Menopause: Celebrate the “Second Talk”

Menopause literally means the “end of monthly cycles” (the end of monthly periods aka menstruation), from the Greek word pausis (cessation) and the root men- (month). Menopause is an event that typically (but not always) occurs in women in midlife, during their late 40s or early 50s, and it signals the end of the fertile phase of a woman’s life. However, rather than being defined by the state of the uterus and the absence of menstrual flow, menopause is more accurately defined as the permanent cessation of the primary functions of the ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining, and the subsequent shedding of the uterine lining (a.k.a. the menses or the period).

This transition from a potentially reproductive to a non-reproductive state is the result of a reduction in female hormonal production by the ovaries. This transition is normally not sudden or abrupt, tends to occur over a period of years, and is a consequence of biological aging. However, for some women, the accompanying signs and effects that can occur during the menopause transition years can significantly disrupt their daily activities and sense of well-being. In addition, women who have some sort of functional disorder affecting the reproductive system (e.g., endometriosis, polycystic ovary syndrome, cancer of the reproductive organs) can go into menopause at a younger age than the normal timeframe. The functional disorders often significantly speed up the menopausal process and create more significant health problems, both physical and emotional, for the affected woman.

The word “menopause” was coined specifically for human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruation. However, menopause also exists in some other animals, many of which do not have monthly menstruation; in this case, the term means a natural end to fertility that occurs before the end of the natural lifespan.

The date of menopause in human females is formally medically defined as the time of the last menstrual period (or menstrual flow of any amount, however small), in those women who have not had a hysterectomy. Women who have their uterus removed but retain their ovaries do not immediately go into menopause, even though their periods cease. Adult women who have their ovaries removed however, go immediately into full surgical menopause, no matter how young they are.

Menopause is an unavoidable change that every woman will experience, assuming she reaches middle age and beyond. It is helpful if women are able to learn what to expect and what options are available to assist the transition, if that becomes necessary. Menopause has a wide starting range, but can usually be expected in the age range of 42–58.  An early menopause can be related to cigarette smoking, higher body mass index, racial and ethnic factors, illnesses, chemotherapy, radiation and the surgical removal of the ovaries, with or without the removal of the uterus.

Menopause can be officially declared (in an adult woman who is not pregnant, is not lactating, and who has an intact uterus) when there has been amenorrhea (absence of any menstruation) for one complete year. However, there are many signs and effects that lead up to this point, many of which may extend well beyond the “official” declaration date of menopause.

These include: irregular menses, vasomotor instability (hot flashes and night sweats), atrophy of genitourinary tissue, increased stress, breast tenderness, vaginal dryness, forgetfulness, mood changes, and in certain cases osteoporosis and/or heart disease. These effects are related to the hormonal changes a woman’s body is going through, and they affect each woman to a different extent.

The only sign or effect that all women universally have in common is that by the end of the menopause transition every woman will have a complete cessation of menses.

In the Western world, the most typical age range for menopause (last period from natural causes) is between the ages of 40 and 61 and the average age for last period is 51 years. The average age of natural menopause (in Australia) is 51.7 years, although this varies considerably from one individual to another. In India and the Philippines, the median age of natural menopause is considerably earlier, at 44 years.

On average, women who smoke cigarettes experience menopause significantly earlier than non-smokers. Women who have undergone hysterectomy with ovary conservation go through menopause on average 3.7 years earlier than the expected age.

Premature menopause

In rare cases, a woman’s ovaries stop working at a very early age, ranging anywhere from the age of puberty to age 40, and this is known as premature ovarian failure (POF). Spontaneous premature ovarian failure affects 1% of women by age 40, and 0.1% of women by age 30. POF is not considered to be due to the normal effects of aging. Known causes of premature ovarian failure include autoimmune disorders, thyroid disease, diabetes mellitus, chemotherapy, being a carrier of the fragile X syndrome gene, and radiotherapy. However, in the majority of spontaneous cases of premature ovarian failure, the cause is unknown, i.e. it is generally idiopathic.

POF INTERNATIONAL ASSOCIATION

POF, pre-mature ovarian failure, is diagnosed or confirmed by high blood levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) on at least 3 occasions at least 4 weeks apart. Rates of premature menopause have been found to be significantly higher in fraternal and identical twins; approximately 5% of twins reach menopause before the age of 40. The reasons for this are not completely understood. Transplants of ovarian tissue between identical twins have been successful in restoring fertility.

Indications and signs: Are these the Signs?

During the menopause transition years, as the body responds to the rapidly fluctuating and dropping levels of natural hormones, a number of effects may appear.

Not every woman experiences bothersome levels of these effects; the range of effects and the degree to which they appear is very variable from person to person.

Effects that are due to low estrogen levels (for example vaginal atrophy and skin drying) will continue after the menopause transition years are over; however, many effects that are caused by the extreme fluctuations in hormone levels (for example hot flashes and mood changes) usually disappear or improve significantly once the perimenopause transition is completely over. All the various possible perimenopause effects are caused by an overall drop, as well as dramatic but erratic fluctuations, in the absolute levels and relative levels of estrogens and progesterone. Effects such as formication (crawling, itching, or tingling skin sensations), may be associated directly with hormone withdrawal.

Both users and non-users of hormone replacement therapy identify lack of energy as the most frequent and distressing effect. Other effects can include vasomotor symptoms such as hot flashes and palpitations, psychological effects such as depression, anxiety, irritability, mood swings, memory problems and lack of concentration, and atrophic effects such as vaginal dryness and urgency of urination.

The average woman also has increasingly erratic menstrual periods, due to skipped ovulation. Typically, the timing of the flow becomes unpredictable. In addition the duration of the flow may be considerably shorter or longer than normal, and the flow itself may be significantly heavier or lighter than was previously the case, including sometimes long episodes of spotting. Early in the process it is not uncommon to have some 2-week cycles.

Further into the process it is common to skip periods for months at a time, and these skipped periods may be followed by a heavier period. The number of skipped periods in a row often increases as the time of last period approaches. At the point when a woman of menopausal age has had no periods or spotting for 12 months, she is considered to be one year into post-menopause.

One way of assessing the impact on women of some of these menopause effects is the Greene Climacteric Scale questionnaire.

Vascular instability

• Hot flashes or hot flushes, including night sweats and, in a few people, cold flashes
• Possible but contentious increased risk of atherosclerosis
• Migraine
• Rapid heartbeat

Urogenital atrophy, also known as vaginal atrophy- Atrophic vaginitis

• Thinning of the membranes of the vulva, the vagina, the cervix, and also the outer urinary tract, along with considerable shrinking and loss in elasticity of all of the outer and inner genital areas.
• Itching
• Dryness
• Bleeding
• Watery discharge
• Urinary frequency
• Urinary incontinence
• Urinary urgency
• Increased susceptibility to inflammation and infection, for example vaginal candidiasis, and urinary tract infections

Skeletal

• Back pain
• Joint pain, Muscle pain
• Osteopenia and the risk of osteoporosis gradually developing over time

Skin, soft tissue

• Breast atrophy
• breast tenderness ± swelling
• Decreased elasticity of the skin
• Formication (itching, tingling, burning, pins and needles, or sensation of ants crawling on or under the skin)
• Skin thinning and becoming drier

Psychological

• Depression and/or anxiety
• Fatigue
• Irritability
• Memory loss, and problems with concentration
• Mood disturbance
• Sleep disturbances, poor quality sleep, light sleep, insomnia and sleepiness

Sexual

• Dyspareunia or painful intercourse
• Decreased libido
• Problems reaching orgasm
• Vaginal dryness and vaginal atrophy

Cohort studies have reached mixed conclusions about medical conditions associated with the menopause. For example, a 2007 study found that menopause was associated with hot flashes; joint pain and muscle pain; and depressed mood. In the same study, it appeared that menopause was not associated with poor sleep, decreased libido, and vaginal dryness. However, in contrast to this, a 2008 study did find an association with poor sleep quality.

GOOD READS FOR MENOPA– USE:

JOKE OF THE DAY:

 MEN 0 PA– USE = Take a pause from Catering to MEN.   <3 

BEST QUESTION EVER:

Q: How many women with MENOPA– USE does it take to change a light bulb?

Woman’s Answer:

One! ONLY ONE!!!! And do you know WHY?

• Because no one else in this house knows HOW to change a light bulb!
• They don’t even know that the bulb is BURNED OUT!!
• They would sit in the dark for THREE DAYS before they figured it out.
• And,once they figured it out, they wouldn’t be able to find the #&%!* lightbulbs despite the fact that they’ve been in the SAME CABINET for the past 17 YEARS!
• But if they did, by some miracle of God, actually find them, 2 DAYS LATER, the chair they dragged to stand on to change the STUPID light bulb would STILL BE IN THE SAME SPOT!!!!!
• AND UNDERNEATH IT WOULD BE THE WRAPPER THE FREAKING LIGHT BULBS CAME IN!!!
• BECA– USE NO ONE EVER PICKS UP OR CARRIES OUT THE GARBAGE!!!!
• IT’S A WONDER WE HAVEN’T ALL SUFFOCATED FROM THE PILES OF GARBAGE THAT ARE A FOOT DEEP THROUGHOUT THE ENTIRE HO– USE!!
• IT WOULD TAKE AN ARMY TO CLEAN THIS PLACE!

…  AND DON’T EVEN GET ME STARTED ON WHO CHANGES THE TOILET PAPER ROLL !

I’m sorry…. What was the question?

Information thanks to Wiki, Mayo Clinic, Massachusetts General Hospital, Be Prepared {Images linked to source}