enough never to experience hot flushes, others have them several times a day.
Some women complain of headaches, palpitations, and excessive tiredness. Many of these symptoms interact with each other - one may make the other worse. This can be particularly true of emotional changes, including irritability, depression and lack of concentration, which also affect many women at this time. However, only a few women suffer from these symptoms at the same time.
Coping with these symptoms is often made more difficult for a woman due to emotional stresses, perhaps because her children have grown up and now lead separate and independent lives, or the knowledge that she has now lost her ability to bear children. These types of stress may not be directly linked to the declining levels of estrogen, but it can add to the problems associated with the symptoms of low estrogen levels.
In contrast to the short-term changes that are limited to a few years before or after menopause, long-term changes become more noticeable at a later age because they result from decreasing levels of estrogen, and tend to progress with increasing age.
The parts of the body that are affected by the deficiency of estrogen include:
The Womb
The womb, not needed any more for reproduction, begins to shrink.
The Vagina
The vagina shortens, narrows, and loses its elasticity. The lining becomes thin and dry, which frequently makes intercourse painful. This, in turn, may be a cause of emotional stress in a sexual relationship.
The Bladder
There may be a weakening of control of the bladder function resulting in leakage of urine (even though loss of estrogen is not the most common cause of this condition). In addition, weakening of the muscles in that region, which occurs after menopause, contributes to the problems of bladder control.
The Skin And The Hair
Decreasing levels of estrogen affects the appearance too. The skin becomes thin and dry, and loses its suppleness. Loss of estrogen also causes reduced hair growth, and the hair is often of a poorer texture.
The Bones And Muscles
Estrogen is particularly important in keeping the bones strong. As estrogen levels decrease, the bones start to become thinner and weaker, even before menopause. This process is called osteoporosis. It is responsible for the "brittle bones" of most elderly women, who can develop fractures more easily. Weakening of the spine often causes some of the bones of the spine to collapse so that there is a loss of height and the "bent back" so often seen in old women. Backache and joint pains can also occur. Muscles can weaken as a result of the decreasing estrogen levels.
Diseases Of The Heart And Blood Vessels
Estrogen seems to be important in protecting young women against deterioration of the blood vessels - a principal cause of heart attacks and strokes which are more common in early and middle aged men. After menopause, incidence of heart attacks and strokes gradually become as common in women as they are in men.
Symptoms Of The Change Of Life
Some Questions You May Want To Ask
Discuss your problems with your own doctor, who may want to treat you directly, or may refer you to a menopause clinic in your area. If your doctor decides to prescribe HRT for you, he or she will probably first examine you to check that you are otherwise healthy, and that hormones are the best answer.
Simply to get rid of symptoms, some women may need to be treated for only a few months, but others may need HRT for a few years, even for short-term basis, to prevent long-term problems, and the onset of other symptoms in later years. Your doctor will decide what is best for you.
No. Replacement of the estrogen lost by the body can influence only the changes that a lack of estrogen brings about. It may also make a woman look and feel healthier, but cannot affect the natural aging process.
No. The declining in the function of the ovaries is neither slowed down nor accelerated by HRT.
HRT is aiming to get back regular bleeding patterns (like periods). These will be completely replaced by the regular bleeds induced by the HRT, which will generally be lighter than your normal menstrual bleedings. These regular bleedings will continue for however long you receive HRT. Even if your periods have ceased before you start HRT, you are likely to have some bleeding.
No. HRT will not affect your fertility in any way. You cannot have children once you have passed your natural menopause and the regular bleeding caused by some forms of HRT (which is not true menstruation) does not alter this.
No. HRT does not act as a contraceptive. If you are still fertile you will continue to need contraception (which must NOT be the pill while you are on HRT) until your doctor tells you that it is no longer necessary.
HRT using natural estrogen replaces the same hormones actually lost by a woman at menopause. It therefore produces very few side-effects. Just as her own hormones may produce some symptoms in a pre-menopausal woman. Women on HRT may experience some minor symptoms, such as breast tenderness, but these usually disappear after a month or two. For full information on the contraindications and side effects, the respective Patient Information Leaflet of the prescribed product should be consulted.
Natural estrogen, the most logical type of estrogen to use, is a well-tried treatment, which has undergone many stringent trials. The present-day evidence suggests that properly supervised HRT, adjusted to suit your needs, carries little risk to your health.
Usually, in hysterectomy the womb is removed, but not the ovaries. Unless (as sometimes happens) the blood supply to the ovaries is reduced after the operation, they continue making hormones in normal amounts, until the age when natural menopause would have occurred. However, if for some reason the ovaries are removed (before reaching menopause), then the woman will suffer a sudden artificial change of life, however young she may be. She may then need HRT to replace the hormones she has lost. The decision to give HRT, however, will depend on the reason for the operation.
Your risk is increased with:
- Smoking
- Lack of exercise
- Increased alcohol consumption
- Hereditary factors: having a mother affected by severe osteoporosis (shown by a very obvious loss of height or a "bent back" or fractures of the wrists or hips)
How Can I Help Myself?
If you are a smoker you are strongly advised to stop now- permanently. That will benefit your arteries and lungs, as well as slowing down the development of osteoporosis. Do plenty of exercise - walking is good- and watch your diet. Ensure that you take ample calcium by taking plenty of milk (skimmed milk is the healthiest) or milk products, such as yogurt and cheese (low-fat cheese is the best). It can be easy to put on weight after menopause - so eat sensibly to keep yourself healthy, and if necessary ask your doctor for advice. If you drink alcohol, do so in moderation.
This is a time when many adjustments to your lifestyle may be necessary, so don't be discouraged too easily if your first attempts fail to provide an answer. Now may be the time to pursue your hobbies, especially those you never had enough time for. You have a third of your lifetime ahead of you, so it is worth investing some real effort now to make that life satisfying.
How Can Your Doctor Help?
You have approached your doctor with one or more early symptoms of the change of life, such as heavy or irregular periods, hot flushes, palpitations, sweating, headaches or excessive tiredness.
So What Can Your Doctor Do To Help?
In the short term, it is possible to treat individual symptoms - for instance, pain-killers for headaches, and tranquilisers for emotional problems. However, that will have no effect on the underlying deficiency. In the previous sections we have discussed how a reduction in the amount of estrogen that the ovaries produce can be responsible for a whole range of disorders, both during and after the change of life. The most convenient way - the most logical and natural way to treat all these disorders simultaneously is to replace the estrogen that has been lost. This is what Hormone Replacement Therapy (HRT) is designed to do.
What Is HRT?
HRT simply aims to replace the estrogen that has been lost. So the best estrogen to use is 'natural' estrogen. In other words, one that is exactly the same as the estrogen produced by the woman's own ovaries.
Benefits From The Hormone Replacement Therapy
Natural estrogen therapy successfully controls headaches and hot flushes and other troublesome symptoms that are directly due to the loss of estrogen, usually within a week or two. Also, if a woman has been having trouble with painful intercourse, estrogen, which makes the lining of the vagina thicker and healthier, will help to make lovemaking more comfortable.
Natural estrogen therapy also helps muscles to regain much of their strength and tone, and there is general improvement in the texture of the skin and hair. If a woman feels healthier, she will look a lot better too!
So much for the obvious problems that result from the climacteric. They respond rapidly to HRT. But doctors nowadays, are taking increasing interest in preventive treatment for healthier people, and many general practitioners run special "Well-Woman Clinics" within their practices.
One of the great benefits of prolonged HRT is the protection of the bones from slow deterioration. Protection of the bones from weakening (osteoporosis) becomes more and more important with advancing age. Many dangerous fractures may be avoided by sustained HRT.
Long-term HRT may also restore the protection that estrogen provided before menopause against deterioration of the arteries that carry blood to the heart, brain and other organs.
Natural estrogen therapy can prevent a lot of unnecessary suffering, not only in women themselves, but also in their families. Your change of life does not need to be a disaster. There is no reason why your menopause should prevent you from leading a full, happy and healthy life many more years to come.
Schering A.G.