Menopause In Women - Part II

Summary of Part I

The term "menopause" comes from two Greek words that mean "month" and "to end." It translates as "the end of the monthlies." The medical definition of menopause is the absence of menstruation (periods) for twelve (12) months. Perimenopause is the transition from reproductive life into menopause and it can range from 2 to 15 years (2 to 6 average), the period though irregular is still seen during this transition.

Things That Occur During Menopause:

Hot Flashes

Changes In Menstrual Cycles

Mood Changes And Irritability

Difficulty With Memory And Attention Span

Insomnia

Vaginal Dryness

Urinary leakage

Skin And Hair Changes

What Are Some Of The Unnatural Causes That Can Result In Menopause?

Chemotherapy.

Radiation.

Surgery.

Drugs (GNRH analogues).

What Can Women Do About The Symptoms Of Menopause (Perimonopause)?

There are many choices in dealing with symptoms associated with approaching menopause. These include:

Healthy Lifestyle Changes;

Hormone Replacement Therapy (HRT);

Other Medications;

Social Support; and

Therapy.

What is a Hysterectomy?

A Hysterectomy is the surgical removal of the uterus and cervix. Sometimes one or both ovaries are removed as well.

Does Having a Hysterectomy result in Menopause?

Not always. If the womb isremoved and the ovaries are left intact, one's menstrual periods will stop. However, the ovaries, which are left behind, will continue to produce estrogen and other ovarian hormones, hence the individual would not be menopausal. If the ovaries are removed at surgery however the patient will be menopausal from that point onwards.

What Effect Does Menopause Have On Sexual Function?

The two main effects are:

Reduced sexual drive.

Decreased vaginal lubrication or vaginal dryness. This can in turn cause painful intercourse and further reduce interest in sex.

What Can Be Used For Vaginal Dryness?

Here are some of the things that can be done to prevent or lessen the effects of vaginal dryness:

Hormone Replacement Therapy (HRT);

Locally applied estrogen cream; and

Locally applied lubricant such as K-y jelly.

What Can Be Done For Persons With A Low Sexual Drive?

Here are some of the things that can be done to improve sexual functions of persons with low sexual drives:

Hormone Replacement Therapy (HRT) has some impact on improving one's sexual drive. In particular, there is a HRT preparation which has an androgen precursor called Gynodian DHEA and estradiol (these are given as intramuscular injections at 6 to 10 week intervals);

Good general health; and

Testosterone Cream.

Menopause And Some Health Alternatives And Drawbacks

Hot Flashes:

Does HRT help? Yes. Estrogen alleviates hot flashes and night sweats. It also relieves mood swings in women with disturbed sleep.

Alternatives: Most research on HRT has involved the drugs Prempro or Premarin, which contain estrogens derived from the urine of pregnant mares. Alternative "bio-identical" or "natural" hormones, such as Tri-est or estrace, contain estrogen synthesized from plants. But these drugs have not been as thoroughly tested.

Other proven treatments for hot flashes include low doses of the antidepressants Effexor (venlafaxine), Prozac (fluoxetine), and paxil (paroxetine).

Some women say Soy relieves their symptoms, but clinical evidence is equivocal. Evening Primrose Oil has been proven more effective than placebo.

Vaginal Dryness:

Does HRT help? Yes.

Alternatives: Estrogen products inserted in the vagina work. These include rings such as Estring, creams such as Estrace, and Premarin, and tablets such as Vagifem and Premarin. Vitamin E suppositories or non-hormonal lubricants such as K-Y jelly may also help some women.

Please note that Premarin comes in both cream and tablet forms.

Heart Attack and Stroke:

Does HRT help? No. In the WHI study that was recently halted, women who took estrogen-progestin therapy had more heart attacks and strokes. Whether estrogen-alone therapy protects from heart disease is unclear.

Alternatives: aerobic exercise and a healthy diet reduce the risk of heart disease. (smoking increases the risk.) More powerful tools include the statin drugs for lowering cholesterol; beta blockers and ACE inhibitors for lowering blood pressure; and aspirin for reducing the risk of heart attack and stroke

Broken Bones:

Does HRT help? Yes. HRT slows down bone loss in postmenopausal women.

Alternatives: Two other classes of drugs strengthen bones, they are Bisphosphonates such as Fosamax (Alendronate) which reduces the risk of fractures, but they can cause damage to the esophagus. Selective Estrogen Receptor Modulators, or SERMs, such as Evista (Raloxifene), also reduce fracture risk. But SERMs can aggravate hot flashes and increase the risk of blood clots. Proven methods for building stronger bones include weight-bearing exercises such as Weightlifting, Yoga, Taichi, Or Even Walking: also taking Calcium and Vitamin D supplements: not smoking, and limiting alcohol also helps.

Alzheimer's Disease:

Does HRT help? So far, No. Estrogen increases blood flow and stimulates neurons. But in clinical trials, HRT has not improved symptoms or slowed their progression in Alzheimer's disease patients with dementia.

Incontinence:

Does HRT help? No. The Heart and Estrogen/Progestin Replacement Study (HERS) was a very large study that revealed HRT could even exacerbate incontinence.

Alternatives: Avoiding coffee and other drinks containing caffeine, a diuretic, can help. So can Kegel exercises, which strengthen pelvic floor muscles. Studies have also show estrogen vaginal creams are effective. Women who have problems during athletics may want to try one of several FDA-approved devices (such as Fem-Assist of the Reliance Urinary Control Insert) that are placed temporarily in or over the urethra.

Wrinkles:

Does HRT help? Possibly estrogen strengthens collagen, the connective tissue that makes skin elastic and flexible; stimulates the fat layer that underlies and help fill out the skin; and helps skin retain moisture. Most doctors say smooth skin is not reason enough to use hormone therapy.

Alternatives: Experts advise slathering on the moisturizer and sunscreen; avoiding direct sun exposure; drinking eight 8 ounce glasses of water each day; and not smoking. Prescription skin products containing retinoic acid, such as Renova or Retin-a, may improve fine lines, wrinkles, and sun damage somewhat, but some women find they cause dryness, redness, and itching

How Do I Know If It's Time To Stop Using Hormones?

In general, doctors are steering patients away from using HRT for more than five years. If you've been using hormones for menopausal symptoms, you may want to try getting off after two to three years. “I suggest women to try to wean themselves of therapy slowly and see how they feel,” says Jan Shifren, M.D., director of the Menopause Program at Massachusetts General Hospital in Boston. “If they feel miserable, they probably should go back on and try again in another six months to a year”.

For more information on “MENOPAUSE IN WOMEN ”, please call The Bahamas Family Planning Association Representative at Telephone 325-2326 of the Health Education Division at Telephone 502-4848.