What Happens At Menopause
Women are born with about a million eggs in each ovary. By puberty about 300,000 eggs remain, and by menopause there are no active eggs left.
On average, a woman in Australia will have 400-500 periods in her lifetime. From about 35-40 years of age, the number of eggs left in your ovaries decreases more quickly and you ovulate less regularly until your periods stop. Menopause means the end of ovulation.
Cardiovascular Issues And Menopause
Coronary artery disease is the leading cause of morbidity and mortality in men and postmenopausal women. Menopause increases the risk for women still further, independent of age. Before menopause, the risk of CAD for women lags behind the risk for men by approximately 10 years after menopause, it catches up. As a result, mortality from CAD is increasing in women. The Framingham study was pivotal in showing the relation between menopause and increased cardiovascular mortality.
The Womens Health Initiative was a randomized, controlled trial that addressed the issue of whether postmenopausal women should take hormone therapy or estrogen therapy for prevention of CAD more than 27,000 healthy women participated in the trial. The investigators concluded that hormone therapy and estrogen therapy are not indicated for the prevention of CAD.
Emerging analyses of WHI data from the Estrogen-Alone Triala double-blind, placebo-controlled, randomized clinical trial evaluating the effects of conjugated equine estrogens on chronic disease incidence among postmenopausal women with prior hysterectomy and after a mean of 7.1 years of follow-upsuggested that treatment effects differ by age. Compared with older women, younger women receiving CEE had a lower risk of CAD.
When Does Menopause Begin And How Long Does It Last
Most women first begin developing menopause symptoms about four years before their last period. Symptoms often continue until about four years after a womans last period.
A small number of women experience menopause symptoms for up to a decade before menopause actually occurs, and 1 in 10 women experience menopausal symptoms for 12 years following their last period.
The median age for menopause is 51, though it may occur on average up to two years earlier for Black and Latina women. More studies are needed to understand the onset of menopause for women of color.
There are many factors that help determine when youll begin menopause, including genetics and ovary health. Perimenopause occurs before menopause. Perimenopause is a time when your hormones begin to change in preparation for menopause.
It can last anywhere from a few months to several years. Many women begin perimenopause some point after their mid-40s. Other women skip perimenopause and enter menopause suddenly.
About 1 percent of women begin menopause before the age of 40, which is called premature menopause or primary ovarian insufficiency. About 5 percent of women undergo menopause between the ages of 40 and 45. This is referred to as early menopause.
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How Is Amenorrhea Diagnosed
Contact your family doctor or a gynecologist if you think you have amenorrhea. If youve never menstruated, the doctor will review your health history and do an exam. A regular physical and pelvic check can show signs of puberty.
For secondary amenorrhea, the doctor will begin with a pregnancy test. If this is negative, he or she will do an exam and review your health history.
Your doctor may order additional tests to rule out or determine a cause. A karyotype test looks at your chromosomes. A genetic test looks for the mutated FMR1 gene. Imaging tests can look at your female organs. A blood test can check your:
- Thyroid function .
- Ovary function .
- Testosterone levels, which can detect PCOS.
- Estrogen levels.
What Causes Uterine Prolapse
Your uterus is held in place within the pelvis by a group of muscles and ligaments. You may hear this called the pelvic floor muscles. When these structures weaken, they become unable to hold the uterus in position, and it begins to sag. Several factors can contribute to the weakening of the pelvic muscles, including:
- Loss of muscle tone as the result of aging.
- Injury during childbirth, especially if you have had many babies or large babies .
- Chronic constipation.
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Shifting The Narrative And Getting Help
Though perimenopause presents as so many different symptoms, there are treatments available. However, there is not one single solution, Dr. Faubion said. The treatment is symptom dependent: If heavy or irregular bleeding is the issue, an intrauterine device, or a birth control pill could help. A low-dose birth control pill may also relieve hot flashes. Birth control pills are made up of so many different permutations and combinations of hormones, its important to discuss which one is right based on your medical history and individual needs, Dr. Nachtigall said. If mood issues are the biggest complaint, an antidepressant might be appropriate. .
Ongoing longitudinal studies are finding associations between women with intense perimenopause symptoms in midlife, and risks of heart disease and osteoporosis in later years. Currently, there is not evidence to support the use of vitamins or supplements like black cohosh or magnesium, contrary to claims that these products help with hot flashes.
Despite expanded and continuing research, finding a knowledgeable physician who wont dismiss your symptoms or tell you theres nothing they can do to help is a struggle for many women. Ms. McKaig said that though her therapist diagnosed her as perimenopausal, her family doctor keeps telling her that her symptoms cant be perimenopause because shes still having her period sometimes. She said shes given up trying to educate her.
Production Of The Female Gametes
The female gametes are the oocytes, which develop within the ovaries within a specialized location termed the follicle. As the oocyte develops, the size and shape of the follicle also changes. When maturation of the oocyte is complete, it is released from the follicle following the secretion of luteinizing hormone from the pituitary gland. The release of the oocyte involves the rupture of the follicle, the process of which is termed ovulation. Following ovulation, the follicle forms the corpus luteum, which prepares the uterine lining for implantation of a fertilized egg via the secretion of progesterone. A detailed diagram of the menstrual cycle is shown above. In females, testosterone is required for proper bone and muscle development, as well as libido . It has been found that female testosterone levels are associated with the degree of sexual arousal.
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Pros & Cons Of Replacing Hormones
Since menopause is caused by a decrease in estrogen and progesterone, why not just replace them and continue on? Hormone replacement therapy is an option for many women who wish to combat the health risks that increase during their postmenopausal years. But this therapy may have its own risks.
Benefits: Estrogen therapy may relieve hot flashes, night sweats, vaginal dryness and protect against bone loss.
Risks: Estrogen-only therapy may increase your risk of breast and uterine cancer, stroke, heart disease, and deep vein thrombosis. Combine hormone therapy could cause an increased risk of breast cancer, stroke, heart disease, deep vein thrombosis, and gallbladder disease.
Talk to your doctor about the right approach to managing your health changes after menopause.
Age Of Depression And Menopause
Studies looking at the age of menopause and depression have found that a later age at menopause and a longer reproductive period are associated with a reduced risk of depression, and it seems that longer exposure to estrogen produced by the body is the reason. Those who go through early menopause appear to be at an increased risk of depression and should talk to their doctors about this possibility.
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Breast Cancer And Menopause
Estrogen therapy is known to benefit postmenopausal women in a multitude of ways, mostly through the relief of vasomotor symptoms associated with postmenopause. Estrogen is also beneficial for the prevention and treatment of osteoporosis.
Much controversy exists about the use of estrogen and breast cancer. Some studies show an increased risk of breast cancer with postmenopausal estrogen use others show a decrease. A possible link to cancer is also suggested by the finding that breast cancer risk is increased in women with an earlier age at menarche and a later age at menopause. However, a reduction in risk is observed with early age at pregnancy and the interruption of menstrual hormonal changes. The role of estrogen in the development of breast cancer continues to be studied.
In the Womens Health Initiative , the incidence of breast cancer increased in the estrogen-plus-progestin versus placebo arm of the study however, the incidence of breast cancer decreased in the estrogen-only versus placebo arm of the study .
Additional follow-up in patients from the WHI suggested similar results: Breast cancer incidence and mortality were increased in the estrogen-plus-progestin group as compared with the placebo group. The role of combined estrogen-plus-progesterone therapy continues to be puzzling in the development of breast cancer.
Perimenopause Vs Menopause Vs Postmenopause
During perimenopause, menstrual periods become irregular. Your periods may be late, or you may completely skip one or more periods. Menstrual flow may also become heavier or lighter.
Menopause is defined as a lack of menstruation for one full year.
Postmenopause refers to the years after menopause has occurred.
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Stop Middle Age Weight Gain
These are my 8 Tips to help you stop menopause weight gain. Estrogen deficiency, the state we find ourselves in once we are in menopause, is associated with insulin resistance and mid center weight gain. Even without changing our exercise routine or diet, women face an increased risk of weight gain, diabetes, and heart disease, just by going through the normal stages of aging. For us women, it can feel that we have lost all control of our bodies. It is my mission to inform all women on the tips and tricks so they can navigate the aging process in optimal health, without weight gain or disease.
What Are Proper Lifting Techniques
There are several tips for lifting heavy objects that can help you avoid injury. These techniques for lifting include:
- Do not try to lift objects that are oddly shaped or too heavy for you to lift alone. Also, avoid lifting heavy objects above waist level.
- Before you lift an object, make sure you have firm footing.
- To pick up an object that is lower than the level of your waist, keep your back straight, and bend at your knees and hips. Do not bend forward at the waist with your knees straight.
- Stand with a wide stance close to the object you are trying to pick up, and keep your feet firm on the ground. Tighten your stomach muscles and lift the object using your leg muscles. Straighten your knees in a steady motion. Do not jerk the object up to your body.
- Stand completely upright without twisting. Always move your feet forward when lifting an object.
- If you are lifting an object from a table, slide it to the edge to the table so that you can hold it close to your body. Bend your knees so that you are close to the object. Use your legs to lift the object and come to a standing position.
- Hold packages close to your body with your arms bent. Keep your stomach muscles tight. Take small steps and go slowly.
- To lower the object, place your feet as you did to lift, tighten stomach muscles and bend your hips and knees.
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Keeping Cool And Staying Comfortable
Dress in loose, layered clothing, especially during the nighttime and during warm or unpredictable weather. This can help you manage hot flashes.
Keeping your bedroom cool and avoiding heavy blankets at night can also help reduce your chances of night sweats. If you regularly have night sweats, consider using a waterproof sheet under your bedding to protect your mattress.
You can also carry a portable fan to help cool you down if youre feeling flushed.
Bioidentical Or Traditional Hormone Therapy
Traditional hormone therapy uses plant derived, man made hormones or hormones found in the urine of pregnant horses. Patients can take it orally, via patch, or topically to the genital area.
Bioidentical hormones are plant derived or man-made hormones similar to the ones your body produces. Some bioidentical hormones are the same as those used in conventional products. Others are not FDA approved and are available only from compounding pharmacies.
Bioidentical products can include a variety of estrogens, progesterone, testosterone or other hormones. Common bioidentical preparations include one or more of three estrogens: estradiol, estriol, and estrone. The estradiol in a traditional hormone therapy regimen is the same as in a bioidentical one. Typically bioidentical hormones are prescribed topically at a dose designed to affect the whole body. They can also be used topically in the vaginal area or given orally.
If a woman still has her uterus, it is important to combine both bioidentical and traditional preparations of estrogen with progesterone to prevent uterine cancer.
According to the Food and Drug Administration , bioidentical hormones arent safer or more effective than the traditional hormones, however, there is some debate in this area. There is some data that topical estrogens are safer than oral. Groups like the American College of Obstetrics and Gynecologists caution against the use of compounded products specifically, citing safety concerns.
Ask Yourself The Following Questions:
- What is the treatment?
- What are the side effects?
- Is it effective?
- How much does it cost?
Once you answer these questions, discuss the therapy with your doctor. Make sure your doctor knows what therapy you are considering in order to discuss possible interactions or side effects with your current treatment.
Can Amenorrhea Be Prevented Or Avoided
It is hard to prevent amenorrhea. Try to maintain a healthy diet and exercise plan. If you are underweight or overweight, talk to your doctor about how to find a balance. Once you begin to menstruate, keep track of your periods each month. This can help identify amenorrhea early on and aid in your diagnosis and treatment. It also is good practice if you try to become pregnant in the future.
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How Is Uterine Prolapse Diagnosed
The healthcare provider will perform a pelvic examination to determine if the uterus has lowered from its normal position. During a pelvic exam, the healthcare provider inserts a speculum and examines the vagina and uterus. Your provider will feel for any bulges caused by the uterus dropping down into the vaginal canal.
What Are The Symptoms Of Uterine Prolapse
If you have a mild case of uterine prolapse, you may not have any obvious symptoms. However, as the uterus slips further out of position, it can place pressure on other pelvic organssuch as the bladder or boweland cause symptoms like:
- A feeling of heaviness or pressure in the pelvis.
- Urination problems, including involuntary loss of urine , the need to urinate frequently or the sudden urge to urinate .
Symptoms can get worse when you stand or walk for long periods of time. In these positions, gravity places extra pressure on the pelvic muscles.
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Does Hrt Come From Horses Urine What Hrt Is Suitable For Vegans
Certain forms of old-fashioned/traditional HRT are derived from horses urine . These types of HRT are known as conjugated equine oestrogens .
However, plant-based HRT is widely available and in many places, such as the UK, is prescribed first line. This plant-based form of oestrogen is termed oestradiol and is body-identical , meaning that it has the same molecular structure as the oestradiol we produce in our bodies pre-menopause.
Transdermal oestradiol is suitable for vegans. Oestradiol implants/pellets are also vegan-friendly. The vast majority of HRT tablets are not suitable for vegans as they tend to contain lactose and/or gelatine .
In vegan patients who require progesterone-cover , the levonorgestrel intrauterine system would be a suitable choice. For vaginal/vulval symptoms Intrarosa pessaries are vegan friendly.
Premarin is not suitable for vegans as it is extracted from the urine of pregnant mares.
Trouble Focusing And Learning
In the lead-up to menopause two-thirds of women may have difficulty with concentration and memory.
Keeping physically and mentally active, following a healthful diet, and maintaining an active social life can help with these issues. For example, some people benefit from finding a new hobby or joining a club or a local activity.
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What Happens And How Does It Feel
For some women this loss of reproductive ability may be deeply felt, and for all women the menopause is a personal experience, not just a medical condition. However, the diminishing release of oestrogen from the ovary as women advance into their 40s is often the cause of symptoms which can be distressing and may need medical attention.
Hot flushes are the most common symptom of the menopause, occurring in three in every four menopausal women. Other common symptoms include night sweats, sleeplessness, vaginal dryness, irritated skin, more frequent urinary incontinence and urinary tract infections, low mood and a reduced interest in sex. Symptoms vary hugely in duration, severity and what impact they have on women.
All the common symptoms of the menopause are associated with a decrease in the bodys production of oestrogen. Oestrogen lack can affect many parts of the body, including the brain, causing changes in emotional well-being, and the skin, influencing its elasticity and thickness.
There is also some evidence that oestrogen deficiency is the cause of some chemical changes in the body which make women after the menopause especially vulnerable to heart disease and stroke.