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Menopausะต Violeta Babiฤ‡



Menopause Violeta Babić



What is Menopause is not an illness. It is a new phase in every woman’s life. Considering the fact that the quality of life today is much better and the lifespan longer than it was in earlier times, 21st century women will spend almost a third of their lives in the menopause, considerably longer than their mothers and grandmothers did. The average woman going through the menopause is of good health and has as many yeas to live as she did during her fertile period. Menopause brings cessation of ovulation and lowering of the level of the estrogen hormone. That is the change to which one needs to get adjusted. 4




o be precise, the word “menopause� means the end of menstrual cycles, the last menstruation. It is the general opinion that a woman is menopausal when a year passes since her last period. On average, women have their last period at the age of 51. However, the term is often used to denote the overall transition period from the pre-menopause to the post-menopause..


Pre-Menopause Monthly periods are still regular, but first menopausal symptoms appear.

Perimenopause In the years before the last menstruation, however, ovaries produce less estrogen and progesterone, the female sex hormones and ovulations grow further apart. Periods are irregular, and symptoms intensify. That period is called the perimenopause. When a woman gets into her late thirties and early forties, fewer eggs mature in the ovaries, and ovulations do not occur necessarily every month (that is why it is more difficult for a woman of that age to get pregnant). Usually by the age of forty ovulation disappears altogether, menstruation stops and the period of fertility comes to a close. Perimenopause stands for all the said gradual changes and the first phase of menopause until the end of ovulation. It can appear early, at the age of thirty five, or much later, when a woman reaches the age of sixty. Still, it is common for perimenopause to start between the ages of forty and fifty and to last from two to five years, although in some women, it lasts up to ten years. The term which has also been in use to indicate this period is climacteric.

Premature Menopause Some women may experience menopause even before the age of forty. In such cases, we are talking about premature menopause. It is considered that the reason for premature onset of menopause is of genetic nature: in some families menopause occurs earlier. Also, in certain instances of stress, illness, or operations, menopause appears earlier. The function of ovaries in women entering premature menopause stops very quickly, therefore, in most cases hormone replacement therapy is necessary. Doctors usually recommend


that the female hormones should be added immediately after the occurrence of first symptoms in order to prevent the development of illnesses (such as osteoporosis and arteriosclerosis) and to make the therapy as effective as possible.

Late Menopause Menopause which occurs after 55 years of age is considered late menopause.

Post-Menopause Post-menopause is the period when menstrual cycles stop, and the organism has already adjusted to the low level of hormones.

Symptoms and Accompanying Phenomena In addition to spacing between menstrual cycles becoming longer, perimenopause and menopause can also be accompanied by a whole set of mild or more intensive phenomena. Symptoms are highly individual and easy to cope with for some women, whereas other women experience them more dramatically. Statistically speaking, about 25% of women do not feel any changes, 50% of women feel some of the physical and psychological changes, and about 25% of women feel acute discomfort.



• irregular menstrual cycles, missed perio • unusuadslly light or heavy mens al flow • decretru ase or increase in the numbers of days betwee n two periods


• hot flashes (night sweats, cold sweats) • sudden mood swings, sensitivity,

• • • • • •

irritability, dizzy spells, having trouble concentrating, fits of crying, anxiousness, depression, nervousness, headaches, migraines, problems with sleeping, a pounding heart, fatigue vaginal dryness urinary problems (inflammation of the bladder, frequent urination) the change in body weight (constitution) changes on hair and skin osteoporosis heart disease and high blood pressure



and night sweats. • I have begun experiencing hot orflashes a beat. misses • My heart occasionally pounds to go to the bathroom. night get up at • I have to urinate often; I even • My vagina is dry and it is itchy inside. : periods last longer, and arrive • My menstrual cycle is disrupted es I miss a period. Sometim earlier than they did before. • My skin is drier than it used to be; I seem to be losing hair and it has no shine. thinner. • My arm and leg hair is becoming brittle. and • My nails have become dry swell. • I have noticed that my legs • I have started gaining weight. • I have trouble falling asleep. • I wake up early. • I am often exhausted and fatigued. • I am constantly on the brink of tears, depressed, nervous, irritable and annoyed. have panic attacks. • I sometimes feel anxious and • I think my concentration is worsening and I am starting to forget things. • I have no interest in sexual intercourse as I used to have. • My libido is increased. • Sexual intercourse has become painful.

of the If you find that most you, statements apply to out the ab or ct talk to your do taken steps which could be minate eli so as to alleviate or opause. the symptoms of men 10

NO SOME SYMPTOMS SHOULD BY NO SE USE AUS ED TO MENOPAU IBE RIB MEANS BE ASCRI n ooff the ny y havee any ist if you Be sure to see your gynecologgist following symptoms: post-coital bleeding; bleeding between periods; al m trual ri g mens blood stains on the underwear anytimee durin cycle; heavy or prolonged bleeding; post-menopausal bleeding.

• • • • •

If you have severe menopausal symptoms, there is the solution.

Hormone Replacement Therapy (HRT) Hormone replacement therapy has proven to effectively reduce the frequency and intensity of hot flashes, eliminate the symptoms of vaginal dryness (atrophy), prevent the development of osteoporosis and bone fractures, and reduce the risk of heart disease in women who had their both ovaries removed. Aside from that, the women who receive the therapy feel better on the whole, they are less depressed, their skin is more beautiful, they age slower, their memory is improved, and they sleep better. Nevertheless, there are also opinions that HRT can have negative effects. One needs to be cautious with every medicine, and HRT is no exception. Therefore, your doctor is there to decide whether or not you need the therapy and how long you are going to receive it. The duration of the symptoms is also individual - it can last from several weeks to ten years, regarding the fact that every woman has her own pace of adjusting to the changes happening in her body.


WHICH ARE THE BENEFITS OF HRT? Apart from significantly alleviating all menopausal symptoms, HRT prevents from developing osteoporosis, Alzheimer’s disease, and reduces the risk of developing colon cancer. Furthermore, it keeps female reproductive organs, bladder and skin healthy. WHEN IS THE BEST TIME TO START HORMONAL TREATMENT? HRT should be started in perimenopause, as soon as you observe changes in the menstrual cycle which have no other cause, especially if they are related to other menopausal symptoms. Your problems will soon either decrease or go away. HOW LONG SHOULD HRT BE USED? It takes several years, five at least. IS HRT GOING TO MAKE ME GAIN WEIGHT? Menopausal women gain weight because of other hormonal changes. Hormone replacement therapy decreases the impact of those changes and prevents accumulation of adipose tissue. In any case, reduce the intake of food and be physically active on a regular basis, and you will not put on weight.


OF I HAVE HEARD THAT HRT INCREASES THE RISK ISED ME DEVELOPING BREAST CANCER. MY DOCTOR ADV IS MY FEAR TO START THE THERAPY, BUT I DO NOT DARE. UNFOUNDED? g breast Research has shown that certain risk of developin in than cancer is slightly higher in women receiving HRT greater than, those not receiving it. However, that risk is not at the age of for instance, the one entailed by having a baby about the ist colog 40. Every woman should talk to her gyne cement therapy advantages and disadvantages of hormone repla you are, know during menopause. If you are worried, as you say that they are that there are substitutions for that therapy and risk-free. WHAT I NEED TO DO BEFORE TAKING HRT? the Before you start taking hormones, you must see on, as inati exam gynecologist for a complete gynecological les for samp well as a breast examination. The doctor will take tion, and, if Pap smear test and the analysis of vaginal secre necessary, will suggest mammography. 13

Going through Menopause is a turning point in every woman’s life and marks the period in which a woman can bear children. Although thinking of menopause can be rather discouraging for some women, there really is no need for worry. By having a positive attitude towards that new phase in your life, you will mitigate any possible psychological and physical problems.


the Menopause



he onset of menopause is gradual, with barely visible symptoms which are often ascribed to stress.

Irregular Menstrual Cycles There are numerous factors which can disturb the menstrual cycle. However, the biggest change comes with the menopause. Prior to entering the menopause, the level of estrogen constantly lowers, ovulations grow further apart, then cease completely, and periods stop. Changes rarely occur suddenly and abruptly. They usually take years to develop. You may notice that your menstrual cycle lasts longer, that periods occur more frequently and last longer, or maybe they appear more seldom and lighter. Sometimes the two patterns alternate. Some women miss their period for months, and then they suddenly start having it again. It is all natural and common in this phase of a woman’s life.

Hot Flashes

Hot flashes - fits of intense heat – are one of the most frequent menopausal symptoms. A sensation of extreme heat from the inside or on the surface of the body comes suddenly. This sensation of heat has a starting point and spreads over the entire body, from the waist up, towards the face, neck and arms, or it starts at the neck, head skin or ears. Some women say they feel it all over their body. It is accompanied by chills, shivering, a quickened heartbeat and sudden sweating. 16

Hot flashes may appear for months, even years before the last period. They can go unnotic ed at first. Not all women experience hot flashes. Abo ut 25% women never experience them. Some wom en feel uncomfortable during hot flashes, others do not. Japanese women do not complain about hot flashes at all. They do not experience them! The y are also said to have greater bone mass, and fewer bone fractures than Western women. The reason for this is considered to be the beneficial influence of soy, whic h is present in the diet of Eastern women more often and in much larger quantities.


WHAT IS IT THAT CAUSES HOT FLASHES? Doctors consider increased secretion of luteinizing hormone (LH), lower level of estrogen and a sudden fall of progesterone to be the causes of the occurrence of hot flashes. That is also the reason why in women who have had their ovaries surgically removed hot flashes appear right after the procedure. CAN PEOPLE SEE THAT I AM HAVING HOT FLASHES? Hot flashes can be visible, but they need not be. If they are visible, they will emerge as red spots on the face, or your face and neck will be wet. HOW OFTEN CAN HOT FLASHES OCCUR? Some women experience them five times a day, some several times a month, and some every half an hour during both night and day. ARE NIGHT SWEATS, IN FACT, HOT FLASHES? Some women experience hot flashes at night as well. Night sweats usually disturb sleep. Women are most often awakened by a surge of heat, and then they sweat so much – because the organism has to cool down – that they have to change, because their nightgown is wet. HOW LONG DO HOT FLASHES LAST? Hot flashes usually last a minute or two, but some women experience hot flashes which can last up to half an hour. ONCE THE HOT FLASHES APPEAR, DOES THAT MEAN THEY WILL NEVER GO AWAY? They can occur several years. For some women, they can be present even ten years, but, as time passes by and a woman gets older, they get weaker and less frequent.


WHAT ARE COLD SWEATS? Cold sweats refer to a sudden appearance of cold sweat on the forehead and head. The hair becomes damp or wet. I HAVE BEEN CONSTANTLY TIRED AND DISSATISFIED LATELY, AND I BREAK OUT IN A SWEAT FROM TIME TO TIME. DOES THIS MEAN THAT I AM ALREADY MENOPAUSAL, ALTHOUGH I AM ONLY 40? Some women experience symptoms of perimenopause in their early forties, and tiredness and problems with concentration connected to hot flashes and sweating can be some of those symptoms. Be sure to consult the gynecologist. He may recommend hormone replacement therapy in order to postpone the perimenopause and alleviate the symptoms. I AM FIFTY YEARS OLD. I’VE BEEN HAVING BIG PROBLEMS WITH PERIODS FOR THE LAST SIX MONTHS. THEY ARE LENGTHY AND HEAVY. IN FACT, BLEEDING ALMOST DOESN’T STOP. IS IT POSSIBLE TO STOP THE BLEEDING WITH SOME MEDICATIONS AND ACCELERATE ENTERING THE MENOPAUSE? THE DOCTOR MENTIONED A HYSTERECTOMY, BUT I DON’T WANT TO UNDERGO THE OPERATION UNLESS I DON’T HAVE TO. Hormonal treatment enables women to go through the menopause easier. Unless the bleeding stops after using medications, the possible next step could be the ablation of the endometrial lining of the uterus. Whether or not the hysterectomy is necessary can be best determined by a doctor. 19

TEN TIPS TO FIGHT HOT FLASHES 1. Make sure that the room temperature is lower, about 20째C. Lowering the room temperature or turning the air conditioner on may reduce the occurrence of hot flashes. the 2. Everything that increases body temperature enhances intensity of hot flashes. Therefore, dress in light layers, n even at winter. Wear underwear and clothes made of cotto wear not Do ers. instead of synthetic shirts and warm pullov turtlenecks and avoid long sleeves if you find it helpful. 3. Water helps, too. A glass of cold water can come in handy in during a hot flash. Before you go to bed, take a long soak long, a take or g, a lukewarm bathtub until it starts coolin almost cold shower. That could reduce night sweats to the least measure. short 4. Devise a night strategy! Wear a cotton nightgown with Cover bed. the by or no sleeves, and have a spare one ready yourself with several thin layers so that you can throw off the covers one by one if you have hot flashes during the night. e the intake of caffeine, alcohol and spicy food. All Reduc 5. these substances can cause hot flashes because they raise blood pressure and accelerate heartbeat. n 6. Talk to your doctor about vitamin therapy. Some wome onal additi succeeded to hold off hot flashes by taking quantities of vitamins E and C. 7. Traditional remedy for hot flashes as well as for other symptoms of menopause is the plant Cimicifuga racemosa. e In ancient days, Native American women used it to sooth menstrual pain. Tablets (or capsules) containing active ingredients of this plant have proven effective. Ask your doctor if you can take the medicine.


8. Herbal remedies, aimed specially at preventing menopausal discomforts such as hot flashes and mood swings. Soy products contain bioflavonoids (phy toestrogens) and can also be of help. Some research has shown that using soy products on a regular basis lowers the risk of breast cancer, and can also have a significant role in stopping the loss of bone mass in the period after the menopause. 9. If necessary, and there are no con traindications, a gynecologist or an endocrinologist may suggest you hormone replacement therapy. 10. Talk to other women about men opause and hot flashes. You might get some good advice.


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