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Which Of The Following Is True About Menopause

Will I Start Menopause If I Have A Hysterectomy

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During a hysterectomy, your uterus is removed. You wont have a period after this procedure. However, if you kept your ovaries removal of your ovaries is called an oophorectomy you may not have symptoms of menopause right away. If your ovaries are also removed, you will have symptoms of menopause immediately.

Social Construction Of Menopause: A Western Historical Context

Throughout history, menopause has had negative connotations. Hippocrates described a climacteric syndrome, which was attributed to a weak uterus causing women to lose power . In 1701, a physician argued that women 45 to 50 years of age develop a condition known as “hysterick fits” . As the label implies, the underlying premise was that menopause affects women on a psychologic level. Others believed that menstruation was a biologic way for the female body to eliminate poisonous chemicals, and lack of menstruation resulted in toxic accumulation . In Puritan New England, women were believed to be the weaker spiritual vessel, and the concept of menopause affecting women and not men was consistent with this overall concept that women were viewed as the weaker sex. Furthermore, it has been noted that the majority of women who were accused of witchcraft during this time were at the approximate age of menopause beginning .

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What Conditions Can Cause Early Menopause

Certain medical and surgical conditions can influence the timing of menopause.

Surgical removal of the ovaries

The surgical removal of the ovaries in an ovulating woman will result in an immediate menopause, sometimes termed a surgical menopause, or induced menopause. In this case, there is no perimenopause, and after surgery, a woman will generally experience the signs and symptoms of menopause. In cases of surgical menopause, women often report that the abrupt onset of menopausal symptoms results in particularly severe symptoms, but this is not always the case.

The ovaries are often removed together with the removal of the uterus . If a hysterectomy is performed without removal of both ovaries in a woman who has not yet reached menopause, the remaining ovary or ovaries are still capable of normal hormone production. While a woman cannot menstruate after the uterus is removed by a hysterectomy, the ovaries themselves can continue to produce hormones up until the normal time when menopause would naturally occur. At this time, a woman could experience the other symptoms of menopause such as hot flashes and mood swings. These symptoms would then not be associated with the cessation of menstruation. Another possibility is that premature ovarian failure will occur earlier than the expected time of menopause, as early as one to two years following the hysterectomy. If this happens, a woman may or may not experience symptoms of menopause.

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How Does Menopause Affect Bone Health

The older a person is, the greater their risk of osteoporosis. A persons risk becomes even greater when they go through menopause. When your estrogen level decreases during menopause, you lose more bone than your body can replace. This makes your bones weaker and more likely to break. To keep your bones strong, its important to get enough calcium and vitamin D in your diet. These help your body absorb calcium. Your doctor can suggest ways to get more calcium through food, drink, and, possibly, a calcium supplement. They may also suggest that you take a vitamin D supplement to help your body process calcium. Ask your doctor what amount of daily calcium and vitamin D is right for you.

Ht Forms And Regimens

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HT comes in several forms:

  • Oral tablets or pills
  • Vaginal ring
  • Topical gel or spray

HT pills and skin patches are considered “systemic” therapy because the medication delivered affects the entire body. The risk for blood clots, heart attacks, and certain types of cancers is higher with hormone pills than with skin patches or other transdermal forms.

Vaginal forms of HT are called “local” therapy. Doctors generally prescribe vaginal applications of low-dose estrogen therapy to specifically treat menopausal symptoms such as vaginal dryness and pain during sex. This type of ET is available in a cream, tablet, or ring that is inserted into the vagina.

“Bioidentical” Hormones

“Bioidentical” hormone therapy is promoted as a supposedly more natural and safer alternative to commercial prescription hormones. Bioidentical hormones are typically compounded in a pharmacy. Some compounding pharmacies claim that they can customize these formulations based on saliva tests that show a woman’s individual hormone levels.

The FDA and many professional medical associations warn patients that “bioidentical” is a marketing term that has no scientific validity. Formulations sold in these pharmacies have not undergone FDA regulatory scrutiny. Some of these compounds contain estriol, a weak form of estrogen, which has not been approved by the FDA for use in any drug. In addition, saliva tests do not give accurate or realistic results, as a woman’s hormone levels fluctuate throughout the day.

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Oral Contraceptives And Vaginal Treatments

Oral contraceptive pills

Oral contraceptive pills are another form of hormone therapy often prescribed for women in perimenopause to treat irregular vaginal bleeding. Women in the menopausal transition tend to have considerable breakthrough bleeding when given estrogen therapy. Therefore, oral contraceptives are often given to women in the menopause transition to regulate menstrual periods, relieve hot flashes, as well as to provide contraception. They are not recommended for women who have already reached menopause, because the dose of estrogen is higher than that needed to control hot flashes and other symptoms. The contraindications for oral contraceptives in women going through the menopause transition are the same as those for premenopausal women.

Local hormone and non-hormone treatments

There are also local hormonal treatments for the symptoms of vaginal estrogen deficiency. Local treatments include the vaginal estrogen ring , vaginal estrogen cream, or vaginal estrogen tablets. Local and oral estrogen treatments are sometimes combined for this purpose.

Vaginal moisturizing agents such as creams or lotions as well as the use of lubricants during intercourse are non-hormonal options for managing the discomfort of vaginal dryness.

Home Remedies: Plant Estrogens

Plant estrogens

Isoflavones are chemical compounds found in soy and other plants that are phytoestrogens, or plant-derived estrogens. There is a perception among many women that plant estrogens are “natural” and therefore safer than HT, but medical researchers haven’t proven this scientifically. Most scientific studies have not shown a benefit of phytoestrogens in controlling hot flashes. In addition, there is concern that some phytoestrogens might act like estrogen in some tissues of the body. Therefore, many experts recommend that women who have a history of breast cancer avoid phytoestrogens.

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Evaluation For Hormone Therapy

All candidates for HT should be thoroughly evaluated with a detailed history and complete physical examination for a proper diagnosis and identification of any contraindications.

Baseline laboratory and imaging studies before administering HT include the following:

  • Hemography

  • Fasting lipid profile

  • Blood sugar levels

  • Serum estradiol levels: In women who will be prescribed an implant and in those whose symptoms persist despite use of an adequate dose of a patch or gel

  • Serum follicle-stimulating hormone levels: To monitor women taking oral preparations for symptomatic control, especially those with premature menopause

  • Ultrasonography: To measure endometrial thickness and ovarian volume

  • Electrocardiography

  • Papanicolaou test

  • Mammography: Performed once every 2-3 years and annually after the age of 50 years

Endometrial sampling is not required in routine practice. However, the presence of abnormal bleeding before or during HT should prompt consideration of ultrasonography to check endometrial thickness , followed by outpatient Pipelle sampling and hysteroscopy. In women with a tight cervix, formal hysteroscopy and dilation and curettage under general anesthesia are advised.

Lifestyle Factors In Controlling The Symptoms And Complications Of Menopause

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Many of the symptoms of menopause and the medical complications that may develop in postmenopausal women can be lessened or even avoided by taking steps to lead a healthy lifestyle.

Which types of doctors treat menopausal symptoms?

The symptoms of menopause are often treated by a womanâs gynecologist. Primary care providers, including family medicine specialists and internists, may also treat the symptoms of menopause.

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What Is Premature Menopause

Menopause, when it occurs between the ages of 45 and 55, is considered “natural” and is a normal part of aging. But, some women can experience menopause early, either as a result of a surgical intervention or damage to the ovaries . Menopause that occurs before the age of 45, regardless of the cause, is called early menopause. Menopause that occurs at 40 or younger is considered premature menopause.

Facts You Should Know About Menopause

  • Menopause is defined as the absence of menstrual periods for 12 months. It is the time in a woman’s life when the function of the ovaries ceases.
  • The process of menopause does not occur overnight, but rather is a gradual process. This so-called perimenopausal transition period is a different experience for each woman.
  • The average age of menopause is 51 years old, but menopause may occur as early as the 30s or as late as the 60s. There is no reliable lab test to predict when a woman will experience menopause.
  • The age at which a woman starts having menstrual periods is not related to the age of menopause onset.
  • Symptoms of menopause can include abnormal vaginal bleeding, hot flashes, vaginal and urinary symptoms, and mood changes.
  • Complications that women may develop after menopause include osteoporosis and heart disease.
  • Treatments for menopause are customized for each woman.
  • Treatments are directed toward alleviating uncomfortable or distressing symptoms.

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Can My Diet Affect How Well I Sleep

The following tips can help reduce sleep problems:

  • Eat regular meals at regular times.
  • Avoid late-night meals and heavy late-night snacks.
  • Limit caffeine, which is found in coffee, tea, chocolate, and cola drinks. Caffeine stays in the bloodstream for up to 6 hours and can interfere with sleep.
  • Avoid alcohol. It may make you feel sleepy, but it actually affects the cycle of REM and non-REM sleep. This may cause you to wake up throughout the night.

Emotional And Cognitive Symptoms

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Women in perimenopause often report a variety of thinking and/or emotional symptoms, including fatigue, memory problems, irritability, and rapid changes in mood. It is difficult to determine exactly which behavioral symptoms are due directly to the hormonal changes of menopause. Research in this area has been difficult for many reasons.

Emotional and cognitive symptoms are so common that it is sometimes difficult in a given woman to know if they are due to menopause. The night sweats that may occur during perimenopause can also contribute to feelings of tiredness and fatigue, which can have an effect on mood and cognitive performance. Finally, many women may be experiencing other life changes during the time of perimenopause or after menopause, such as stressful life events, that may also cause emotional symptoms.

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Cardiovascular Disease And Hrt

Women over 60 have a small increased risk of developing heart disease or stroke on combined oral HRT. Although the increase in risk is small, it needs to be considered when starting HRT, as the risk occurs early in treatment and persists with time.

Oestrogen used on its own increases the risk of stroke further if taken in tablet form, but not if using a skin patch. Similarly, tibolone increases the risk of stroke in women from their mid-60s.

Women who commence HRT around the typical time of menopause have lower risks of cardiovascular disease than women aged 60 or more.

Hrt For Breast Cancer Survivors

It is advisable for women with a history of breast cancer to avoid HRT unless other treatments are ineffective, and their quality of life is made intolerable by menopausal symptoms. In these circumstances, HRT should only be prescribed in consultation with the womans breast surgeon or oncologist.

Evidence has not conclusively shown that HRT will increase the risk of breast cancer recurring in a woman with a history of the disease. However, oestrogen and progestogens may stimulate some types of cells in the breast and some types of HRT use have been associated with an increase in the risk of breast cancer in women without a history of breast cancer.

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Increased Risk Of Some Health Conditions

After menopause, the risk of certain health issues appears to increase. Menopause does not cause these conditions, but the hormonal changes involved may play some role.

Osteoporosis: This is a long-term condition in which bone strength and density decrease. A doctor may recommend taking vitamin D supplements and eating more calcium-rich foods to maintain bone strength.

Cardiovascular disease: The American Heart Association note that, while a decline in estrogen due to menopause may increase the risk of cardiovascular disease, taking hormone therapy will not reduce this risk.

Breast cancer: Some types of breast cancer are more likely to develop after menopause. Menopause breast cancer, but hormonal changes involved appear to increase the risk.

Skin changes can also occur around the time of menopause. Find out more.

Can Menopause Affect My Sex Life

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After menopause, your body has less estrogen. This major change in your hormonal balance can affect your sex life. Many menopausal women may notice that theyre not as easily aroused as before. Sometimes, women also may be less sensitive to touch and other physical contact than before menopause.

These feelings, coupled with the other emotional changes you may be experiencing, can all lead to a decreased interest in sex. Keep in mind that your body is going through a lot of change during menopause. Some of the other factors that can play a role in a decreased sex drive can include:

  • Having bladder control problems.
  • Having trouble sleeping through the night.
  • Experiencing stress, anxiety or depression.
  • Coping with other medical conditions and medications.

All of these factors can disrupt your life and even cause tension in your relationship. In addition to these changes, the lower levels of estrogen in your body can actually cause a decrease in the blood supply to the vagina. This can cause dryness. When you dont have the right amount of lubrication in the vagina, it can be thin, pale and dry. This can lead to painful intercourse.

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Alternative And Complementary Menopause Treatments

Some studies have found that soy products relieve hot flashes, but researchers are still looking into it. There arenât many large studies on whether other supplements such as black cohosh or âbioidenticalâ hormones work for menopause symptoms. Talk to your doctor before starting any herbal or dietary supplements.

Yoga, tai chi, and acupuncture are safer ways to manage menopause symptoms.

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.

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Pregnancy Is Still Possible

Menopause marks the end of a females reproductive years, but it is still possible to become pregnant around or after this time.

Perimenopause can start 4 8 years before menopause. As long as menstruation continues, a person can become pregnant. However, the chances of conceiving and having a full-term pregnancy decline as a person approaches menopause.

Advances in reproductive technology mean it is also possible to become pregnant after menopause. This will usually be with donated eggs or embryos that the individual preserved earlier in life.

There may be a higher risk of pregnancy loss, preterm birth, and risks to the womans health, depending on the individuals age and health status at the time of conception.

However, as one points out, younger people who have not entered menopause may also experience similar issues.

Learn more here about becoming pregnant around the time of menopause.

Cardiovascular Issues And Menopause

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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.

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