MENOPAUSE

Menopause is a part of the normal life cycle of women. Research has discovered ways of effectively preventing or managing some of the problems that can be associated with menopause.

Menopause is the cessation of ovulation; that is, the ovaries no longer release eggs. It may occur prematurely as a result of the failure of the ovaries to develop properly, because of immune problems, or due to the surgical removal of the ovaries.

After menopause, the ovaries no longer secrete two critical steroid hormones in the amount or pattern characteristic of a regular menstrual cycle. These two hormones are estrogen and progesterone.

Who is affected?

The average age of menopause is about 48 to 52 years. Fewer than one of every 100 women experience menopause before age 40 (premature menopause). The transition from regular ovarian function to its absence is often called the perimenopause or climacteric. It can occur rapidly or slowly. The time involved can range from a month or two to up to 5 years. Nowadays, the average woman who reaches menopause will probably live another 30 or more years. Thus, the management of menopause, like that of aging in general, is a medical and social issue.

What are its effects?

The loss of female hormone production can cause both acute and chronic consequences in hormone-dependent tissues such as the brain, bones, heart, blood vessels, and skin. After menopause, women are at increased risk for osteoporosis, heart disease, urinary incontinence, acute burning or itching of the vulva or vagina, and painful sexual intercourse. At least half of women also report symptoms such as night sweats and hot flashes, insomnia, changes in mood and sexual desire, and a decrease in memory or concentration. Changes in body or scalp hair or in skin tone may also occur. After menopause, 70 percent of women develop cardiovascular disease, and 30 percent develop osteoporosis.

What is the role of endocrinology?

The medical management of menopause is in its infancy. The goal is to improve the quality of the last third to one-half of a woman's life by preventing the harmful consequences of estrogen hormone deprivation. Preventing these problems will delay or eliminate the need for medical treatment and nursing home care. Estrogen and progesterone replacement therapy decreases symptoms associated with menopause. The proper dosage, treatment schedule, hormone preparation, and routes of administration of estrogen replacement may vary for each individual.

Other issues

Menopausal women should also think about other areas of their health apart from those related to hormonal deficiency. Problems like diabetes, osteoporosis, lipid disorders, hypertension all increase in frequency with advancing age. These should also be properly treated.