Menopause
Menopause
What is menopause?
Menopause is a natural phase in life that occurs to every woman. Literally it means “the end of monthly cycles" which defines the point in time when a woman experiences her last menstrual period. However, menopause does not occur suddenly or abruptly. It usually follows a biological and natural transition which tends to occur over a period of years in three different stages: perimenopause, menopause and postmenopause. This can be referred to as the menopausal transition.- Perimenopause is the first stage in the menopausal transition that leads to menopause. During this period, the ovaries begin to produce smaller amounts of estrogen leading to irregular menstrual cycles. The average age of perimenopause in Canada is 45.1 years – but it can start anytime between ages 39 and 51.[1]
- Menopause is the point in time where the menstrual cycle is interrupted permanently due to a decline of estrogen in the body. It is said that a woman has reached menopause when she has had no menstrual periods for 12 consecutive months. The average age of menopause in Canada is 51.[2]
- Postmenopause is the last stage in the menopausal transition. It begins right after a woman has reached menopause and continues for the rest of her lifetime. It is expected that Canadian women spend approximately one third of their life in this stage.[3]
[1]SOGC. (February 2006).The Menopause Handbook: a companion guide to the Society of Obstetricians and Gynaecologists of Canada Menopause Consensus Report. Page 2.
What causes menopause?
As a woman goes through the menopausal transition, the ovaries, which produce estrogen during the child-bearing years,begin to produce less of this hormone as menopause is being reached. This will cause irregularities in the menstrual cycle. Then, eventually, the ovaries will produce less and less estrogen until they shut down, thus a woman will no longer have menstrual periods.[1]Even though menopause occurs naturally in most women, it can also be induced due to unusual events, such as when the ovaries are damaged by radiation, chemotherapy or other medications; or when the uterus is surgically removed (hysterectomy). Induced menopause is distinct from natural menopause because levels of estrogen are abruptly reduced in the body.[2]
[1]Rice, G. (Updated March 17, 2011). Female hormones. Net Doctor. Retrieved on April 27, 2011 from http://www.netdoctor.co.uk/womenshealth/features/hormone.htm
What are the symptoms related to menopause?
During the menopausal transition, the body may experience uncomfortable and challenging symptoms that cansignificantly impact a woman’s quality of life.During perimenopause most women will experience vasomotor symptoms. These symptoms usually last from 6 months to 2 years, however they may last longer. Vasomotor symptoms include the following:
· Hot Flashes
· Night sweats
· Sleep disturbances
· Anxiety attacks
· Nausea and Dizziness
· Fatigue
· Irritability
· Changes in mood, concentration and memory
During postmenopause, most women will experience urogenital and sexual symptoms that develop progressively as estrogen levels in the body decrease. Due to this, in some cases, urogenital and sexual symptoms may appear earlier in perimenopause.
Different from vasomotor symptoms, urogenital symptoms progress and worsen with time unless treated. Urogenital and sexual symptoms include the following:
· Vaginal dryness, discharge and bleeding
· Itching
· Burning sensation
· Pain during sexual intercourse or dyspareunia
· Decrease or loss of libido
· Recurrent urinary tract infection, urge and stress incontinence
Hormonal deficiency due to menopause may also lead to other symptoms such as osteoporosis, unwanted facial hair, joint pain, skin or soft tissue and breast tenderness.
For more information on urogenital and sexual symptoms go to the section “Menopause and the Vaginal Health”.
What are my treatment options?
Depending on the severity the symptoms, a doctor may recommend a treatment for the relief of these symptoms.Women are often treated with low doses of hormones with a treatment called hormone replacement therapy (HRT). Yet when hormones are not an option due to its risks and adverse effects; non-hormonal therapies can be prescribed as alternatives to hormone replacement therapy. According to the Society of Obstetricians and Gynaecologists of Canada (SOGC), hormone replacement therapy is the most effective option for the treatment of menopausal symptoms.[1]
Talk to your doctor to see which treatment option is right for you.
[1]SOGC. (February 2006).The Menopause Handbook: a companion guide to the Society of Obstetricians and Gynaecologists of Canada Menopause Consensus Report.
How can I manage the symptoms related to menopause?
For some women reaching menopause, lifestyle modifications and behavioural changes can reduce the severity of the symptoms and make your transition through this phase easier.[1] Lowering the core body temperature using a fan, keeping cool by dressing in light layers, and consuming cold foods and drinks may help prevent hot flashes.[2] [3] The following lifestyle modifications are recommended[4]:
Diet
Canada’s Food Guide, recommends a diet rich in plant-based foods, low in saturated fat and trans-fatty acids, high in dietary fibre, and accompanied by six to eight glasses of water per day. This diet provides adequate nutrients and vitamins for most women throughout the stages of menopause. It may also be necessary to consider taking supplements to obtain optimal amounts of calcium, vitamin D and folate.
Exercise
Weight Gain
As women experience perimenopause, weight gain is common, but not inevitable. This is a result of a natural reduction in the metabolic rate, and in most cases can be minimized or controlled by following a low-fat diet combined with a moderate exercise plan.
Stress
Stress can affect someone’s quality of life at any age, and for many women, seems to increase during the menopausal transition. Stress reduction strategies that may be beneficial include regular exercise, yoga, tai chi, massage, meditation, paced respiration, and relaxation techniques. Some of these techniques have also been helpful in relieving vasomotor symptoms.
Smoking
Smoking during menopause may require higher doses of estrogen to control vasomotor symptoms, and although contraceptive pills are commonly prescribed to control irregular bleeding and vasomotor symptoms during perimenopause, they should not be used by women who smoke, or who use nicotine patches or gum.
Alcohol
Alcohol aggravates menopausal symptoms such as hot flashes, insomnia, and depression and may contribute to weight gain by adding empty calories to the diet. Therefore, alcohol should be avoided.
Caffeine
Caffeine may aggravate menopausal symptoms such as hot flashes and insomnia. Consuming more than three cups of caffeinated beverages daily may increase the risk of hip fracture. It is therefore prudent to limit the intake of caffeine-containing foods and beverages and to add low-fat milk to coffee and tea as a means of increasing calcium intake.
[1] SOGC. (February 2006).The Menopause Handbook: a companion guide to the Society of Obstetricians and Gynaecologists of Canada Menopause Consensus Report. Page 3.