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changes that no longer allow her to get pregnant. It is a natural event that normally occurs in women age 45 55.
Symptoms
Symptoms vary from woman to woman. They may last 5 or more years. Some women may have worse symptoms than others. Symptoms of surgical menopause can be more severe and start more suddenly. The first thing you may notice is that your periods start to change. They might occur more often or less often. Some women might get their period every 3 weeks. This might last for 1 - 3 years before the periods completely stop. Common symptoms of menopause include:
Menstrual periods that occur less often and eventually stop Heart pounding or racing Hot flashes, usually worst during the first 1 - 2 years Night sweats Skin flushing Sleeping problems (insomnia)
Other symptoms of menopause may include: Decreased interest in sex, possibly decreased response to sexual stimulation
Forgetfulness (in some women) Headaches Mood swings including irritability, depression, and anxiety Urine leakage Vaginal dryness and painful sexual intercourse Vaginal infections Joint aches and pains Irregular heartbeat (palpitations)
Estradiol FSH LH
Your health care provider will perform a pelvic exam. Decreased estrogen can cause changes in the lining of the vagina. Bone loss increases during the first few years after your last period. Your doctor may order a bone density test to look for bone loss related to osteoporosis.
Treatment
Treatment for menopause depends on many things, including how bad your symptoms are, your overall health, and your preference. It may include lifestyle changes or hormone therapy. HORMONE THERAPY
Hormone therapy may help if you have severe hot flashes, night sweats, mood issues, or vaginal dryness. Hormone therapy is treatment with estrogen and, sometimes, progesterone. Talk to your doctor about the benefits and risks of hormone therapy. Your doctor should be aware of your entire medical history before prescribing hormone therapy (HT). Learn about options that do not involve taking hormones. Several major studies have questioned the health benefits and risks of hormone therapy, including the risk of developing breast cancer, heart attacks, strokes, and blood clots. Current guidelines support the use of HT for the treatment of hot flashes. Specific recommendations:
HT should not be used in women who started menopause many years ago, except for estrogen vaginal creams. The medicine should not be used for longer than 5 years.
Women taking HT have a low risk for stroke, heart disease, blood clots, or breast cancer.
To reduce the risks of estrogen therapy, your doctor may recommend: A lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream or skin patch rather than a pill) Frequent and regular pelvic exams and Pap smears to detect problems as early as possible
Frequent and regular physical exams, including breast exams and mammograms
If you have a uterus and decide to take estrogen, you should also take progesterone to prevent cancer of the lining of the uterus (endometrial cancer). If you do not have a uterus, you do not need progesterone. See also: Hormone therapy
ALTERNATIVES TO HORMONE THERAPY There are other medicines available to help with mood swings, hot flashes, and other symptoms. These include:
Antidepressants, including paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac)
A blood pressure medicine called clonidine Gabapentin, a seizure drug that also helps reduce hot flashes
DIET AND LIFESTYLE CHANGES Hormones are not always needed to reduce symptoms of menopause. There are many steps you can take to reduce symptoms. Diet changes:
Avoid caffeine, alcohol, and spicy foods. Eat soy foods. Soy contains estrogen. Get plenty of calcium and vitamin D in food or supplements.
Do Kegel exercises every day. They strengthen the muscles of your vagina and pelvis. Practice slow, deep breathing whenever a hot flash starts to come on. Try taking six breaths a minute. Try yoga, tai chi, or meditation.
Other tips:
Dress lightly and in layers. Keep having sex. Use water-based lubricants or a vaginal moisturizer during sex. See an acupuncture specialist.
Complications
Some women have vaginal bleeding after menopause. This is often nothing to worry about. However, you should tell your health care provider if this occurs. It may be an early sign of other health problems, including cancer. Decreased estrogen levels have been linked with some long-term effects, including: Bone loss and osteoporosis in some women
You have had 12 consecutive months with no period and suddenly vaginal bleeding or spotting begins again, even if it is a very small amount
Prevention
Menopause is a natural and expected part of a woman's development and does not need to be prevented. You can reduce your risk of long-term problems such as osteoporosis and heart disease by taking the following steps: Control your blood pressure, cholesterol, and other risk factors for heart disease.
Do NOT smoke. Cigarette use can cause early menopause. Eat a low-fat diet.
Get regular exercise. Resistance exercises help strengthen your bones and improve your balance. If you show early signs of bone loss or have a strong family history of osteoporosis, talk to your doctor about medications that can help stop further weakening.
feeling. Remember, menopause isn't simply physical changes, but emotional and spiritual changes as well. 4. Mood swings, sudden tears. Note: Mood swings can include anything from mood shifts (happy one moment, depressed the next) to sudden bouts of crying when nothing overt has occurred to cause the crying. Mood swings can and have been misdiagnosed as bipolar disorder because one can feel such extremes of emotions due to hormone imbalance. Anxiety, depression, panic attacks and even feelings of agoraphobia aren't uncommon during menopause. The panic attacks often can develop with the onset of hot flashes. For some women, hot flashes can be severe and quite frightening. 5. Trouble sleeping through the night (with or without night sweats). Note: This can develop into insomnia or just waking at 2 in the morning for an hour. Relaxation and breathing exercises can be useful at this time. 6. Irregular periods: shorter, lighter or heavier periods, flooding, and phantom periods. Note: A phantom period is when you experience all the symptoms you're accustomed to having before you menstruate -- but... no period comes. This is a common experience during perimenopause before a woman's period actually stops. 7. Loss of libido (sex drive). Note: Not every woman loses her libido entirely during perimenopause, although some may temporarily. Many women simply have a decreased interest in sex - often it's simply because they generally don't feel well and sex is the last thing on their mind! Also, bear in mind that there are many medications that can affect one's libido, including the anti-depressants some women take to cope with the depression and anxiety associated with menopause to anti-hypertensives. 8. Dry vagina (results in painful intercourse) 9. Crashing fatigue. Note: I've never been able to determine if the "fatigue" associated with perimenopause is a symptom in and of itself, or if it's a side effect of the cumulative symptoms and general exhaustion (from them) many women experience. Take all the symptoms and "dump" them on one person -- is it any wonder perimenopausal women are so fatigued? If you can, try to find time to grab a nap. One of the things that helped my fatigue, and it's all chronicled in my personal odyssey to find remedies, is the use of considerable amounts of soy isoflavones and protein, which I found in Revival Soy. I can't say that it specifically targeted and relieved the crashing fatigue, but it helped so many other symptoms and gave me a burst of energy, that I feel comfortable in attributing the fatigue relief to Revival. There are various vitamins, such as those in the "B" family that can help with fatigue as well. Also, increased amounts of vitamin C.
10. Anxiety, feeling ill at ease. Note: One of the biggest complaints during menopause. 11. Feelings of dread, apprehension, and doom (includes thoughts of death, picturing one's own death). Note: It's possible that this can be a manifestation of depression associated with menopause, or possibly feelings that come from going through daily discomfort through a difficult menopause transition that can last anywhere from 3-12 years. A woman living under these circumstances can feel totally overwhelmed and frightened by the physical, psychological and spiritual changes. When there seems to be no reprieve from the suffering, for some it can leave them feeling drained wondering when and IF they'll ever feel well again. It isn't unusual for women at this time of life to have thoughts about dying. One phase of their life is coming to a close (not soon enough for many). There may be apprehension and fear about moving on to the next phase of life and wondering whether things will get better or worse. 12. Difficulty concentrating, disorientation, & mental confusion. Note: Forgetfulness during perimenopause is often referred to lightly and humorously as "brain fog" but it's not always funny. 13. Disturbing memory lapses. 14. Incontinence -- especially upon sneezing, laughing: urge incontinence (reflects a general loss of smooth muscle tone). 15. Itchy, crawly skin (feeling of ants crawling under the skin, not just dry, itchy skin Note: the feeling of ants crawling on your skin is called "formication") 16. Aching, sore joints, muscles and tendons. (may include such problems as carpal tunnel syndrome). Note: Osteoarthritis can develop during perimenopause - and those with existing arthritic and/or rheumatic pain may find it's exacerbated during the menopausal transition. 17. Increased tension in muscles. 18. Breast tenderness. Note: Breast swelling, soreness, pain. 19. Headache change: increase or decrease. Note: Many women develop migraine headaches during perimenopause. However, if one doesn't have a history of migraine headeaches, they're generally a short-lived experience of perimenopause. 20. Gastrointestinal distress, indigestion, flatulence, gas pain, nausea. Note: For nausea, try some ginger or, as I use, boiling hot water
with a few teaspoons of lemon or lemon juice concentrate in it. Many women also develop acid reflux (Gerd). For some, it can be an uncomfortable feeling of severe burning sensations in the throat. If it persists, see your health care practitioner. 21. Sudden bouts of bloat. Note: Bloating, water retention are common complaints during perimenopause. Also, Acid reflux and heartburn are very common during perimenopause. Treat them as you would if you weren't going through menopause. 22. Depression (has a quality from other depression, the inability to cope is overwhelming, there is a feeling of a loss of self. Natural hormone therapy, ameliorates the depression dramatically). Note: There are various natural methods of treating depression. Read Power Surge's Menopause Survival Tips. Also, many women using progestins or progesterone supplementation experience "depression" as a side effect. Power Surge recommends only naturally compounded, bio-identical hormones. Naturally compounded estrogen and progesterone supplementation doses can be individually adjusted to suit each woman's needs. So, if a woman is experiencing depression from progesterone, the level of progesterone supplementation can be reduced until the compounding pharmacist comes up with the right blend. The combination of estrogen and progesterone is important in achieving the desired results. Other remedies, such as St. John's Wort can be very effective in alleviating the depression associated with menopause. My personal experience was that my perimenopause-related depression was eliminated when I started using Revival Soy Protein Revival is excellent for mood swings, but I was astonished by the impact it had on the hormonerelated "lows" I experienced before using it. 23. Exacerbation of any existing conditions. Note: Often, conditions women had prior to entering perimenopause become exaggerated (worse) during the menopause transition. 24. Increase in allergies. Note: Many women who suffer from allergies develop worse allergies during the menopausal years. Many women who've never had allergy or respiratory problems may develop them for the first time. Many people don't realize that histamine levels are affected by hormone levels. Women can develop wheezing, coughing and a host of respiratory problems. This generally disappears as the hormones level out once a woman becomes menopausal. 25. Weight gain. (is often around the waist and thighs, resulting in "the disappearing waistline" and changes in body shape.)
26. Hair loss or thinning, head or whole body, increase in facial hair. Note: There is often a loss of pubic hair during menopause. Many women are more comfortable simply shaving their pubic area instead of having patches of hair. 27. Dizziness, light-headedness, episodes of loss of balance. Note: Although common complaints during menopause, I always recommend anyone suffering from dizziness, dysequilibrium have her blood pressure checked just to be on the safe side. However, women can experience these symptoms during perimenopause without having hypertension. 28. Changes in body odor. Note: I wouldn't be too concerned about this one. It can happen, but in 13 years of running Power Surge, I've heard of relatively few cases of developing body odor during menopause. 29. Electric shock sensation under the skin & in the head ("take the feeling of a rubber band snapping against the skin, multiply it (exponentially, sometimes) radiate it & put it in the layer of tissues between skin & muscle & sometimes a precursor to a hot flash.") Note: Those buzzing sensations, as though you've put your finger into a live electrical socket, can be frightening. They're all part of the hormones, nerve endings and electrical waves running through our bodies when our hormones are constantly fluctuating. Many women experience this during perimenopause, but it eventually passes. 30. Tingling in the extremities (can also be a symptom of B-12 deficiency, diabetes, or from an alteration in the flexibility of blood vessels in the extremities.) 31. Gum problems, increased bleeding. 32. Burning tongue 33. Osteoporosis (after several years) 34. Brittle fingernails, which peel & break easily.
Acne and other skin eruptions Itching wildly and erratic rashes
Shoulder pain / joints / arthritis development or flare up in preexisting conditions "Heart pain" - a feeling of pain in the area of the heart (if persistent, get checked by your health care practitioner) Acid reflux / heartburn / difficulty digesting certain foods Some of the 34 signs may also be symptoms of one of the following:
mild discomfort, and some experience severe symptoms that impact their quality of life. Menstrual Changes Many women experience irregular periods due to the changing hormone levels and the decreased frequency of ovulation (egg release). The changes may be subtle at first and then gradually become more noticeable. Common changes include the following: Short cycles (less than 28 days)
Bleeding for fewer days than usual Heavier than usual bleeding Lighter than usual bleeding Missed periods
Although menstrual irregularities are expected during menopause, menstrual changes can also be caused by conditions such as fibroids or pregnancy. Women who experience heavy bleeding (usually with clots), periods that come more often than every 3 weeks, spotting between periods, or bleeding after intercourse should see their physician or other health care provider. After menopause, women no longer menstruate. Any woman who experiences vaginal bleeding after menopause should see her physician or other health care provider. Hormone treatments can sometimes cause vaginal bleeding to resume. Menopause & Hot Flashes As many as 85% of women experience hot flashes during menopause. Hot flashes are vasomotor symptoms that cause a warm or hot flushed sensation that usually begins in the head and face and then radiates down the neck to other parts of the body. There may be red blotches on the skin. Each hot flash averages 2.7 minutes and is characterized by: Sudden increase in heart rate
Hot flashes can occur before, during, or after menopause. They can begin when a woman's cycles are still regular or, more commonly, as menopause approaches and her cycles become irregular. They usually last for less than a year following the last menstrual period, although some women continue to experience hot flashes 5 to 10 years after menopause. Hot flashes can occur once a month, once a week, or several times an hour. They can happen any time of day or night. If they happen at night (i.e., night sweats), they can interrupt sleep and drench clothing and sheets. Loss of sleep can eventually lead to irritability and fatigue.
Self-care for Hot Flashes According to The Boston Women's Health Book Collective's Our Bodies, Ourselves for the New Century, women can do several things to prevent or reduce hot flashes: Eat enough calcium and other nutrients necessary for calcium absorption.
Limit caffeine (coffee, tea, alcohol, chocolate), alcohol, sugar, hot drinks and soups, and spicy foods. Every day eat at least one food rich in phytoestrogens, a form of estrogen that is found in soy products (soy milk, soy yogurt, soy nuts, tofu, miso, tempeh), legumes, and certain vegetables and fruits (squash, yams, carrots, papayas). Some women find vitamin B-complex helpful. Some women find vitamin E helpful (wheat germ, corn and soybean oil; brown rice and millet; legumes; corn; almonds). The evidence is inconclusive however, and some researchers warn that women who have breast cancer should NOT take vitamin E supplements. Stay active: Physical activity can relieve hot flashes, stress, and depression, and can improve sleep. Reduce stress: Hot flashes may increase in frequency and intensity during stressful times.
Menopause & Skin Changes Estrogen keeps the skin smooth and moist. The loss of estrogen during menopause makes the skin dry, thin, lax, and transparent. The blood vessels are easier to see, and the skin bruises easily.
Menopause & Vaginal Changes Women may experience vaginal changes. In particular, the tissues of the vagina and vulva may become thin and dry (called vaginal atrophy), which can lead to itching and discomfort during sexual intercourse. In some women, vaginal dryness is the first sign of menopause. In one study about 20% of the women reported experiencing vaginal dryness, and 15% found it "bothersome." Vaginal dryness can be treated with hormone replacement therapy, vaginal lubricants and moisturizers, and by eating foods high in phytoestrogens (e.g., soy foods).
Menopause & Psychological Changes Although many women think that depression and anxiety are inevitable consequences of menopause, there is no scientific evidence to support this. For example, studies have shown that women at midlife are less likely to be depressed than younger, menstruating women. Still, menopause may trigger psychological changes or make it more difficult to deal with psychological problems already present. Menopausal women commonly seek medical advice for: Night sweats Hot flashes Headaches Tiredness Lethargy Irritability Anxiety Nervousness
Depression Sleep difficulties (often associated with night sweats) Inability to concentrate
Menopause & Urogenital Changes As a woman approaches menopause, the lining of the urethra thins and the pelvic muscles weaken. As a result, women may
Feel the need to urinate more frequently, even though the bladder may not be full (urinary frequency); Leak urine when coughing, sneezing, laughing, or lifting (urinary incontinence); 40% of postmenopausal women experience urinary incontinence); Need to get out of bed several times during the night to urinate (nocturia); or Feel painful urination.
Health Risks of Menopause Menopause & Cardiovascular Disease Heart disease is the leading cause of death in women over the age of 50. Twice as many women die from cardiovascular disease than from cancer, and more women than men die from cardiovascular disease. Menopause is believed to increase the risk for heart disease due to biochemical changes in the blood resulting from decreased estrogen levels. Preventative health care (e.g., regular exercise and healthy diet, moderate alcohol use, avoid tobacco products) can reduce the risk for heart disease. Menopause & Osteoporosis Postmenopausal women are at an increased risk for osteoporosis, a disease characterized by decreased bone density that causes bones to become
porous and fragile. Bone loss is rapid during the first 4 to 5 years after menopause. Twenty-five percent of all women show radiologic evidence of osteoporosis (i.e., it can be seen on an x-ray even though it may not be symptomatic) by the age of 60. Osteoporosis increases the risk for bone fractures, especially in the wrist, hip, and spine. Twenty-five percent of women who live to the age of 80 suffer a fractured hip. About 80% of all hip fractures in the United States are due to osteoporosis. The risk for osteoporosis can be reduced through preventative health care. Adequate calcium and vitamin D intake and exercise are especially important.
Women can change their dietary and lifestyle habits to decrease their risk and should talk to their physician or health care provider about what steps they can take. Osteoporosis has been associated with the following risk factors:
Alcohol abuse Cigarette smoking High sodium intake Sedentary lifestyle High caffeine intake High animal protein intake Early menopause Family history of osteoporosis Caucasian or Asian ethnicity Nulliparity (never having been pregnant)