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Menopause

Menopause

Menopause is the point in a woman’s life when menstruation stops for good. This means she is no longer able to have children. Menopause occurs in most women between the ages of 35 and 58. It is a natural event in a woman’s life. Surgical menopause occurs when a woman has both of her ovaries removed.
What is going on in the body?

By the time a woman is in her mid 30s, the level of the hormone estrogen in her body begins to drop. Levels gradually decline until a woman stops menstruating. The period during which estrogen levels are dropping but the woman is still menstruating is called perimenopause or premenopause. The point at which the estrogen level has declined enough so that menstruation stops is called menopause. The period of time that begins after menstruation permanently stops is known as postmenopause.
What are the causes and risks of the condition?

Menopause is a natural part of a woman’s life. A woman’s estrogen level decreases over time, causing her to stop menstruating. A woman who has her ovaries removed because of disease will also go through menopause.
Symptoms & Signs
What are the signs and symptoms of the condition?

Symptoms of menopause vary from woman to woman. Some women will have severe symptoms. Others will have mild symptoms or none at all. The symptoms may occur for a few weeks, a few months, or even several years. The symptoms may come and go. Some common physical symptoms include:
disturbed sleep patterns, or other sleep disorders
hot flashes, which are a sudden sensation of heat in the whole body or in the upper part of the body
irregular menstrual periods
leakage of urine when coughing, laughing, lifting, or during exercise
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more frequent urination
night sweats
pain during sexual intercourse, known as dyspareunia

Women who are menopausal do not experience any more mental illnesses than any other group. However, the following psychological symptoms are common during menopause:
anxiety
depression
difficulty remembering things
irritability
lack of concentration
less desire for sex
sleeplessness
tearfulness

Menopause usually occurs during a time in life when other dramatic changes are taking place. Common changes during midlife include:
becoming a grandparent
changing careers
starting retirement
losing a parent
having children grow up and leave home

These changes along with the changes going on in a woman’s body during menopause may result in increased stress.
Diagnosis & Tests
How is the condition diagnosed?

Diagnosis is usually made by the woman’s medical history and supporting symptoms. A blood test can be used to measure estrogen levels. A pelvic exam and Pap smear may show effects of decreased estrogen.
Prevention & Expectations
What can be done to prevent the condition?

There is no prevention. All women will experience menopause.
What are the long-term effects of the condition?

Certain diseases are associated with estrogen loss in women. A woman who is past menopause is at higher risk for the following conditions:
heart disease
osteoporosis, which is a loss in bone density and hardness
urinary tract infections
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Many women have more desire for sex after menopause. This may be because pregnancy is no longer a worry. However, women who are still menstruating, and women who have stopped menstruating within the past year, may still get pregnant. Barrier birth control methods, intrauterine devices, which are also called IUDs, or tubal ligation can prevent pregnancy.
What are the risks to others?

Menopause is not catching. It poses no risks to others.
Treatment & Monitoring
What are the treatments for the condition?

Menopause itself is not treated. Certain health problems, such as osteoporosis are linked to the loss of estrogen. To help prevent such problems, many women take estrogen to replace what their body is no longer able to produce. This treatment is called estrogen replacement therapy, which is also called ERT, or hormone replacement therapy, which is also called HRT.

The American Heart Association recently issued recommendations about HRT in women. For women who have already had a heart attack or have heart disease, it appears that HRT does not protect against having another heart attack or dying from heart disease.

For women who have not already had a heart attack or who do not have heart disease, HRT should not be started for the sole purpose of preventing heart disease. In fact, a recent study has shown that there is a slight increase in the risk for heart attack and stroke in women who are on HRT.

Overall, the decision to use HRT should be based upon the proven benefits and risks of HRT. A woman should discuss the benefits and risks with her doctor. Together, they can choose the best course of action.

Symptoms associated with menopause may also be treated. During menopause, sexual intercourse may become painful, a condition known as dyspareunia. This condition is often caused by vaginal drying, and can result in a decline in sexual interest. Creams are available to help with lubrication. Kegel exercises of the pelvic muscle can treat urinary leakage. Surgery or medicine may also be used.
What are the side effects of the treatments?

Side effects to HRT can include headaches, bloating, vaginal bleeding, breast tenderness, and irritability. Recent studies have also linked HRT to an increased risk of heart attack, stroke, and cancers of the breast, ovary, and uterus.
What happens after treatment for the condition?

Most menopausal symptoms will go away once menstruation stops.
How is the condition monitored?

A woman’s progress through menopause is monitored through regular Pap smears and pelvic exams. Any new or worsening symptoms should be reported to the doctor.

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