Menopause is a natural phase in every woman’s life, but what exactly happens during menopause, and how can we manage menopausal symptoms? Let’s dive deep into this topic.
Menopause is defined as the time in a woman’s life when there is a permanent cessation of ovarian function. It’s confirmed when a woman hasn’t had a menstrual period for one year. The average age of menopause is 51.1 years.
Another condition to be aware of is ‘Premature Ovarian Insufficiency’ (POI). This is when menopause occurs before the age of 40. This condition affects about 1% of women. Another form of menopause, termed “surgical or induced menopause,” occurs due to the removal or damage to both ovaries or because of treatments like chemotherapy or radiation.
Our reproductive journey starts long before we’re born. Here’s a brief overview:
Before you reach menopause, you’ll undergo a phase called “perimenopause.” This is when menstrual cycles start to become irregular, shifting from a predictable pattern to increasingly anovulatory cycles, and finally, the cessation of menses.
The process of reproductive aging is complex and is categorized into various stages. One of the well-recognized frameworks for understanding reproductive aging is the Stages of Reproductive Aging Workshop (STRAW). This classification helps in understanding the transition from reproductive years to menopause.
In the early stages of the menopausal transition, signs include increased variability in menstrual cyclicity (more than seven days apart), elevated FSH levels, decreased AMH, and a reduced antral follicle count (AFC).
As a woman moves into the late menopausal transition, which typically spans 1 to 3 years, vasomotor symptoms such as hot flashes become prevalent. Other indicators in this stage are an interval of amenorrhea lasting 60 days or more, culminating with 12 consecutive months of amenorrhea.
Following this, the early postmenopausal phase encompasses the first six years after the final menstrual period (FMP). The late postmenopausal stage spans from 6 years after FMP until death.
These insights, presented at the North American Menopause Society (NAMS) Meeting in 2011, offer a comprehensive understanding of the stages women undergo during this significant life transition.
As women transition into the menopausal phase, they often experience a range of symptoms that can impact their daily lives. Here are some of the most frequently reported challenges:
It’s essential for women to recognize these symptoms and understand they are not alone. Many treatments and therapies are available to relieve and improve the quality of life during this significant transition.
Vasomotor symptoms, particularly hot flashes, are a prevalent concern for many women transitioning into menopause. In fact, between 60-80% of women report experiencing such symptoms. While most women may only endure these symptoms for a year, up to 25% continue to experience them five years after their final menses. These hot flashes, which can occur as frequently as every hour, often come accompanied by sweating, palpitations, anxiety, sleep disturbances, and a diminished quality of life.
To alleviate these symptoms, several treatments are available:
However, caution is advised when considering systemic hormone therapy, especially for those with contraindications such as unexplained vaginal bleeding, estrogen-dependent cancers, severe liver disease, and several others.
Lastly, while there’s a buzz around bioidentical hormones, the evidence does not support their use over conventional menopausal hormone therapy. They come with important concerns, including variable purity, potency, and possible risks associated with variable bioavailability.
Hormone Replacement Therapy (HRT) plays a pivotal role in alleviating the challenges associated with menopause. According to the North American Menopause Society’s position statement, for women under 60 years of age or those within ten years from their Last Menstrual Period (LMP), the benefits of HRT generally outweigh the risks. However, for older women or those more than a decade from their LMP, the balance shifts with greater absolute risks of Coronary Artery Disease (CAD), stroke, and Venous Thromboembolism (VTE).
The primary indications for HRT include:
Various HRT regimens are available, including continuous and cyclic methods, using combinations of estrogens and progestins. The Women’s Health Initiative (WHI) study, which enrolled over 27,000 postmenopausal women, has provided some insights into the risks and benefits of HRT.
The study revealed that younger women who initiate HRT closer to the age of menopause showed no increase in coronary heart disease (CHD) or stroke and even displayed trends towards cardiac protection, especially with estrogen therapy. The risk of CHD, stroke, and VTE increases the further out from the onset of menopause one is when starting HRT.
It is important to discuss the benefits and risks of initiating HRT with your provider so that a personalized treatment plan can be made based on your risk factors.
Adding testosterone to the mix, it’s noteworthy that the hormone’s levels decrease after menopause primarily due to the reduced peripheral conversion of androstenedione. Though testosterone can improve sexual function, it’s not FDA-approved for use in women and is used off-label. Its benefits need to be weighed against potential side effects like hirsutism, acne, and others.
ACOG’s guidelines further clarify that systemic HRT is the most effective therapy for vasomotor symptoms. They recommend individualized treatment, using the lowest effective dose, and local therapy for vaginal symptoms only. It’s important to note that HRT should not be used for primary or secondary prevention of coronary heart disease currently. The general recommendation is to discontinue systemic estrogen by the age of 65.
Menopause can sometimes throw a wrench in one’s sexual well-being. Common challenges include:
But there’s hope. Treatments range from lubricants and hormone therapy to relationship counseling and health optimization.
One of the significant health concerns for post-menopausal women is osteoporosis, a condition where bones become weak and brittle. This increases the risk of fractures, especially in the hip, which can lead to decreased mobility and independence.
It’s crucial for postmenopausal women, especially those aged 65 or older, to get screened for osteoporosis. Younger women with increased risk factors should also consider screening.
Premature Ovarian Insufficiency (POI) is a condition where a woman’s ovaries cease to function before the age of 40. Infertility can bring about feelings of loss and grief, especially for those who hope to conceive. However, reproductive medicine offers hope and a suite of options.
Fertility Treatments for Early Menopause
While natural conception might be challenging with early menopause, several fertility treatments can pave the way for potential parenthood:
Emotional Considerations
The journey through early menopause and the pursuit of fertility treatments is as emotional as it is medical. Many women grapple with feelings of inadequacy, loss, or guilt. It’s crucial to seek psychological counseling or support groups familiar with these unique challenges. This emotional support can be invaluable throughout a woman’s fertility journey.
Menopause, whether natural, premature, or induced, represents a significant transition in a woman’s life, bringing with it various physiological and emotional changes. Understanding its intricacies and seeking timely interventions can lead to a better quality of life despite the challenges. From managing bothersome symptoms to navigating the complexities of fertility post-menopause, modern medicine and supportive therapies offer a beacon of hope. Knowledge, support, and self-compassion are key in any health journey. By arming oneself with information and seeking the proper medical and emotional guidance, women can confidently traverse the menopausal landscape, embracing each phase with strength and resilience.
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