Taking Charge of Menopause

by Food and Drug Administration (FDA)

"I was 40 when I first started having night sweats," says Patti Shields, 42, of Birmingham, Ala. "I'd wake up in the middle of the night, and even though the air conditioner was running full blast, I'd be covered in sweat."

Shields is talking about menopause, the rite of passage that signals the end of a woman's reproductive years. "Those night sweats — and the other symptoms I began to notice — suddenly made me feel old. One day I'm a young woman in her prime, and the next day I'm worrying about whether or not I'm prepared for retirement and thinking about 'getting my affairs in order.' It was a classic overreaction," she says, laughing.

Medical scholars dispassionately define menopause as "the cessation of menstruation." For women, it is much more than that. Because menopause marks the end of fertility, many women see it as a time of freedom from menstrual periods and pregnancy.

"Women shouldn't think of menopause as a death sentence," says Holly Richter, M.D., assistant professor of medical/surgical gynecology at the University of Alabama at Birmingham. "It is a transition from a healthy reproductive life to a healthy nonreproductive life. If women see themselves not just as a uterus, but instead look at themselves as a whole person, this nonreproductive life can be as fulfilling as their reproductive years."

Menopause is the result of ovarian failure, which sounds ominous, but is actually a normal part of aging. Over time, the ovaries gradually lose the ability to produce estrogen and progesterone, the hormones that govern the menstrual cycle. Estrogen can also protect against several health threats, most notably heart disease and osteoporosis. Loss of these hormones, especially estrogen, causes hot flashes and other symptoms associated with menopause.

In the United States, the average age of natural menopause — defined as one year without a menstrual period — is 51, but some women reach menopause in their 40s, and a few in their 60s.

Menopause before age 40 is considered premature menopause. There can be several causes, including genetics or autoimmune disorders, and a medical evaluation is needed.

Induced menopause can occur at any age due to surgical removal of the ovaries or damage to ovaries from treatments such as chemotherapy or radiation.

The Journey Begins

Menopause is a gradual process, says Richter, a journey that takes years to navigate. Most women notice their bodies are changing by their mid-30s. Hormone fluctuations cause disruptions in the menstrual cycle, such as lighter or heavier bleeding, and longer, shorter or skipped periods.

As ovarian function decreases, hormone production becomes erratic and diminishes, causing the onset of menopausal symptoms. Most women begin experiencing these symptoms two to 10 years before menstrual periods end. These years mark the "perimenopause."

As estrogen levels wane, many woman experience only a few changes, while others find themselves plagued by the full array, which include:

Hot flashes — This is the hallmark symptom of menopause, and experts say 85 percent of women will experience these personal heat waves. Starting in the center of the body, a flash of heat spreads like a wall of flame to the top of the head, flushing the face, neck and arms a fiery red, and making skin warm to the touch. The flash can last from seconds to 30 minutes and is accompanied by increased heart rate, shallow breathing, and sweating. A chill and exhaustion usually follow. Hot flashes can occur as many as 50 times a day.

Night sweats — These hot flashes that occur during sleep cause a woman to wake drenched in sweat, sometimes several times a night. Because of these sleep disturbances, daytime fatigue can become a problem.

Vaginal atrophy — The loss of estrogen causes the tissues of the vagina and vulva to become thin and dry. Sex often becomes painful. Additionally, the vagina can become inflamed and irritated from a high alkaline content, a condition called "atrophic vaginitis."

Urinary tract changes — Thinning of the lining of the urethra and weakening of surrounding pelvic muscles may lead to more frequent urination, frequent bladder infections, painful urination, sudden urinary urgency, and frequent urination during the night. Urinary incontinence may also become a problem.

Loss of libido — In addition to losing their ability to secrete estrogen, the ovaries no longer produce testosterone — the hormone responsible for sex drive in both men and women. Some women's bodies may produce the tiny amount needed through the adrenal glands. Many women, however, lose all testosterone, and with it their sex drive.

Emotional changes — Irritability, mood swings, anxiety, and depression are frequently the result of fluctuating hormones.

Formication — This bizarre symptom, the feeling that ants are crawling over the skin, occurs in about 20 percent of women, according to Lois Jovanovic, M.D., in her book A Woman Doctor's Guide to Menopause.

These changes may continue up to three years following a woman's last menstrual period, a time known as the "climacteric."

About the Author

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