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   Lane clinic

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Physicians treating - menopausal health	clinic

Jonathan Thomas, MD	Mistie Mills, MD, MHA	John Gay, MD, MPH
James Green, MD, JD	William Griffin, MD

Menopause...

is the cessation, or stopping, of menstrual periods. It signals the end of the reproductive portion of a woman’s life. However, it signals the beginning of another phase of life, and is a natural part of aging. Women today can expect to live one third of their lives after menopause. It is important to be prepared and informed as you enter this phase of life, and make it a time for attention to good health and wellness.

Menopause occurs when the ovaries stop producing estrogen. This is usually a gradual process, and the years that precede menopause are known as perimenopause. The average age of menopause in the US is 51; however, perimenopausal symptoms can begin in the early forties. Menopause can also occur when

the ovaries are surgically removed. In a small percentage of women, menopause occurs before the age of 40.

The most common symptom of menopause is hot flashes, a sudden intense sensation of heat radiating throughout the body, especially the face. Some women experience hot flashes at night, or night sweats, which may wake them from sleep. Sleep in general may be disrupted in menopause. This can affect daily activities with family and work. The vagina and urinary tract may become dry and easily irritated as estrogen levels fall. Some women experience pain with intercourse, increased vaginal and urinary tract infections, and

bladder urgency or frequency. Menopausal women are at higher risk for osteoporosis—bone ss that can result in fractures at the hip, wrist and spine. Menopausal women are also at higher risk for heart disease and stroke.

Many women elect to use hormone therapy after menopause, to relieve symptoms and decrease the rate of bone loss. In women who have had a hysterectomy, hormone therapy can be estrogen only. However, women who still have a uterus need both estrogen and progesterone. This combination helps decrease the risk of endometrial cancer— cancer of the uterine lining—that can occur when estrogen is taken alone. The benefits of hormone therapy include improvement in hot flashes, sleep, vaginal dryness and urinary symptoms. Estrogen also helps protect against bone loss. However, hormone therapy can have associated risks. These include a small, but increased risk of stroke, blood clots, heart attack and breast cancer in women taking both estrogen and progestins. Women who take estrogen alone have an increased risk of stroke. Hormone therapy should be discussed in detail with your doctor. If you elect to take hormone therapy you should take the smallest dose effective for you, for the shortest period of time, and re-evaluate hormone therapy yearly with your doctor.

There are other options for treatment of menopausal symptoms. These include soy and black cohosh. For some women these alternatives work well. However, herbal alternatives are not FDA approved, and women should tell their doctor about any herbal or over the counter medicines they take

Menopause is a time for attention to a healthy, balanced diet, and regular exercise. Calcium intake of 1000mg daily is recommended for women using hormone therapy, with 1500mg daily if no hormones are taken. This may require a calcium supplement, and it should contain vitamin D to aid in absorbing calcium. Routine visits for breast, pelvic, pap and rectal exams are important. Mammograms should be done yearly over age 50. Colonoscopy is now recommended at age 50, for colon cancer screening.

Resources:

www.knowmenopause.com