MENOPAUSE
Some women continue to menstruate normally until the onset of menopause and then simply cease to have periods. But for most women, the transition is not so orderly. You can expect to see a variety of changes. What they are and why they happen is the subject of the discussion that follows. Under other headings, you'll find more on the symptoms and management of the most troubling of these problems.
Changing Hormonal Patterns
A woman's egg supply, as much as 2 million in the ovaries at birth, is programmed for depletion. When the supply is almost exhausted because of the aging process, or the ovaries are surgically removed, the menstrual cycle comes to an end. In fact, the reproductive cycle begins to change several years before menopause, a period referred to as perimenopause.
During this time, typically starting in the late 40's, the ovaries' response to the various stimulating hormones produced by the brain becomes unsynchronized, until eventually the aging ovaries fail to respond at all. They start to produce less progesterone, losing their ability to ovulate and develop the subsequent corpus luteum. When ovulation stops, estrogen levels decline and menstruation ceases.
As ovulatory cycles become more irregular throughout perimenopause, the body's sensitive hormonal rhythm is thrown off and menstruation may vary more from month to month. In addition, two hormones known as androgens begin to play a bigger role. Though referred to as male sex hormones, they are in fact produced in small amounts by the female body as well. As levels of the female hormones decline, the impact of these "male" hormones can increase.
The bottom line is that fluctuating blood levels of hormones during the transitional years can create a number of physiological changes. These may be less unsettling for women who have an understanding of what their bodies are going through.
A woman's egg supply, as much as 2 million in the ovaries at birth, is programmed for depletion. When the supply is almost exhausted because of the aging process, or the ovaries are surgically removed, the menstrual cycle comes to an end. In fact, the reproductive cycle begins to change several years before menopause, a period referred to as perimenopause.
During this time, typically starting in the late 40's, the ovaries' response to the various stimulating hormones produced by the brain becomes unsynchronized, until eventually the aging ovaries fail to respond at all. They start to produce less progesterone, losing their ability to ovulate and develop the subsequent corpus luteum. When ovulation stops, estrogen levels decline and menstruation ceases.
As ovulatory cycles become more irregular throughout perimenopause, the body's sensitive hormonal rhythm is thrown off and menstruation may vary more from month to month. In addition, two hormones known as androgens begin to play a bigger role. Though referred to as male sex hormones, they are in fact produced in small amounts by the female body as well. As levels of the female hormones decline, the impact of these "male" hormones can increase.
The bottom line is that fluctuating blood levels of hormones during the transitional years can create a number of physiological changes. These may be less unsettling for women who have an understanding of what their bodies are going through.
Menopause at a Glance
See Chart AboveThe wide array of problems on the chart may seem daunting; but fortunately, few women experience every one of them. Hot flashes are the most common complaint. However, these annoying sensations pass in due course, while other symptoms may pose a much greater long-term threat. Be particularly alert for lower back pain, which may signal the onset of osteoporosis, the bone-weakening disorder that leaves older women prey to fractures. Remember, too, that menopause robs you of estrogen's protective effect on the heart, and that heart disease is the Number One killer of women. (For more information, see "Heart Disease: The Greatest Threat of All.")
Changes in the Menstrual Cycle
Cyclical Changes occur for the vast majority of women whose periods do not just stop. The perimenopausal years may be marked by skipped menstrual periods, heavier or lighter than usual bleeding, and changes in the frequency of cycles. During some menstrual cycles, no egg may be produced; these are called anovulatory cycles.
Light, short, or skipped periods occur as the ovaries' hormonal response becomes unpredictable. Heavy and prolonged bleeding arise when a longer than normal release of estrogen overstimulates growth of the uterine lining. The lining may be irregular or thickened and may not slough off completely or evenly, causing menstruation to stop and start again. Clotting may be noticeable in menstrual bleeding.
The physical changes that accompany the menstrual cycle may also become less predictable and regular. Such signs as breast tenderness, fluid retention and headache may occur at unpredictable times.
Fertility declines as a woman enters her 40s, but it does not disappear entirely until menopause is complete. To avoid unplanned pregnancies, doctors recommend using birth control until a full year has passed since the last menstrual cycle.
Cyclical Changes occur for the vast majority of women whose periods do not just stop. The perimenopausal years may be marked by skipped menstrual periods, heavier or lighter than usual bleeding, and changes in the frequency of cycles. During some menstrual cycles, no egg may be produced; these are called anovulatory cycles.
Light, short, or skipped periods occur as the ovaries' hormonal response becomes unpredictable. Heavy and prolonged bleeding arise when a longer than normal release of estrogen overstimulates growth of the uterine lining. The lining may be irregular or thickened and may not slough off completely or evenly, causing menstruation to stop and start again. Clotting may be noticeable in menstrual bleeding.
The physical changes that accompany the menstrual cycle may also become less predictable and regular. Such signs as breast tenderness, fluid retention and headache may occur at unpredictable times.
Fertility declines as a woman enters her 40s, but it does not disappear entirely until menopause is complete. To avoid unplanned pregnancies, doctors recommend using birth control until a full year has passed since the last menstrual cycle.
Muscle Tone and Elasticity
Skin and mucous membranes in various parts of the body become drier because of the decline in estrogen levels and the aging process in general. Women who once worried about oily skin may now find their skin dry and itchy and may need to apply moisturizers and hand creams.
As the body ages and the estrogen level declines, the fatty layer beneath the skin surface that makes the skin appear supple and youthful begins to shrink from a loss of elasticity and moisture. The outer skin layer is now looser than the deeper layers, and begins to fold and wrinkle. The skin may also develop a rougher texture.
During midlife, it is especially important to protect your skin from the sun. Aging skin produces less melanin, the pigment that causes your skin to tan instead of burn. This decreases your natural protection from harmful UV rays.
Thinning skin also reveals any harmful effects of previous years of sun exposure. Limiting sun exposure and using sunscreen is a prudent and effective way to delay aging of the skin.
Vaginal Changes are the first sign of approaching menopause for some women, while many do not notice changes until five to ten years after menopause. As estrogen levels drop, the vulva and vagina lose elasticity, resulting in vaginal dryness, itching and a shrinking process known as vaginal atrophy in which the vagina becomes shorter and narrower at the opening. Vaginal membranes also become thinner, hold less moisture, and lubricate more slowly. The thinner vaginal lining becomes more susceptible to tears. Reduced secretion of cervical mucus can add to the problem. The result of all these changes can be discomfort, vaginal infections, and painful intercourse.
Skin and mucous membranes in various parts of the body become drier because of the decline in estrogen levels and the aging process in general. Women who once worried about oily skin may now find their skin dry and itchy and may need to apply moisturizers and hand creams.
As the body ages and the estrogen level declines, the fatty layer beneath the skin surface that makes the skin appear supple and youthful begins to shrink from a loss of elasticity and moisture. The outer skin layer is now looser than the deeper layers, and begins to fold and wrinkle. The skin may also develop a rougher texture.
During midlife, it is especially important to protect your skin from the sun. Aging skin produces less melanin, the pigment that causes your skin to tan instead of burn. This decreases your natural protection from harmful UV rays.
Thinning skin also reveals any harmful effects of previous years of sun exposure. Limiting sun exposure and using sunscreen is a prudent and effective way to delay aging of the skin.
Vaginal Changes are the first sign of approaching menopause for some women, while many do not notice changes until five to ten years after menopause. As estrogen levels drop, the vulva and vagina lose elasticity, resulting in vaginal dryness, itching and a shrinking process known as vaginal atrophy in which the vagina becomes shorter and narrower at the opening. Vaginal membranes also become thinner, hold less moisture, and lubricate more slowly. The thinner vaginal lining becomes more susceptible to tears. Reduced secretion of cervical mucus can add to the problem. The result of all these changes can be discomfort, vaginal infections, and painful intercourse.
Breast Changes are also apparent as estrogen's stimulation of the breast tissue is reduced, causing glandular tissue to shrink. Loss of elasticity causes the breasts to droop and flatten, losing their earlier fullness. Nipples become smaller and flatter and may lose their erectile properties.
Women who have been bothered by breast tenderness and cysts related to the menstrual cycle are often relieved to find that these symptoms disappear after menopause.
Abdominal wall tone may lessen gradually as we age, resulting in a protruding stomach. Regular exercise to strengthen the abdominal muscles can help maintain muscle tone.
A sudden increase in the size of the abdomen may be the first warning sign of ovarian tumors. Stomach enlargement may also be caused by inadequate nutrition or exercise, but should be seen promptly by your gynecologist.
Women who have been bothered by breast tenderness and cysts related to the menstrual cycle are often relieved to find that these symptoms disappear after menopause.
Abdominal wall tone may lessen gradually as we age, resulting in a protruding stomach. Regular exercise to strengthen the abdominal muscles can help maintain muscle tone.
A sudden increase in the size of the abdomen may be the first warning sign of ovarian tumors. Stomach enlargement may also be caused by inadequate nutrition or exercise, but should be seen promptly by your gynecologist.
Hair, Bones, and Teeth
Hair all over the body can change in texture and quantity during menopause. For some women, the increased effects of the body's androgens can result in darker, thicker and wiry body hair on the pubis, underarms, face, chest, lower abdomen, and back. This sprouting of excess, coarse hair, known as hirsutism, is usually related to hormonal changes. However, not all cases of hirsutism are menopause-related, so check with your physician for proper diagnosis.
The softer hair on your head also begins to change in texture as you reach your forties. A loss of luster occurs because individual hair shafts begin to thin and dry as a result of hormonal changes. The replacement process for normal daily hair loss becomes slower, and new replacement hair is generally dryer, with less shine. Many women also note a thinning of pubic and underarm hair after menopause. Female baldness, a rare problem, may begin about age forty. See a dermatologist if hair loss persists.
Changes in hair texture and thickness can be minimized by avoiding over-styling. Good nutrition can also slow the brittleness of hair that comes with normal aging.
Bone strength is critical at all ages but particularly during and after menopause. As estrogen and progesterone levels fall drastically, the bones begin to lose mass. This causes them to become progressively more fragile. Backaches, common in midlife, may indicate the beginning of bone loss as a result of declining estrogen levels. These pains are localized, beginning in the lower back. Severe loss of bone becomes a condition called osteoporosis, which strikes at least half of all women age 50 and older. In fact, by the time a woman is 80, she may have lost 40 percent of her bone mass. Osteoporosis leaves a woman vulnerable to bone fractures, especially in the hip, spine, and wrist.
Teeth and the mouth are similarly affected. Dental problems that can occur around midlife, such as receding gums or loose teeth, may be related to declining levels of estrogen and a loss of bone mass. Gingivectomy, a procedure to repair the gums after periodontal disease, is a common oral surgery procedure for women in midlife, especially for those prone to osteoporosis. Maintenance of your teeth and gums, including daily cleaning, and flossing, professional cleaning and regular checkups, will help reduce your risk of these dental problems.
Hair all over the body can change in texture and quantity during menopause. For some women, the increased effects of the body's androgens can result in darker, thicker and wiry body hair on the pubis, underarms, face, chest, lower abdomen, and back. This sprouting of excess, coarse hair, known as hirsutism, is usually related to hormonal changes. However, not all cases of hirsutism are menopause-related, so check with your physician for proper diagnosis.
The softer hair on your head also begins to change in texture as you reach your forties. A loss of luster occurs because individual hair shafts begin to thin and dry as a result of hormonal changes. The replacement process for normal daily hair loss becomes slower, and new replacement hair is generally dryer, with less shine. Many women also note a thinning of pubic and underarm hair after menopause. Female baldness, a rare problem, may begin about age forty. See a dermatologist if hair loss persists.
Changes in hair texture and thickness can be minimized by avoiding over-styling. Good nutrition can also slow the brittleness of hair that comes with normal aging.
Bone strength is critical at all ages but particularly during and after menopause. As estrogen and progesterone levels fall drastically, the bones begin to lose mass. This causes them to become progressively more fragile. Backaches, common in midlife, may indicate the beginning of bone loss as a result of declining estrogen levels. These pains are localized, beginning in the lower back. Severe loss of bone becomes a condition called osteoporosis, which strikes at least half of all women age 50 and older. In fact, by the time a woman is 80, she may have lost 40 percent of her bone mass. Osteoporosis leaves a woman vulnerable to bone fractures, especially in the hip, spine, and wrist.
Teeth and the mouth are similarly affected. Dental problems that can occur around midlife, such as receding gums or loose teeth, may be related to declining levels of estrogen and a loss of bone mass. Gingivectomy, a procedure to repair the gums after periodontal disease, is a common oral surgery procedure for women in midlife, especially for those prone to osteoporosis. Maintenance of your teeth and gums, including daily cleaning, and flossing, professional cleaning and regular checkups, will help reduce your risk of these dental problems.
Menopause: Myths and Realities
Myth: Menopausal women are unhappy and depressed.
Reality: Most women cope very well with the physical challenges of menopause. Serious mental health problems do not increase. While some women may experience emotional distress, this is often related to sleep disturbance and deprivation due to hot flashes.
Myth: All women going through menopause are plagued by hot flashes.
Reality: About 80 percent of American women experience only mild symptoms, or none at all, during menopause. When hot flashes do occur, in most cases they are mild and disappear after a few months, rarely persisting for more than 2 or 3 years.
Myth: Menopause is the end of your sex life.
Reality: Libido, or sexual desire, does decline with aging, but many women continue to enjoy a satisfying sex life deep into old age. Some women find sex more enjoyable after menopause when concerns about pregnancy are past.
Myth: Menopausal women are unhappy and depressed.
Reality: Most women cope very well with the physical challenges of menopause. Serious mental health problems do not increase. While some women may experience emotional distress, this is often related to sleep disturbance and deprivation due to hot flashes.
Myth: All women going through menopause are plagued by hot flashes.
Reality: About 80 percent of American women experience only mild symptoms, or none at all, during menopause. When hot flashes do occur, in most cases they are mild and disappear after a few months, rarely persisting for more than 2 or 3 years.
Myth: Menopause is the end of your sex life.
Reality: Libido, or sexual desire, does decline with aging, but many women continue to enjoy a satisfying sex life deep into old age. Some women find sex more enjoyable after menopause when concerns about pregnancy are past.
Last Updated: January 1, 2003
2007 Thomson Healthcare. All Rights Reserved.
2007 Thomson Healthcare. All Rights Reserved.
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