Menopause is when women stop have menstrual periods for 12 months. The years leading up to this point are called "perimenopause" or around menopause. Without 12 months of having a period, you have gone through the change, you are now in menopause. For the rest of your life, you are now considered "post menopause". The average age that women go through menopause is 51 years but it can occur from the age of 30 to the late 50s.
The Menstrual Cycle
Estrogen is made from your ovaries (the two glands on the side of your uterus) during the entire menstrual cycle. It causes the endometrium (lining of the uterus) to thicken each month. On about the 14th days of your menstrual cycle, an egg is released from one of the ovaries. This is called ovulation. After ovulation, progesterone levels increase. If the egg is not fertilized by sperm, no pregnancy occurs. This causes the levels of estrogen and progesterone to decrease. This lets the uterus know to shed its lining which causes pleading during your period.
Menstrual changes
Menopause is a normal part of life. Each woman goes through menopause differently, affected by a wide variety of factors such as genetic issues (when did your mother begin to go through “the change”?) and lifestyle issues (general health, exercise, smoking). When your ovaries stop making enough of the female hormones estrogen and progesterone, you begin this natural biological process. Menopause is surgically induced when the ovaries are removed via a surgical operation. Once the ovaries are removed, either at the time of a hysterectomy or at a later date in a separate procedure called an oophorectomy, then menopausal symptoms will begin. The source of estrogen, the ovaries, has been eliminated.
As menopause nears, the ovaries make less estrogen. Every woman will have different signs but the most common one is the irregularity of your periods; you may skip one or more periods, the flow may become lighter or heavier and bleeding may last longer or shorter for you. **Please not an egg is still being produced and you still may get pregnant.** Other signs include vaginal dryness, vaginal and urinary tract changes, hot flashes, sleep problems and emotional distress.
Menopause Treatment
There are numerous therapy options available for you. Talk with your provider to create a plan that will work best for you. The plan will address the symptoms you are having along with any concerns you may have to fit your comfort level.
Hormone therapy is one option. There are two types of hormone therapy. First, there’s estrogen–plus–progestin therapy. Estrogen helps relieve your menopausal symptoms, and the progestin helps protect the uterus.
The other is estrogen-alone therapy for women who have had their uterus removed during a hysterectomy–and do not need the progestin. And the good news is that both types of therapy also help protect your bones.
There are a number of ways to take hormone therapy. To treat symptoms of menopause like hot flashes, night sweats, and vaginal dryness, your doctor will likely prescribe a pill. Although the pill is the most commonly prescribed form, a patch applied to the skin can treat those symptoms as well. Now, if you're only bothered by vaginal symptoms, like dryness, itching, and burning, your doctor can prescribe a cream that can be applied directly to your vagina.
There are alternatives to hormone replace therapy, discuss with your provider at the next appointment.
Additional menopausal concerns
Bone changes occur as a part of normal part of aging. Menopause increases the rate of bone loss which can lead to osteopenia (low bone mass) or osteoprosis. These increase the risk of breaking bones. A bone scan or DXA of the hip, spine and forearm will test the bone measurement. We perform DXA's at our clinic using the gold standard scan of the hip, spine and forearm. We also have Vetebral Fracture Assessment (VFA) which scans the hip for potential compression fractucres. A referral is required from your provider (it does not have to be one of our providers) for the DXA.
The estrogen produced by women's ovaries before menopause protects them from heart attacks and strokes. When less estrogen is made after menopause, women lose much of this protection. The risk of heart attack and stroke then increases. We offer a carotid ultrasound at our clinic once a month. This will compare your carotid arteries against those of your peer's of the same age. A referral is required from your provider (it does not have to be one of our providers) for the carotid ultrasound.
Periodic Testing
|
Pap Test |
Yearly *If low risk and have three normal tests in a row, the provider and patient can decide to have less often. |
| Mammogram | Every 1-2 years from age 40 to 49Annually beginning at age 50 |
| Colorectal cancer screening | Yearly fecal occult blood test, plus either sigmoidscopy every 5 years beginning at age 50, colonoscopy every 10 years or double contrast barium enema every 5-10 years. |
| DXA | The National Osteoporosis Foundation suggests initial screening of the following groups of postmenopausal women: 1) All women over 65 years of age. 2) Postmenopausal women over age 50 with one or more risk factors, including any bone fracture after age 40, fracture related to osteoporosis in a first-degree relative, current smoking, and weight less than 127 pounds. Some experts recommend all postmenopausal women not taking hormone replacement therapy have a baseline screening bone density test performed. The bone density testing should be repeated based upon consultation with your physician. |
| Cholesterol | Every five years beginning at age 45 |
| Fasting glucose testing | Every three years after age 45 |
| Flu vaccine | Once a year beginning at age 50 years |
| Tetanus-diphtheria booster | Once every 10 years |
| Pneumonia vaccine | After age 65 (unless high risk), then every 5-10 years |