what is menopause and why does everyone consider it so bad?

Question

what happens to you and when?

Answer 1

Then normal termination of a monthly period, occurring ususally between the ages of 45 and 50. Symptoms include hot flashes, headaches, vulvar discomfort, painful sexual intercourse and mental depression. the symptoms correlate with the diminution of ovarian function and hormone production.

Answer 2

Lets see my mom and mom in law have or are in it right now and they say it is bad cause of the night sweats and hot flashes lets see there is also mood swings and my mom in law has restless leg syndrome. I think it has to do with the changes in you hormones adn estrogen level your body is preparing to not have a period any more. I have also heard that it kills your sex drive but thats something I really don't want to hear about from my mom or in law LOL.

Answer 3

What is the menopause?

The menopause, also called the change of life, is defined as the end of the last menstrual period. In Western women it occurs on average at 51 years, but there is a wide range of normal extending from your 30s to 60s.

What is the menopause like?

The menopause occurs when the ovaries no longer respond to the controlling hormones released by the pituitary gland of the brain. As a result, the ovaries fail to release an egg each month and to produce the female sex hormones oestrogen and progesterone.

It is the fall in the levels of these hormones in the bloodstream that gives rise to the symptoms of menopause.

Research into the menopause is relatively recent. One hundred years ago, when life expectancy was shorter, most women did not live long after the menopause and so little was known about it.

How does the menopause start?

Many women experience symptoms of the menopause and irregular periods for several years up to the menopause itself.

This is called the climacteric, or 'perimenopause', and represents the gradual decline in the normal function of the ovaries.

One of the common problems of the climacteric is that periods become erratic both in spacing and amount. Until the periods peter out altogether, heavy bleeding can cause plenty of problems.

Treatments for heavy bleeding are listed below.

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines such as ibuprofen (eg Nurofen) that are used as painkillers and to lower a raised temperature.

They reduce the amount of blood lost in a period and help reduce pain. Mefenamic acid (eg Ponstan) is another painkiller used in the same way.

Tranexamic acid

Tranexamic acid (Cyklokapron) is a drug that encourages blood to clot on a bleeding surface, which can reduce heavy menstrual bleeding. It’s only used for the heaviest three or four days of each period.

It’s not suitable for women with a previous history of clots in the veins (thrombosis). Nausea, vomiting and diarrhoea are the likeliest side effects from this drug.

Progestogen tablets

Oral progestogen tablets will cut menstrual flow when given for long enough (21 days each cycle), as will the progestogen released from the Mirena intra-uterine system.

Mirena is currently the most effective non-surgical way of dealing with excessive vaginal bleeding.

There are other drug options that can be used by specialists, if necessary, but these can be accompanied by significant side effects.

Hysterectomy

Heavy menstrual bleeding is the most common reason for having a hysterectomy. One in five women have had a hysterectomy before the age of 60.

Complete removal of the uterus is a relatively major operation. This means it is accompanied by risks such as those of an anaesthetic, of bleeding at operation, wound infection, vein clots post-operatively and so on.

However, these are risks that apply to any operation. In practice, hysterectomy is a successful and well-tolerated procedure.

Endometrial ablation

Lesser surgical procedures to treat heavy bleeding are now possible using fibre-optic instruments that can destroy the lining of the uterus (endometrial ablation).

This works because it is only the inner lining of the uterus that is hormone-sensitive and responsible for menstruation.

The procedure does not completely remove every piece of the uterine lining, and 30-90 per cent of women still get some menstrual bleeding afterwards, but usually it is light.

For the same reason, if you later take HRT after an endometrial ablation, you will still need to use a combined HRT preparation and not just oestrogen alone.

What is the menopause like?

Every woman experiences the menopause differently.

Many hardly notice 'the change', except perhaps their periods become irregular. Others suffer every symptom and find their lives are severely affected.

The transition into the menopause is usually gradual and is accompanied by a range of symptoms.

Hot flushes and sweating

The most common symptoms by far are ‘hot flushes’ and sweating attacks. These episodes can happen at any time, as often as several times an hour.

Each hot flush usually lasts for three to six minutes.

Exactly why flushes and sweats occur is not fully understood, but mostly it is because the automatic controls of the nervous system become erratic.

This triggers the skin blood vessels to open and signals the sweat glands to become active at any time. Usually, this would only happen if you were too hot and needed to lose heat.

Sleep disturbance

Sleeping difficulty can be due to problems falling asleep, restlessness or night-time sweats. Some women sweat heavily and have to get up to change the sheets several times a night.

Psychological changes

Depression, mood swings, tiredness or headaches are all possible symptoms. Forgetfulness or irritability can be distressing for both you and the rest of the family.

Physical changes

o During the menopause your skin becomes thinner.

o A lack of oestrogen often means the glands in the vagina don't produce as much lubrication as before and this may cause stinging around the vagina during sex.

o Some women don't feel like having sex, whereas others find their orgasms become less intense.

o The lack of oestrogen also affects the bladder and you may find you need to pass water more often.

o There is a gradual rise in the risk of heart disease and stroke after the menopause.

o Falling oestrogen levels result in unfavourable changes in cholesterol and fat levels in the blood, causing a predisposition to these problems.


Osteoporosis

In recent years there has been a lot of interest in osteoporosis (thinning of the bones) in connection with the menopause.

Oestrogen normally stimulates the bone-building cells.

As a result of the drop in oestrogen, women tend to lose bone mass and strength for several years following the menopause. Ultimately, this can make the bones more likely to collapse or fracture.

What can make the menopause easier?

Medical treatment is available for women who are troubled by symptoms of the menopause.

Hormone replacement therapy

Hormone replacement therapy (HRT) alleviates the symptoms of the menopause by adjusting hormone levels.

It involves receiving a small daily dose of oestrogen. Women who have not had a hysterectomy are also given a progesterone-like drug as part of the HRT. This is called combined HRT.

Combined HRT can be described as either sequential or continuous.

Sequential combined HRT is suitable for women who are perimenopausal, ie still experiencing erratic menstrual bleeding. Most preparations are designed to mimic the menstrual cycle and result in monthly periods. They are based around a 28-day cycle in which oestrogen is taken every day and a progesterone is added for the last 12 to 14 days of the cycle. For women who are borderline postmenopausal and have very infrequent bleeds, there is also a sequential preparation available that results in three-monthly bleeds.

Once a woman has not had a natural period for a year and is described as postmenopausal, continuous combined HRT is more suitable. This form of HRT does not produce periods and involves taking a daily dose of oestrogen and progesterone.

How is HRT taken?

There are many ways of taking HRT, with the most usual being a daily tablet. Alternatives include skin patches, a small pellet or implant under the skin, a gel applied daily to the skin, a ring inserted into the vagina, or a nasal spray.

What are the side effects of HRT?

The majority of women have no side effects, but the following are fairly common:

o nausea

o breast tenderness

o weight gain

o fluid retention.


These symptoms often settle after the first few months of treatment. If they don't, it's worth consulting your doctor or gynaecologist to adjust the medication.

How effective is HRT?

HRT is effective at relieving hot flushes and vaginal dryness and many women report an improvement in their general sense of wellbeing.

However, HRT is not a magic fix and if disturbed mood or behaviour is due to underlying problems at home or work, HRT cannot be expected to improve matters.

HRT is often taken for a short spell of six months to a year to relieve hot flushes.

The long-term benefits of HRT have recently been brought into question.

Previously it was thought that HRT prevented heart disease and strokes by slowing the development of hardening of the arteries. Several major research studies reported in 2002 and 2003 have shown this is not so.

The possibility that HRT users are less likely to develop Alzheimer's disease is still to be confirmed, but it does seem that HRT offers some protection against developing bowel cancer.

The most important result of these research studies has been the confirmation that HRT increases the risk of developing breast cancer and endometrial cancer (cancer of the lining of the womb).

The risks with HRT

To put into perspective the magnitude of these risks, it helps to put together some figures.

For purposes of comparison, the risks are stated as the number of people affected per 10,000 women-years of observation. This can mean one thousand women observed over 10 years or five thousand women over two years, etc. Menopause is the transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether.

Causes, incidence, and risk factors Return to top

Menopause is a natural event that normally occurs between the ages of 45 and 55.

Once menopause is complete (called postmenopause), you can no longer become pregnant.

The symptoms of menopause are caused by changes in estrogen and progesterone levels. As the ovaries become less functional, they produce less of these hormones and the body responds accordingly. The specific symptoms you experience and how significant (mild, moderate, or severe) varies from woman to woman.

In some women, menstrual flow comes to a sudden halt. More commonly, it tapers off. During this time, your menstrual periods generally become either more closely or more widely spaced. This irregularity may last for 1 to 3 years before menstruation finally ends completely.

A gradual decrease of estrogen generally allows your body to slowly adjust to the hormonal changes. When estrogen drops suddenly, as is seen when the ovaries are removed surgically (called surgical menopause), symptoms can be more severe.

Symptoms Return to top

The potential symptoms include:

* Hot flashes and skin flushing
* Night sweats
* Insomnia
* Mood swings including irritability, depression, and anxiety
* Irregular menstrual periods
* Spotting of blood in between periods
* Vaginal dryness and painful sexual intercourse
* Decreased sex drive
* Vaginal infections
* Urinary tract infections

In addition, the long-term effects of menopause include:

* Bone loss and eventual osteoporosis
* Changes in cholesterol levels and greater risk of heart disease

Signs and tests Return to top

Blood and urine tests can be used to measure hormone levels that may indicate when a woman is close to menopause or has already gone through menopause. Examples of these tests include:

* Estradiol
* FSH
* LH

A pelvic exam may indicate changes in the vaginal lining caused by changes in estrogen levels. A bone density test may be performed to screen for low bone density levels seen with osteoporosis.

Treatment Return to top

Menopause is a natural process. It does not require treatment unless the symptoms, such as hot flashes or vaginal dryness, are particularly bothersome.

One big decision you may face is whether or not to take hormones to relieve your symptoms. Discuss this thoroughly with your doctor, weighing your risks against any possible benefits. Pay careful attention to the many options currently available to you that do not involve taking hormones.

If you have a uterus and decide to take estrogen, you must also take progesterone to prevent endometrial cancer (cancer of the lining of the uterus). If you do not have a uterus, progesterone is not necessary.

HORMONE REPLACEMENT THERAPY

For years, hormone replacement therapy (HRT) was the main treatment for menopause symptoms. Many physicians believed that HRT was not only good for reducing menopausal symptoms, but also reduced the risk of heart disease and bone fractures from osteoporosis. However, the results of a major study -- called the Women's Health Initiative -- has led physicians to revise their recommendations.

In fact, this important study was stopped early because the health risks outweighed the health benefits. Women taking the hormones did see some benefits. But they greatly increased their risk for breast cancer, heart attacks, strokes, and blood clots.

If your symptoms are severe, you may still want to consider HRT for short-term use (2-4 years) to reduce vaginal dryness, hot flashes, and other symptoms.

To reduce the risks of estrogen replacement therapy and still gain the benefits of the treatment, your doctor may recommend:

* Using estrogen/progesterone regimens that do not contain the form of progesterone used in the study.
* Using a lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream rather than a pill).
* Having frequent and regular pelvic exams and Pap smears to detect problems as early as possible.
* Having frequent and regular physical exams, including breast exams and mammograms.

ALTERNATIVES TO HRT

The good news is that you can take many steps to reduce your symptoms without taking hormones:

* Dress lightly and in layers
* Avoid caffeine, alcohol, and spicy foods
* Practice slow, deep breathing whenever a hot flash starts to come on (try taking six breaths per minute)
* See an acupuncturist
* Use relaxation techniques like yoga, tai chi, or meditation
* Eat soy foods
* Remain sexually active to preserve elasticity of your vagina
* Perform Kegel exercises daily to strengthen the muscles of your vagina and pelvis
* Use water-based lubricants during sexual intercourse

There are also some medications available to help with mood swings, hot flashes, and other symptoms. These include low doses of antidepressants such as paroxetine (Paxil), venlafaxine (Effexor), and fluoxetine (Prozac), or clonidine, which is normally used to control high blood pressure.

Complications Return to top

Estrogen is responsible for the buildup of the lining of the uterine cavity. During the reproductive years, this buildup occurs and then is shed (menstruation). This usually happens about a once a month.

The menopausal decrease in estrogen prevents this buildup from occurring. However, hormones produced by the adrenal glands are converted to estrogen, and sometimes this will cause postmenopausal bleeding.

This is often nothing to worry about, but because postmenopausal bleeding may also be an early indication of other problems, including cancer, a physician should always check any postmenopausal bleeding.

Decreased estrogen levels are also associated with an increased risk of developing osteoporosis and possibly an increased risk of cardiovascular disease.

Calling your health care provider Return to top

Call your health care provider if:

* You are spotting blood between periods
* You have had 12 consecutive months with no period and suddenly vaginal bleeding begins again

Prevention Return to top

Menopause is a natural and expected part of a woman's development and does not need to be prevented. However, there are ways to reduce or eliminate some of the symptoms that accompany menopause. You can also reduce your risk of long-term problems like osteoporosis and heart disease.

* DO NOT smoke -- cigarette use can cause early menopause
* Exercise regularly to strengthen your bones, including activity that works with the resistance of gravity
* Take calcium and vitamin D
* Eat a low-fat diet
* If you show early signs of bone loss, talk to your doctor about medications that can help stop further weakening
* Control your blood pressure, cholesterol, and other risk factors for heart disease