By Hector Medina, M.D.
When a woman stops having menstrual periods for one year, she has entered menopause. This means she is no longer in her reproductive years. Most women experience menopause between their mid-40s and late 50s, although 50 is the average age. In some cases, menopause can occur prematurely as the result of surgical removal of the ovaries or certain cancer treatments - such as chemotherapy or radiation therapy of the pelvic or abdominal area.
Perimenopause is the term used to describe the several years of fluctuating hormone levels and symptoms leading up to menopause. During this phase, women typically have longer menstrual cycles and may experience heavier menstrual bleeding, hot flashes, headaches, insomnia, heart palpitations, mood swings, depression, anxiety and irritability. Some women experience few or no symptoms at all.
Postmenopause describes the timeframe after a woman no longer has menstrual periods for one year. At this point, the symptoms described above generally increase for about a year before subsiding, as estrogen and progesterone levels stabilize. Some women continue to have some perimenopause symptoms, such as hot flashes, during this phase, while others do not. After estrogen levels drop to a certain level, most women experience vaginal dryness and irritation. Some also experience decreased sexual interest.
Lifestyle changes are the best treatment for perimenopause and some postmenopause symptoms. These include getting adequate exercise; eating a healthful diet; and avoiding too much alcohol, caffeine and stress. Some women find yoga, meditation, leisurely baths and deep breathing to be very effective.
If lifestyle changes don’t do the trick, there are also treatment options such as antidepressants, blood pressure medication and hormone therapy to reduce the various types of menopausal symptoms, so be sure to talk to your doctor. For vaginal dryness, there are many over-the-counter lubricants and moisturizers to alleviate discomfort.
Up until recently, the medical profession has encouraged perimenopausal and postmenopausal women to take hormone replacement therapy (HRT). Recent studies, however, show risks involved with HRT, including stroke, heart attack, blood clots and breast cancer. So now we advise women to decide with their doctors whether this treatment is right for them. For example, if you are at high risk for osteoporosis, HRT may be beneficial since it has been shown to strengthen bone density.
If you are on HRT and want to stop the treatment, it is very important that you taper off the dosage over a period of several weeks or months to avoid the unpleasant symptoms that may come with a sudden drop in hormones in your system.
It’s also important to know that the leading cause of death in postmenopausal women is cardiovascular disease. One in three postmenopausal women develops heart disease. Key risk factors are age, family history of heart disease, smoking, hypertension, diabetes, obesity and a sedentary lifestyle. Key lifestyle changes you can make include not smoking, getting enough exercise, and eating a healthful diet. Also, if you are at risk for breast cancer or osteoporosis, please speak with your doctor about lifestyle changes and proper medical care.
