Confirming That The Menopause Has Taken Place
Its not always easy to confirm that the menopause has actually happened. Of course, irregular periods and the occasional hot flush are a sign that changes are taking place, but identifying the time of the actual menopause is not so simple, especially if you are taking the Pill or have started Hormone Replacement Therapy for the relief of peri-menopausal symptoms.
The question may seem irrelevant, but it is helpful to know the date of your last period, not only so that you can respond to symptoms in the most appropriate way, but also for contraceptive purposes. A truly menopausal woman will be infertile and will have no need of contraception. However, most doctors advise menopausal women under 50 to continue with their contraception for two years after their last period and for one year if they are over 50.
Most doctors will evaluate a womans menopausal status according to her symptoms , pattern of periods, and medical record. It is possible to take a blood test to measure levels of a reproductive hormone known as FSH. However, while elevated FSH levels may be a sign of the menopause, the test is not always accurate and results cant be guaranteed. Measurement of FSH is not required to diagnose perimenopause or menopause in women aged over 45 years.
This is also the case in those rare instances of premature ovarian Insufficiency, when the hormonal system fails at an early age and the ovaries lose their normal function.
When Does Menopause Occur
Most women reach menopause between 45-55 years of age, and the average age for women in Australia to reach menopause is 51-52 years. Some women will have a later menopause, at up to 60 years of age, especially if there is a family history of late menopause.
Menopause sometimes occurs earlier than expected as a result of cancer treatment, surgery or unknown causes. This is discussed further in ‘Causes of menopause’.
So Why Doesnt The Menstrual Cycle Start At Birth
Good question. The eggs are there, so whats stopping the menstrual cycle from starting up?
The menstrual cycle is on hold until a girl reaches puberty. Puberty begins when the hypothalamus in the brain starts to produce gonadotropin-releasing hormone .
In turn, GnRH stimulates the pituitary gland to produce follicle-stimulating hormone . FSH initiates egg development and causes estrogen levels to rise.
With all of this going on inside of us, its no wonder some of us experience the associated mood swings!
Wondering about the first sign of puberty? Menstruation starts about 2 years after the breast bud that little bit of tender tissue that develops into a breast appears. While the average age is 12, others can start as early as 8, and most will start by age 15.
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Not Everyone Is Eligible
Most people are eligible to begin melatonin treatment. Melatonin is available without a prescription, though its always a good idea to discuss new supplements with a doctor.
Ovarian rejuvenation is now available at several fertility clinics around the United States. Most people in good health with working ovaries are eligible for this elective procedure. But costs can be steep, and it isnt covered by insurance.
Clinical trials can sometimes allow for more affordable treatment. Unfortunately, clinical trials arent always taking place, and when they are, they may only recruit a small number of patients. Trials also have specific recruitment criteria, such as being over 35 or the ability to receive IVF treatments at an out-of-town clinic.
What You Were Born With
Remember, women are born with all the eggs they are ever going to have, and they dont make any new eggs during their lifetime. Women are born with approximately two million eggs in their ovaries, but about eleven thousand of them die every month prior to puberty. As a teenager, a woman has only three hundred thousand to four hundred thousand remaining eggs, and from that point on, approximately one thousand eggs are destined to die each month. This phenomenon is completely independent of any hormone production, birth control pills, pregnancies, nutritional supplements, or even health or lifestyle. Nothing stops this inexorable death of approximately one thousand eggs every month regardless of ovulation, ovarian inhibition, or stimulation. Whenever the woman runs out of her supply of eggs, the ovaries cease to make estrogen, and she goes through menopause. Despite a lot of journalistic hype, there is no similar phenomenon in men. Men continue to make sperm and testosterone at virtually the same rates, with only a very modest diminution as they age.
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How Many Eggs Does A Woman Have At Puberty
Even though a female doesnt typically start menstruation and have the ability to get pregnant until they are between the age of 10-15, eggs are constantly degenerating and being lost throughout infancy and adolescence. As a prepubescent female, approximately 10,000 eggs will degenerate and die each month. That means by the time a woman reaches puberty, they only have 300,000-400,000 eggs left in their ovaries .
Can You Get Pregnant During Menopause
The answer is yes. You can get pregnant in the process of menopause or during perimenopause. During perimenopause, your menstrual cycle may become irregular, with your periods stopping and starting again in uneven time intervals. Therefore, it is not safe to assume that you have reached your menopause once your menstruation stops, as you may only be undergoing the transitional phase. It is best to wait at least a year before finally assuming that you are indeed menopausal. It may be useful to know that women usually experience menopause at around 51 years old, although some experience it at only 40 years and others as late as 55 years.
Additionally, menopause is not guaranteed when your period stops because of other pre-existing medical conditions. The best way to tell whether you are indeed menopausal is to ask your doctor. It is highly advisable to consult your doctor so you can be certain that you are indeed menopausal and not just experiencing perimenopause or some kind of medical condition.
After your menopause is through, your hormones will stop fluctuating and will stabilize at low levels. If your doctor confirms that you are indeed post-menopausal, you will no longer be able to conceive. This is because your ovaries will no longer have any eggs that may be released and become fertilized by sperm cells. Hence, you no longer need to worry about protection and contraception during intercourse.
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A Word About Hormone Replacement Therapy
The issue of whether or not you should take hormone replacement therapy is a complex one and involves an evaluation of the advantages and potential risks of taking hormones. There is no right answer to the question do I need hormones? Menopause is not a disease but a stage of life that every woman experiences differently. The decision over whether you should or should not take hormones will depend on a variety of factors including:
- Your own emotional predisposition to the use of hormones
- The severity of your symptoms
- Your overall risk for heart disease, in the case of estrogen/progestin combinations
- Your overall risk for breast cancer, in the case of estrogen
- Whether or not accepting even the small risks associated with HRT is worth the improvement in your symptoms.
- The length of time you may require HRT
The final decision, of course, will be yours. Our interest is in providing you with the best and most recent information.
What Does ‘egg Reserve’ Mean
Women are born with all the eggs that they will have during their lifetime. On average, their supply of eggs at birth is around 1 million oocytes. At puberty, this amount is reduced to 400,000-500,000. After the first ever menstrual period, women release an egg per month, and it is estimated that only 400-500 will be ovulated during their reproductive years. The rest will degenerate eventually.
A woman’s ovarian reserve is defined as the supply of egg that she has depending on age. It is a determining factor when trying to conceive, either naturally or by Assisted Reproductive Technology .
The most fertile period in a woman’s life encompasses from ages 16 to 30. At this point, both her egg supply and quality should be excellent. Unfortunately, the egg reserve goes through a major decrease from age 35-37.
At age 40, the ovarian reserve is considerably low, and will keep on diminishing until its complete depletion approximately at ages 45-55. This period marks the beginning of a new phase in the woman’s reproductive life: menopause.
Unluckily, some women experience a decrease in the quality and quantity of their eggs earlier than expected. This is known as early or premature menopause. For this reason, women who want to have children after age 35 should have their ovarian reserve tested.
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How Do Most Women Experience Menopause
Since its very difficult to determine when a woman runs out of eggs we rely on other signs and symptoms that coincide with that time frame just prior to menopause. Some women have almost no symptoms of menopause while others have a great many. Generally, these symptoms start 1-5 years prior to menopause though the onset of these symptoms does not actually predict when menopause will occur.
This raises an important pointthere is no test that will reliably predict when menopause will occur. The tests that are available will confirm that menopause has happened but not its about to happen.
The symptoms of approaching menopause include
- Change in bleeding patterns
- Vaginal dryness
- Onset or worsening of urinary incontinence
About 75% of women will experience some of these symptoms. The majority of women with menopausal symptoms require no treatment. Perhaps the most disabling symptoms that women experience are related to night sweats and hot flushes. Frequently, these symptoms cause marked sleep disturbance and may be the real cause of other concomitant symptomsdifficulty concentrating on tasks, anxiety, irritability and depression.
Symptoms Of Established Menopause
Vaginal dryness and atrophyThere are many treatments for vaginal dryness. Your choice will depend on whether or not you are experiencing other menopausal-symptoms and to what extent they are interfering with your quality of life. The treatments can be as simple as vaginal lubricants for the simple replacement of lubrication or more involved if one is concerned about forestalling vaginal atrophy. Vaginal atrophy is a late symptom of menopause and generally takes 5-10 years to develop after the onset of menopausal hot flashes. It is caused by prolonged estrogen loss and results in a shortening and narrowing of the vagina. Additionally, the tissues of the vagina become thin and easily traumatized with intercourse. Most experts agree that vaginal or oral estrogens plan an important role in the prevention and treatment of vaginal atrophy.
Onset and worsening of urinary stress incontinence Urinary incontinence is common and often bothersome enough to be the cause of social embarrassment. Typically these symptoms start or worsen during the perimenopause since the tissues of the bladder and its supporting structures are estrogen dependent. It is important to discuss these symptoms with your health care provider so that the true source of the problem can be isolated and treatment offered.
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Choosing The Right Therapy For You
I respect a womanâs choice, being aware of the modest risk involved, to stay on HRT for a longer period of time if she finds that she is symptomatic when stopping therapy.
Beware of alternative therapies. Just because we have found that mainstream therapy is not as good as we thought in the late last century, this is not a reason to embark on untested therapy.
There are two main options promoted in the alternative therapy range, one outside of our profession and one in. The oestrogen receptor on the cells of our body is the method by which oestrogen works. Oestrogen, the key, turns the lock, the receptor, and stimulates the cell to turn on and off systems within itself to produce its effect.
Stimulating the receptor produces the effect, no matter how it is stimulated. The oestrogen receptor is easily tricked. For example, the âoestrogenâ in the pill is very different from natural oestrogen but works the same.
There are many naturally occurring substances that have oestrogenic action, and will ânaturallyâ stimulate the oestrogen receptor. So-called phytoestrogens, soy products, are an example. Many herbal products contain phytoestrogens. These phytoestrogens have a fairly weak effect, but it is still oestrogen therapy. No matter how the receptor is stimulated, this is still hormone replacement therapy. Less effective and less studied, but it still carries the same potential risk.
Are Egg Quality And Quantity Related
While they are certainly not married to each other, there are some correlations between both age and egg quantity and age and egg quality. Unfortunately, there is no real measure of egg quality as there is egg quantity. The only real way to tell is to fertilize an egg and determine if it fertilizes, develops into an embryo, and either test the embryo using Pre-implantation Genetic Testing or if the embryo develops into a fetus and healthy baby.
One study shown below clearly shows that the number of abnormal embryos goes up drastically as a woman ages.
While they are in no way guaranteed to go hand in hand, there is substantial evidence that the average egg is of poorer quality as age goes up, and ovarian reserve goes down.
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Treatment Of Approaching Menopause
Menstrual abnormalities-Many women experience a variety of menstrual disorders . Most of these abnormalities require no treatment whatsoever. Some women, however, do experience very troublesome symptoms during the perimenopausal years such as heavy vaginal bleeding, inter-menstrual spotting and even continuous vaginal bleeding. Oftentimes, the patient may select from a host of options including the option of simple observation.
Hot flashes, night sweats and insomniaThese so-called vasomotor symptoms are probably the leading reason women seek consultations regarding this transitional phase of life. While many women can tolerate mild hot flashes and a variety of other menopausal-related issues, frequent hot flashes associated with sleep disturbance can be debilitating. Unquestionably, the most effective treatment for moderate to severe hot flashes remains estrogen therapy. For women who have a uterus the estrogen must be balanced with a progestational agent to prevent uterine cancer. Women without a uterus may take estrogen alone.
Non-hormonal treatments that work with lesser degrees of success, and unfortunately a greater number of undesirable side effects include SSRIs such as Prozac, Zoloft, Celexa and Lexapro.
Gabapentin , an anti-seizure medication, has been used with various degrees of success. Other medications that seems to work reasonably well include synthetic progestins and Clonidine.
Fertility In The Aging Male
Unlike the early fertility decline seen in women, a mans decrease in sperm characteristics occurs much later. Sperm quality deteriorates somewhat as men get older, but it generally does not become a problem before a man is in his 60s. Though not as abrupt or noticeable as the changes in women, changes in fertility and sexual functioning do occur in men as they grow older. Despite these changes, there is no maximum age at which a man cannot father a child, as evidenced by men in their 60s and 70s conceiving with younger partners. As men age, their testes tend to get smaller and softer, and sperm morphology and motility tend to decline. In addition, there is a slightly higher risk of gene defects in their sperm. Aging men may develop medical illnesses that adversely affect their sexual and reproductive function. Not all men experience significant changes in reproductive or sexual functioning as they age, especially men who maintain good health over the years. If a man does have problems with libido or erections, he should seek treatment through his primary care provider and/or urologist. Decreased libido may be related to low levels of testosterone.
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Can I Tell If Im Approaching Menopause
The frustrating reality is that there is great variation among women. Some women have few if any symptoms at age 50 and may be 1-5 years away from menopause. Other women have hot flashes at age 45 and may still be 1 7 years away from menopause. So the simple answer is noyou cant predict when youll be menopausal. But the question is thisdoes it matter?
I know it sounds like a ridiculous question but the truth is that menopause isnt treated according to whether or not you still have eggs left or estrogen is still being produced by the ovaries. Menopause is primarily treated because of symptoms that a woman experienceshot flashes, night sweats, palpitations, insomnia, etc. Whether or not youre still having periods and still producing estrogen these symptoms can still be addressed. You dont need to be officially menopausal to get relief of these symptoms.
A word about definitions
So the bottom line is this: avoid the confusion in trying to define exactly where you are in the menopause process. After all, menopause is just another aging processin this case the aging of the reproductive organs. Instead of trying to define where you are in the aging process, focus on whether or not youre feeling well, having symptoms or concerned about other aspects of menopause including the loss of skin elasticity, bone health, vaginal dryness or other menopause-related issue.
Women Have Just An Eighth Of Their Eggs Left By 30 Scientists Claim
Biological clock: Ninety-five per cent of women have just an eighth of their eggs left by the time they reach 30, according to scientists
Female fertility declines so rapidly that the average 30-year-old has barely an eighth of her eggs left, research has shown.
The first study to chart the fate of a woman’s supply of eggs from conception to the menopause found that by the age of 30, the average woman will have just 12 per cent of her eggs left.
Although the decline of a woman’s ‘ovarian reserve’ has been tracked before, this study is the first to track it from before birth right through to the end of child bearing years.
Researcher Dr Tom Kelsey, of St Andrews University, said: ‘There are women waiting for the next promotion or waiting to meet Mr Right.
‘Women often do not realise how seriously ovarian reserve declines after the age of 35.
‘Every year that goes by you are losing a big proportion of your ovarian reserve.
‘A lot of people get to their menopause in their mid or late 40s.; It is only the average age that is 50 or 51.’
Working with Edinburgh University experts, Dr Kelsey counted the number of eggs in the ovaries of 325 women of a variety of ages.
The information was then fed into a computer programme which worked out how the supply declined with time.
The analysis also showed that, up until the age of 25, lifestyle factors such as smoking or alcohol have little effect on a woman’s fertility.
The research is reported in the journal PLoS ONE.
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