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Menopause and HRT


Symptoms of Menopause

Physical Changes At Menopause
Other Symptoms
Hot Flashes
Irregular periods
Vaginal/Urinary Tract Changes
Menopause and Sex
Menopause and Mental Health

Menopause affects people differently. Some women notice little difference in their bodies or moods, while others find the change extremely bothersome and disruptive. Estrogen and progesterone affect virtually all tissues in the body, but everyone is influenced by them differently.

A typical example of a menopausal woman is described by Joan Borysenko of Mind- Body Clinic of Harvard Medical School and author of "A woman’s book of life:"

"At fifty-two, Cynthia is still menstruating, but irregularly. She occasionally skips periods, sometimes has periods barely two weeks apart, and occasionally she has very heavy bleeding, or flooding. Several times daily she has hot flashes that last for two to three minutes, turning her face and neck crimson and leaving her with an odd tingling sensation, but these are not as disturbing as night sweats that cause her to throw off damp covers and often strip off her nightgown. No sooner does she fall asleep, it seems, that she awakens chilled and puts her nightgown back on, only to wake up a short time later hot and sweaty. The cycle often repeats itself two or three times in the course of a night, and she sometimes wakes up for good at four or four-thirty A.M., unable to doze off again.

Like many people whose sleep is interrupted, Cynthia suffers from two kinds of fatigue. One stems from simple lack of sleep. The other has its roots in what she calls the "three-A. M. horror show." In the quiet hours of the night, she finds herself at the mercy of an anxious mind that seizes on potential problems and embroiders them into catastrophic proportions. Her mind goes round and round considering the what-ifs. What if her daughter Susan can't raise the money to go back to school to become an X-ray technician? What if her husband's company downsizes and he loses his job? What if her college-age son drinks too much and gets in an accident? What if the breast pain she has been experiencing means that she has breast cancer?

Her nightly worry fests are increasing her stress level. As a result she is fatigued during the day and experiencing more hot flashes than she would if she could relax. Furthermore, she finds herself drawn to her typical "stress diet" including plenty of sweet rolls, coffee, diet soda, and fatty meat, her traditional comfort foods. The sweets, often eaten instead of a meal, are causing major fluctuations in blood sugar, leading to hypoglycemia and fatigue. The caffeine is increasing blood pressure and heart rate, making her hot flashes worse. More caffeine is present in the diet soda, as are phosphates, which displace calcium from her bones, predisposing her to osteoporosis. Furthermore, the caffeine is contributing to the fibrocystic condition of Cynthia's breasts, causing mastodynia, or breast pain."

This gives in a nutshell, the common experience of women who undergo menopausal symptoms.

Important: Some of the symptoms of menopause may be actually signs of more serious conditions that require medical attention. Please check Call or Contact Your Doctor section for more information.

The most common symptoms of menopause are:

Physical Changes At Menopause
bulletSome shrinking of the vagina, cervix uterus, and ovaries
bulletShortening of the vagina, with loss of muscle tone and thinning of the lining
bulletChanges in labia majora including possible thinning, paleness, and loss of elasticity
bulletLoss of muscle tone of supporting ligaments
bulletReduction in vaginal and cervical secretions
bulletChanges in breast size, firmness, and shape
bulletThinning of body hair in most women; possible increase of facial hair
bulletWrinkling and loss of skin tone
bulletLoss of bone mass
bulletSlowing of metabolic rate

Other Symptoms
bulletHot flashes
bulletNight sweats, often leading to sleep disturbance
bulletMood swings.
bulletThinning of the bones.
bulletWeight gain.
bulletAn irregular or rapid heart beat.
bulletDifficulty holding the urine
bulletVaginal dryness, itching or other discomfort which results in painful sexual intercourse
bulletMore or less interest in sex.
bulletSkin changes such as dryness and increased moles.
bulletBrittle bones, leading to frequent fractures that may be slow to heal
bulletVaricose veins
bulletRheumatic symptoms
bulletIrregular bleeding

Hot Flashes

Hot flashes, or flushes, are the most common symptom of menopause, affecting more than 60 percent of menopausal women.

A hot flash is a sudden waves of heat that can start in the waist or chest and work their way to the neck and face and sometimes the rest of the body. The face and neck may become flushed, with red blotches. This is often followed by profuse sweating and then cold shivering as body temperature readjusts. They are more common in the evening and during hot weather. They can hit as often as every 90 minutes. Each one can last from 15 seconds to 30 minutes - 5 minutes is average. Seventy-five to eighty percent of women going through menopause experience hot flashes. Hot flashes bother some women more than others. Sometimes heart palpitations accompany hot flashes.

Hot flashes occur sporadically and often start several years before other signs of menopause. They gradually decline in frequency and intensity with age. Eighty percent of all women with hot flashes have them for 2 years or less, while a small percentage have them for more than 5 years. Hot flashes can happen at any time. They can be as mild as a light blush, or severe enough to wake you from a deep sleep. Some women even develop insomnia. Others have experienced that caffeine, alcohol, hot drinks, spicy foods, and stressful or frightening events can sometimes trigger a hot flash. However, avoiding these triggers will not necessarily prevent all episodes.

Hot flashes appear to be a direct result of decreasing estrogen levels. If there is no estrogen, your glands release other hormones that dilate blood vessels and destabilize body temperature. Hormone therapy relieves the discomfort of hot flashes in most cases. Vitamin E may offer minor relief.

Irregular periods

This varies and can include:
bulletPeriods that get shorter and lighter for 2 or more years
bulletPeriods that stop for a few months and then start up again and are more widely spaced
bulletPeriods that bring heavy bleeding and/or the passage of many or large blood clots. This can lead to anemia.

Vaginal/Urinary Tract Changes

With advancing age, the walls of the vagina become thinner, dryer, less elastic and more vulnerable to infection. These changes can make sexual intercourse uncomfortable or painful.

Lubricate the vagina with water-soluble lubricants. Avoid petroleum jelly; many women are allergic, and it damages condoms.

Tissues in the urinary tract also change with age, sometimes leaving women more susceptible to involuntary loss of urine (incontinence), particularly if certain chronic illnesses or urinary infections are also present. Bladder training is a simple and effective treatment for most cases of incontinence and is less expensive and safer than medication or surgery.

Within 4 or 5 years after the final menstrual period, there is an increased chance of vaginal and urinary tract infections. Infections are easily treated with antibiotics, but often tend to recur. To help prevent these infections, urinate before and after intercourse, be sure your bladder is not full for long periods, drink plenty of fluids, and keep your genital area clean. Douching is not thought to be effective in preventing infection.

Menopause and Mental Health

Despite the common myth to the contrary, menopause does not cause unpredictable mood swings, depression, or stress in most women.

Studies showed that women already taking hormones who are experiencing mood or behavioral problems sometimes respond well to a change in dosage or type of estrogen.

Also, women of childbearing age, particularly those with young children at home, tend to report more emotional problems than women of other ages.

Menopausal women were no more depressed than the general population: about 10 percent are occasionally depressed and 5 percent are persistently depressed. The exception is women who undergo surgical menopause. Their depression rate is reportedly double that of women who have a natural menopause.

Emotional changes associated with menopause:
bulletMood changes
bulletLack of concentration, difficulty with memory
bulletTension, anxiety, depression
bulletInsomnia, which may result from hot flashes that interrupt sleep

Menopause and Sex

For some women menopause brings a decrease in sexual activity. Reduced hormone levels cause subtle changes in the genital tissues. Lower estrogen levels decrease the blood supply to the vagina and the nerves and glands surrounding it. This makes delicate tissues thinner, drier, and less able to produce secretions to comfortably lubricate before and during intercourse. So, some women show a lack of interest in sex. Estrogen creams and oral estrogen can restore secretions and tissue elasticity. Water-soluble lubricants can also help.

Some women actually feel liberated after menopause and report an increased interest in sex. They feel relieved that the children are out of the house and pregnancy is no longer a worry.

Next Topic: Long-Term Effects Of Estrogen Deficiency

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