Menopause
- A woman stops having periods and is no longer able to get pregnant naturally
- Periods usually start to become less frequent over a few months or years before they stop altogether
- Sometimes period can stop suddenly.
- A natural part of aging that usually occurs between 45 and 55
1. Cause
a. Naturally declining reproductive hormones
- As aging, production of estrogen and progesterone decrease, thus fertility declines
- Estrogen and progesterone are the hormones that regulate menstruation
- Around 40s, menstrual period become chaos until ovaries stop releasing eggs, and thus menopause
- Menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent
b. Surgery that removes the ovaries (oophorectomy)
- Ovaries produce estrogen and progesterone that regulate the menstrual cycle
- remove ovaries causes immediate menopause
- likely to have hot flashes and experience other menopausal signs and symptoms.
- Signs and symptoms can be severe, as hormonal changes occur abruptly rather than gradually over several years.
c. Surgery that removes uterus but not ovaries (hysterectomy)
- doesn't cause immediate menopause
- Although no longer have periods, your ovaries still release eggs and produce estrogen and progesterone.
d. Chemotherapy and radiation therapy.
- These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment.
- The halt to menstruation (and fertility) is not always permanent
- Radiation therapy to other parts of the body, such as breast tissue or the head and neck, won't affect menopause.
e. Primary ovarian insufficiency
- About 1% of women experience menopause before age 40 (premature menopause).
- This result from failure of ovaries to produce normal levels of reproductive hormones (primary ovarian insufficiency)
- stem from genetic factors or autoimmune disease.
- hormone therapy is typically recommended
2. Symptoms
Symptoms usually start a few months or years before your periods stop, known as the perimenopause, and can persist for some time afterwards.
Perimenopause symptoms
Changes to periods
- may start having either unusually light or heavy periods.
- have period every 2 or 3 weeks, or may not have period for months at a time
- Eventually menopause
Common menopausal symptoms
- Hot flushes – short, sudden feelings of heat, usually in the face, neck and chest, which can make skin red and sweaty
- Night sweats – hot flushes that occur at night
- Difficulty sleeping – this may make you feel tired and irritable during the day
- A reduced sex drive (libido)
- Problems with memory and concentration
- Vaginal dryness and pain, itching or discomfort during sex
- Headaches
- Mood changes, such as low mood or anxiety
- Palpitations – heartbeats that suddenly become more noticeable
- Joint stiffness, aches and pains
- Reduced muscle mass
- Recurrent urinary tract infections (UTIs)
3. Complications
a. Heart and blood vessel (cardiovascular) disease
- due to estrogen levels decline
- Prevention: regular exercise, eat a healthy diet and maintain a normal weight
b. Osteoporosis
- During the first few years after menopause, bone density may lose at a rapid rate
- Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists.
c. Urinary incontinence
- due to the tissues of vagina and urethra lose elasticity
- may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence)
- Relieve symptoms of incontinence
- Kegel exercises--Strengthening pelvic floor muscles
- Topical vaginal estrogen
- Treatment: Hormone therapy
d. Sexual function
- Discomfort and slight bleeding during sexual intercourse
- due to vaginal dryness from decreased moisture production and loss of elasticity
- Reduce desire for sexual activity (libido)
- Relieve: Water-based vaginal moisturizers and lubricants
e. Weight gain
- due to metabolism slows
- Prevention: Eat less and exercise more to maintain your current weight
4. Treatment
a. Hormone replacement therapy (HRT)
- replaces the hormones that are missing
- Most symptoms are caused by low oestrogen levels
- progestogen to protect the lining of the womb
- Available as tablets, skin patches, a gel to rub into the skin or implants
- Benefit:
- Relieve most menopausal symptoms
- Prevent thinning of the bones----osteoporosis
- Risk: slightly increase the risk of breast cancer and blood clots
**Risks of HRT are small and usually outweighed by the benefits
b. Hot flushes and night sweats
- wearing light clothing
- keeping bedroom cool at night
- taking a cool shower, using a fan or having a cold drink
- trying to reduce stress levels
- avoiding potential triggers, such as spicy food, caffeine, smoking and alcohol
- taking regular exercise and losing weight if overweight
- If the flushes and sweats are frequent or severe, suggest taking HRT.
c. Mood changes
- Getting plenty of rest
- Taking regular exercise
- Doing relaxing activities, eg, yoga and tai chi
- Hormone replacement therapy (HRT)
- Cognitive behavioural therapy (CBT)
- therapy that can improve low mood and feelings of anxiety
- Antidepressants if one have been diagnosed with depression
Related Link: 【Pharmacology】Antidepressants 【TCM & Neuro】中药治疗抑郁 Herbs that treat Depression
d. Weak bones
- Hormone replacement therapy (HRT)
- help to prevent bones getting weaker
- effect does not tend to last after treatment stops
- Exercising regularly
- weight-bearing and resistance exercises
- Healthy diet
- includes plenty of fruit, vegetables and sources of calcium, such as low-fat milk and yoghurt
- Getting some sunlight
- triggers the production of vitamin D, which can help to keep your bones strong
- stopping smoking and cutting down on alcohol
- taking calcium and/or vitamin D supplements
5. Reference
https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
https://www.nhs.uk/conditions/menopause/
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