Diagnosing Menopause

Before menopause, the female body produces the hormones estrogen and progestero Menopause | Additional Resources | Imaginis - The Women's Health & Wellness Resource Network

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Diagnosing Menopause

Before menopause, the female body produces the hormones estrogen and progesterone in the ovaries. Estrogen works to regulate a woman’s monthly menstrual cycle and secondary sexual characteristics (such as breast development and function), and also prepares the body for fertilization and reproduction. Progesterone is released each month during menstruation to prepare the uterus for possible pregnancy and to prepare the breasts for lactation (milk production). As a woman reaches menopause, typically around 50 years old, her body produces less and less estrogen and progesterone.

This loss of estrogen and progesterone usually results in irregular periods and other symptoms such as hot flashes, vaginal changes, sleep disturbances, etc. At this time, a woman’s physician will usually test her follicle stimulating hormone (FSH) level. FSH is a hormone that is secreted by the body’s pituitary gland to stimulate growth of ova (female reproductive eggs). As the ovaries produce less estrogen, the pituitary gland increases production of FSH to try to stimulate the ovaries into producing more estrogen.

While FSH levels can help determine a woman’s stage of menopause, FSH levels do tend to fluctuate from month-to-month during peri-menopause. Women who take oral contraceptive pills will have to temporarily stop taking them so that their FSH levels can be measured accurately. In addition, as a woman nears menopause, the walls of her vagina will become thinner and dryer. At this time, the physician may take a sample of the vaginal wall when performing a Pap smear. However, it is also important for a woman to keep track of her menstrual periods when they begin to become irregular to help her physician know when she is in the pre-menopausal and peri-menopausal stages.

Coping With Short Term Effects of Menopause

While menopausal symptoms (hot flashes, vaginal dryness, sleep disturbances, etc.) are temporary, they are usually bothersome to most women. There are a variety of ways to treat these symptoms, from natural remedies (such as dressing in layers to reduce the effects of hot flashes) to taking hormone replacement therapy.

Hormone replacement therapy (HRT) is synthetic estrogen and/or progesterone (called progestin). It is designed to "replace" a menopausal woman’s depleting hormone levels. HRT helps to relieve hot flashes and other menopausal symptoms. Research has also shown that HRT may also help prevent osteoporosis, heart disease, short-term memory loss, depression and other diseases or conditions in post-menopausal women.

While HRT can greatly reduce menopausal symptoms and may provide protection against other diseases and conditions, there is also conflicting evidence that supports a link between HRT and an increased risk for breast cancer. However, current research shows the risk to be small and that it appears to be related to the duration of treatment and the general breast cancer risk of the patient. Further research will provide more information on the risks of HRT. Because HRT can provide many benefits, patients and physicians should make the decision about HRT together, based on a woman’s individual medical situation and circumstances.

For women who choose not to take HRT, there are a variety of over-the-counter products available. Some of these products contain phytoestrogens, natural chemicals that act like a weak form of estrogen. Some research suggests that products containing phytoestrogens (such as soy) may help alleviate menopausal symptoms, although further research is still needed to confirm this association. Women should discuss the use of these products with their physicians, as they may not be appropriate for all women.

Some women find that regular exercise can improve hot flashes. Calcium is also thought to reduce the occurrence of hot flashes. The National Institute on Aging provides the following suggestions to help improve hot flashes:

In 2001, the American College of Obstetricians and Gynecologists (ACOG) issued new practice guidelines to physicians regarding the use of over-the-counter botanical products as alternatives to HRT in relieving menopausal symptoms. The chart below summarizes their findings.

ACOG Summary: Botancial Products to Treat Menopausal Symptoms

Soy May be effective at relieving menopausal symptoms for two years or less. Safe in dietary amounts. Large amounts may be harmful for women who have or have had breast cancer or other women.
Black Cohosh May be effective at relieving menopausal symptoms for six months or less.
Wild and Mexican Yam Not expected to be effective at relieving menopausal symptoms.
Dong Quai Not expected to be effective at relieving menopausal symptoms. Potentially toxic. May increase risk for skin cancer.

Source: American College of Obstetricians and Gynecologists. Click here for more information.

  • Dress in easily removable layers
  • Drink a glass of cold water or juice at the onset of a flash
  • Keep a thermos of ice water by the bed to drink when needed
  • Keep an ice pack by the bed at night to use on the skin when a hot flash occurs
  • Use cotton sheets, lingerie and clothing which lets the skin "breathe"

Women who experience vaginal dryness, irritation, or discharge are encouraged to ask their physicians about using vaginal lubricants to help relieve these symptoms. In some cases, vaginal discharge can be an indication of a more serious condition, such as endometrial cancer (cancer of the uterine lining), and may require further investigation.

Menopause and Osteoporosis

The loss of estrogen at menopause is associated with a significantly increased risk of osteoporosis. Osteoporosis is a decrease in normal bone mineral density. A loss of bone density causes bones to become brittle, and in turn, may lead to more frequent fractures and other serious effects. It is estimated that one in two women over 50 will have an osteoporosis-related fracture.

Before a woman reaches her mid-30s, her body gains more bone than it loses. Around age 35, this process balances out. However, the onset of menopause (and a decrease in estrogen) around 50 years of age may speed up the rate of bone loss. Bone loss, known as osteopenia, may eventually become more severe and result in osteoporosis. When this occurs, a woman is at greater risk for bone injury and fracture, even with relatively minor trauma.

The key to avoiding severe effects from osteoporosis and bone fractures associated with the condition is prevention. Women may protect themselves from severe bone loss by:

 Click here for more information on osteoporosis.

Menopause and Heart Disease

When a woman reaches menopause, her risk of heart disease increases due to a loss of estrogen. An estimated 9,000 American women under age 45 have heart attacks each year versus 250,000 women over age 65. Researchers believe that estrogen helps protect women against heart disease in their reproductive years and appears to help maintain lower cholesterol levels and improve artery flexibility and expandability. Pre-menopausal women are still at risk of heart disease, but the risk is significantly lower than for post-menopausal women, according to researchers. When a woman’s estrogen production ceases at menopause, her arteries tend to lose their flexibility and her risk of heart disease increases significantly since no collateral (back-up) blood supply is developed.

Because many of the other risk factors for heart disease are controllable, women can minimize their risk of heart disease by focusing on these controllable risk factors. Many of these risk factors can be changed with modifications to diet, exercise, or drug therapy. Women should talk to their physicians about their risk of heart disease and how best to minimize this risk.

Controllable risk factors for heart disease include:

  • High cholesterol
  • High blood pressure
  • Smoking
  • Obesity
  • Lack of physical activity
  • Stress

  Click here to learn more about heart disease.

Regular Physical Exams After Menopause

Because menopause and advancing age increase the risk for several diseases and conditions, it is very important that women continue to receive annual physical exams once they reach menopause.

Women 40 years of age and older should have the following specific exams every year in addition to an overall physical exam:

Beginning at age 50, women should also have a sigmoidoscopy every three to five years to screen for colon cancer. A sigmoidoscopy involves examining the rectum and lower portion of the colon. Women who have a family history of cancer or other illnesses should talk to their physicians about beginning screening exams at an earlier age. With continued focus on their health, women can continue to lead long, productive lives for decades after menopause.

Additional Resources and References

Updated: January 15, 2008