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Physiotherapy => Backache => Menopause
Menopause
INTRODUCTION
Menopause, permanent ending of menstruation in women. Menopause is usually preceded by 10 to 15 years during which the ovaries gradually stop producing eggs and sex hormones, a period called the climacteric. Perimenopause encompasses this period of changing ovarian activity and also the first few years without menstrual cycling, typically characterized by hormonal and physical changes and sometimes emotional and psychological changes as well.
In the United States most women experience menopause in their late 40s or early 50s-about half by age 51. Menopause before age 35 is called premature menopause and may occur because of certain diseases, autoimmune reactions (in which the body's immune defenses attack the body's own cells, tissues, or organs), surgery, medical treatment such as radiation or drug therapies, or for unknown reasons. If both ovaries are surgically removed (due to ovarian cancer, for example), the woman will cease menstruation, a condition referred to as surgical menopause. Women who have a hysterectomy (surgical removal of the uterus) will no longer have menstrual periods, but if the ovaries are not removed the hormonal changes of menopause will not take place until the ovaries stop functioning.
PHYSIOLOGY
Women are born with a finite number of ovarian follicles that develop into eggs. The process of ovulation, in which an egg is released from the ovary, is regulated by several sex hormones. As a woman matures and passes through her reproductive years, when an egg is released each month, her supply of eggs gradually decreases. As menopause approaches, ovarian follicles gradually become less sensitive to the hormones that control ovulation, follicle stimulating hormone (FSH) and luteinizing hormone (LH), increasingly disrupting egg development and ovulation. The ovaries produce less estrogen, which directs the growth of the uterine lining during the first part of the menstrual cycle. Even when ovulation continues to occur, the decreased sensitivity to LH causes problems in the development and function of the corpusluteum (the ovarian follicle after ovulation). This leads to deficiencies in the production of progesterone, the hormone that controls the second half of the menstrual cycle. The hypothalamus, the part of the brain that controls hormone production and regulation, recognizes these hormone deficiencies and signals the pituitary gland, located in the base of the brain, to increase production of FSH and LH. Tests showing elevated levels of FSH in the blood are used to confirm that a women is perimenopausal.
Ovulation eventually becomes less frequent and stops altogether. Soon there is not enough estrogen produced to stimulate the lining of the uterus and menstruation also stops. FSH and LH levels remain high for two to three years after menopause and then decline.
A new hormone balance is established after menopause. The ovaries continue to produce small amounts of androgens and estrogen but most of the estrogen in postmenopausal women comes from conversion of other hormones made by the adrenal glands, which mostly takes place in fat cells. The liver and kidneys also aid in estrogen conversion.
SIGNS AND SYMPTOMS
The experience of menopause differs among women, depending on differences in diet and nutrition, general health and health care, and even how women are taught to think about menopause. Not all women experience symptoms. All physical symptoms should be discussed with a health care provider to rule out potential causes other than approaching menopause.
For a number of years before menopause women may notice longer menstrual periods, heavier menstrual flow, spotting, or irregularity. Hormone pills or low-dose birth control pills may be prescribed to control bleeding problems. Hot flashes or hot flushes range from a passing feeling of warmth in the face and upper body to extreme sweating and visible redness of the skin followed by chills. Heart palpitations and feelings of suffocation can also occur.
As estrogen levels decline, the vaginal walls become less elastic and thinner. Vaginal secretions are reduced and are less acidic, increasing the chances for vaginal infections. Insufficient vaginal lubrication during sexual activity can make intercourse uncomfortable or painful. Some women report a decreased interest in sex and a decline in sexual activity with menopause that are not due to vaginal problems.
Psychological symptoms may include depression, mood swings, weepiness, and other emotional flare-ups, as well as memory lapses. Although declining levels of estrogen may play a role in these symptoms, a number of other factors and stresses need to be considered as well. Excess alcohol, caffeine, or sugar may stress the adrenal glands and decrease the amount of adrenal androgens available for conversion to estrogen, thereby lowering estrogen and making menopausal symptoms worse. Smoking decreases estrogen production by the ovaries, leading to earlier menopause and osteoporosis. Stressful life events that may contribute to the emotional symptoms at the time of menopause include children leaving home and caring for aging parents.
ADAPTATION TO MENOPAUSE
In order to relieve symptoms of menopause, as well as to reduce specific health risks in menopausal and postmenopausal women, physicians often prescribe the synthetic hormones estrogen, progestin (a synthetic form of progesterone), and sometimes androgens. This therapeutic approach is called hormone replacement therapy (HRT). Administered as oral tablets, skin patches, or vaginal creams or suppositories, HRT alleviates symptoms of menopause and may increase verbal memory. It also may counteract some serious health problems associated with menopausal women, such as the increased risk for cardiovascular disease. The use of HRT reduces this risk by promoting favorable effects on cholesterol and arterial tissue.
The use of HRT also helps to combat bone calcium loss, which accelerates in women for three to seven years after menopause. Calcium loss can lead to osteoporosis, thinning and weakening of the bones, making them vulnerable to fracture; HRT significantly slows the loss of bone density, lessening the risk of osteoporosis.
Women who have had a hysterectomy can use estrogen replacement alone, but women with a uterus need the addition of progestin to prevent hyperplasia (overgrowth) of the endometrium (uterine lining) and decrease the risk of endometrial cancer. Androgens may help women with decreased sexual interest.
Hormone replacement therapy may be taken continuously or cyclically (usually three weeks on and one week off). Symptoms may return each month during the hormone-free week. The therapy may be associated with an increased risk of breast cancer with prolonged use, although its benefits may outweigh this risk. Each woman and her health care provider should assess her need for symptom control and the potential risks and benefits before starting HRT. Women who have a history of endometrial cancer, breast cancer, stroke, blood-clotting disorders, liver dysfunction, and undiagnosed abnormal vaginal bleeding should generally not take HRT. More research is needed on the long-term effects of the various HRT regimes.
Other ways of reducing negative effects of menopause include eating a healthy diet, eliminating caffeine and alcohol, reducing sugar and salt intake, stopping smoking, and taking vitamin supplements. Exercise helps increase conversion of androgens to estrogens and can help alleviate menopausal symptoms.
How women view menopause may also affect symptoms. Traditionally in our culture, menopause has been viewed negatively, as a period of fluctuating hormones that incapacitates women. In fact, many women experience only minor discomfort during menopause, and some find renewed energy and enthusiasm after menopause.
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