Menopause

Menopause is a process of normal change in a woman's body. Medically termed as the 'physiological cessation of menstrual cycles' in women pertaining to advancing age, menopause marks the end of a woman's monthly menstrual period. Menopause can be diagnosed in women following continuous absence of menstrual periods for a span of at least 12 months.

A normal menopausal period often happens between the ages of 45 and 55 years. However, there are cases when there are changes in the age factor or reaching menopause. Menopause should not be associated to a disease or an illness. It is a natural process of transition between two phases of a woman’s life.  

Women reach the stage of menopause, when the ovaries no longer react to the controlling hormones released by the pituitary gland of the brain. Thereby, the ovaries fail to release eggs each month and to produce the female sex hormones oestrogen and progesterone. This falling level of hormones in the bloodstream provides the first symptoms of menopause.

Menopause in women also brings about physiological and psychological changes in women. The hormone estrogen present in the body of a woman (when young) helps in the strengthening of the bone. But with the falling levels of estrogen at menopause, the bones weaken leading to the condition called osteoporosis.  Osteoporosis makes the bones brittle making it more vulnerable to fracture.

Stages of menopause
Following are the stages of menopause:

  ¤ Premenopause
Premenopause refers to a woman's reproductive or fertile life, from the first menstrual period to the last. It has been misused to describe the years immediately before menopause (perimenopause) or to describe premature menopause.

  ¤ Perimenopause
Perimenopause in women represents the immediate years preceding menopause. Perimenopause can be regarded as the period when the hormonal changes in the body starts evolving, consequently providing the initial hint of menopause symptoms. The onset of perimenopause is typically between 45 and 60 years old and can span a 2-6 year period.

  ¤ Menopause
Menopause is the stage where a woman has her last period. It can be regarded as is the permanent cessation of the menstruation and fertility. While most women experience natural menopause cycle, there are, however, a few cases when premature or artificial menopause is experienced. Menopause is confirmed by 12 consecutive months of continuous absence of menstrual period.

  ¤ Postmenopause
Postmenopause refers to the post-menopause stage in a woman's life after the last menstrual period. Postmenopause can spring up new health issues due to the reduced production of female hormones like estrogen and progesterone. The two potential serious health concerns in postmenopausal women is osteoporosis and heart disease.

Treatments
Menopause itself requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and on preventing or lessening chronic conditions that may occur with aging. The treatments include:

Hormone Replacement Therapy (HRT)
Hormone replacement therapy (HRT) uses estrogens and progestin (synthetic progesterone) to ease the symptoms of menopause. The various types and dosages of estrogen and progestin are available and the type of HRT often depends on particular symptoms. For example, women who experience vaginal dryness may opt for a vaginal cream or vaginal ring insert, both of which alleviate dryness. The vaginal ring insert can also help urinary tract problems. For women who suffer from hot flashes, pills or patches may be helpful. HRT has many short-term and long-term side effects. It is important to weigh all of the potential benefits and risks, preferences, and needs before beginning HRT. The benefits and side effects vary considerably from woman to woman. Minor side effects include bloating, breast tenderness, cramping, irritability, depression, and menstrual bleeding for months or years following menopause. More serious risk includes breast cancer, endometrial cancer, blood clots and the cardiovascular diseases. HRT may help to prevent or delay the development of many diseases, such as osteoporosis, Alzheimer's disease, urinary incontinence, skin aging and colon cancer.

• Gabapentin (Neurontin): This drug is approved to treat seizures and is commonly used to manage chronic, nerve-related pain, but it also has been shown to significantly reduce hot flashes. Side effects may include drowsiness, dizziness, nausea and swelling.
• Vaginal estrogen: To relieve vaginal dryness, estrogen can be administered locally using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen locally to vaginal tissue, and can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
• Selective estrogen receptor modulators (SERMs): SERMs are a group of drugs that includes raloxifene (Evista). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots.
• Clonidine (Catapres, others): Clonidine, a pill or patch typically used to treat high blood pressure, may significantly reduce the frequency of hot flashes, but side effects such as dizziness, drowsiness, dry mouth and constipation are common.
• Bisphosphonates: Doctors may recommend these non-hormonal medications, which include alendronate (Fosamax) and risedronate (Actonel), to prevent or treat osteoporosis. These medications effectively reduce both bone loss and your risk of fractures and have replaced estrogen as the main treatment for osteoporosis in women. Side effects may include nausea, abdominal pain and irritation of the esophagus.
• Vaginal estrogen: To relieve vaginal dryness, estrogen can be administered locally using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen locally to vaginal tissue, and can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms. Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each.

Complementary & Alternative Medicine
Many approaches have been promoted as aids in managing the symptoms of menopause. Below are several complementary and alternative treatments that have been or are being studied:

Phytoestrogens: There are mainly two main types of phytoestrogens i.e. isoflavones and lignans.  Isoflavones are found in soybeans, chickpeas and other legumes whereas lignans occur in flaxseeds, whole grains and some fruits and vegetables. Researchers find that adding them to your daily diets seems to help hot flashes, whereas some studies indicate that phytoestrogens may increase breast cancer growth. Other studies indicate that phytoestrogens may inhibit the development of breast cancer.

Black cohosh: This herb is used extensively in Europe for treating hot flashes and has become increasingly popular in the United States. The North American Menopause Society supports short-term use of black cohosh for treating menopausal symptoms.

Vitamin E: This vitamin occasionally provides relief from mild hot flashes for some women. However, taking more than 400 international units of vitamin E supplements daily may not be safe.