Are You In Menopause?


If you are a woman between the ages of 48 and 54 and your last period was six months ago, you are probably in menopause. If you've had a complete hysterectomy or are taking estrogen blockers for breast cancer, you are also in menopause, even if you are younger.

About fifteen percent of women experience no symptoms at menopause. If you are one of those lucky few, it's likely that your hormones have declined gradually as your periods tapered off and you have neither too much estrogen—leading to cystic breasts, excessive bleeding, anxiety or insomnia—nor too much progesterone—leading to depression and fatigue that are often misdiagnosed.

You may see a slight increase in weight, and a slight rise in your cholesterol level and blood pressure. You will want to maintain a good exercise regimen, and eat a diet of whole grains, fresh fruits and vegetables that contain antioxidants and other critical vitamins and minerals, and avoid caffeine, sugar and saturated fats. It's a good idea to get a bone mass index test and take calcium and vitamin D supplements to ward off osteoporosis.

If your last period was six months ago but you are not between the ages of 48 and 54 and have not experienced a medical or surgical procedure to explain your symptom, you may be in premature ovarian failure or be experiencing very early menopause, or ovulation may have stopped for other reasons.

Tests that will assist you and your physician in figuring out what is happening in your body include tests for FSH (follicle stimulating hormone) levels, which are usually high when a woman is in menopause. You may also want to have tests for anemia, thyroid function, blood sugar and liver function, as well as a pap smear.

The rest of menopausal women typically experience some or all of the following symptoms. Here are some explanations for what's causing them and what can be done to relieve them.

Are You In Menopause? (<i>cont'd</i>)

Do you have hot flashes?

Hot flashes are a sensation of heat suffusing your neck, head and face for a few seconds to a few minutes. They are thought to be caused by increasingly strong signals from the hypothalamus, a small pea-sized structure in your brain, which sets off secretions (follicle stimulating hormone or FSH) from the pituitary gland that are meant to trigger ovulation by stimulating the production of estrogen in your ovaries.

It is also thought that the second brain signal in the ovulation process, luteinizing hormone or LH, which is intended to trigger the release from the follicle of a matured egg into the fallopian tube, is also involved in hot flashes. The sharp decrease in your body's production of progesterone when ovulation has stopped may have something to do with this process as well.

The hypothalamus is also your body's thermostat, sending chemical signals to cool off the body when it gets too hot. During menopause, the hypothalamus appears to go awry, sending its cooling-off signal at the wrong time. As a result, after the hot flash, many women have chills. About 85 percent of women experience hot flashes, some for a few months, some for as many as five years. You may have heart palpitations, sweating, chills or dizziness along with hot flashes.

Some women get relief from hot flashes with estrogen replacement therapy or hormone replacement therapy (a combination of estrogen and progesterone). Other women find vitamin E supplements are helpful, and still others are using alternative remedies such as black cohosh to relieve hot flashes. Other helpful lifestyle changes include reducing the amount of caffeine in all forms that you consume, reducing smoking (which constricts blood vessels), and increasing aerobic exercise to improve blood flow.

Do you have trouble getting to sleep, staying asleep, or waking too early?

Sleep disturbances are common in menopause. Either you can't get to sleep or you wake frequently during the night and don't get enough REM (rapid eye movement) sleep, thought to be essential for rest. The next morning, you are exhausted. Over time, this constant battle for sleep takes its toll.

The regular production of estrogen, progesterone, and androgens (testosterone) during ovulation has helped to regulate your sleep cycle, until now. In menopause, lower levels of progesterone, a natural sedative, in relation to fluctuating levels of estrogen—which, when high, can cause anxiety and restlessness—leave you less able to drift off into restful sleep and stay asleep. Women who suffer from night sweats, the nighttime equivalent of hot flashes, also experience sleep disturbances and may awake in the middle of the night with their sheets soaked.

Women have tried a number of solutions to this problem. Changing your exercise time to earlier in the day rather than in the evening after work may help. Avoiding all caffeine products is advisable. Some women have had success with hormone replacement therapy and others have turned to herbal remedies such as chamomile tea or kava kava. Consult your healthcare provider about what may work for you.

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If you are feeling chronically tired, it's a good idea to get liver function and thyroid function tests. Often women in menopause have undiagnosed hypothyroidism, which significantly affects their metabolism of food into energy, as well as their mood.

Are you forgetful or unable to concentrate?

Forgetfulness, short-term memory loss, feeling confused or distracted, or being unable to focus or concentrate are symptoms of the brain fog that often accompanies menopause. Mental clarity for women is linked to estrogen, for which there are many receptors in the brain. The drop in estrogen levels at menopause affects these brain functions.

Many women become so forgetful or unable to concentrate at menopause that they worry they have Alzheimer's disease. It's likely not Alzheimer's. Unfortunately, recent studies published in The Journal of the American Geriatric Societyand theJournal of the American Medical Associationappear to indicate that estrogen replacement therapy is not the solution to this problem of forgetfulness and inability to concentrate.

However, there are lifestyle solutions that may help you. Oxygen is critical for brain function. Your brain uses 20 percent of your body's total energy production. So you need to support your body in transporting oxygen and critical nutrients to your brain. Many doctors suggest that women avoid sugar, red meat, saturated fats, alcohol, and caffeine, as well as give up smoking.

In addition, increasing consumption of whole grains, fresh, raw fruits and vegetables that are high in natural antioxidants such as vitamin C and beta carotene should help. Oranges, grapefruits, carrots, sweet potatoes, tomatoes, broccoli and green leafy vegetables are in this category. Other women benefit from increasing consumption of cold water fish such as salmon and decreasing the number of red-meat meals eaten each week.

You might consider lowering stress levels by practicing yoga or t'ai chi or meditation or by listening to soothing music and practicing deep breathing. Some women have had good results with gingko biloba, an herbal vasodilator that has been tested in 400 studies for its effect on memory and attention. There is no one-size-fits-all in women's health. Ask your healthcare provider what would work best for you.

Have you lost your sex drive?

Loss of sex drive, or libido, is tied to a drop in testosterone, the male hormone a woman's body naturally produces when she ovulates that causes her to want to have sex at the time that an egg is ready to be fertilized. When you stop ovulating at menopause, your testosterone production drops by about half.

Usually you will have had hot flashes and vaginal dryness (as the tissues thin and do not lubricate during sex as well) before you experience this symptom. Many doctors are now prescribing a very low dose of testosterone to restore a woman's libido at menopause.

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There are also estrogen creams, such as Premarin, that you can apply directly to the vagina to build up tissues. Estrogen will rebuild vaginal cells, relieving dryness and painful intercourse, and also help to restore sensation and orgasmic intensity, and it will reduce bladder infections.

Do you have stiff or aching joints?

Joint pain, which first shows up as early morning stiffness, is generally caused by the progressive deterioration of cartilage in your joints called osteoarthritis. Cartilage is the rubbery tissue that covers the ends of your bones and acts like a shock absorber where bones meet.

You have this cartilage at your hip joints, knees, elbows, fingers, wrists, ankles, shoulders, neck, toes and jaw, and between the vertebrae in your spine. As you age, this cartilage wears down until bone grinds on bone. The conventional treatment for osteoarthritis is aspirin in various forms and strengths.

But recently, combinations of glucosamine, which stimulates the manufacture of the chains of sugars, amino acids and sulfur that make up the GAG layer critical to joint movement, and MSM (methylsulfonlmethane), an anti-inflammatory derived from foods, seem to be gaining popularity as well for relieving pain and restoring movement. Check with your physician.

Are you having bladder control problems?

During your reproductive years, constant production of estrogen kept many of the tissues in your body doing their job correctly. As you age, and your estrogen production decreases, the lining of your bladder thins and the muscle structures that support it weaken.

As a result, a smaller amount of urine in your bladder causes you to feel that you must void sooner than you did before (urge incontinence) and you may have leakage when you sneeze, exercise, cough, or dance (stress incontinence). About one in six women have a problem with stress incontinence between the ages of 40 and 65. Doctors often recommend kegel exercises to strengthen the muscles that control voiding, reducing coffee intake because coffee is a diuretic, and the application of estrogen cream directly to the urethral tissue. A very low dose, such as 0.5 mg estriol cream, is sufficient to solve the problem according to some physicians. There are also urinary control inserts that may work for you. Ask your doctor about your options.