Wellness

Menopause

30 October 2015




Menopause happens in women's lives when the cycle function of the ovaries and menstruation end. I'm in menopause...and now?

...and now what?


What is it?

Menopause happens in women's lives when the cycle function of the ovaries and menstruation end. 

Menopause begins when they have their last menstrual period. However, that fact is only confirmed later on, when they have no menstrual flow for at least 12 months. The average age for menopause to begin is around 50 years, but it can also appear in women with only 40 years. Regular menstrual cycles may continue until menopause, but in general the last menstrual period has a variable duration and a variable amount of flow. Progressively, menstrual cycles will be fewer and accompanied by the release of an egg. 

Premature menopause is the one that happens before the 40’s. Among the causes, there’s the genetic predisposition or autoimmune disorders in which antibodies are created and can damage various glands, including the ovaries. Smoking is also associated with premature menopause. 
Artificial menopause derives from a medical intervention that reduces or stops hormone secretion from the ovaries. These interventions include surgery to extract the ovary or to reduce the amount of blood that is received and also chemotherapy or radiotherapy to the pelvis (including the ovaries), to treat cancer. Surgical interventions that emerge from the uterus (hysterectomy) stop the bleeding and do not affect the amount of hormones of the ovaries that remain intact and therefore do not cause menopause. 

Symptoms

During the menstrual period prior to menopause (called perimenopause or menopause) there may be no symptoms or they may be mild, moderate or acute. 

  • Hot flashes affect 75% of women. During a heat map, skin, especially on the head and the neck, become red and sweating can be intense. Most women have hot flashes for more than one year and 25% to 50% suffer for more than five years. They last between 30 seconds and 5 minutes and may be followed by chills.
  • Psychological and emotional symptoms such as fatigue, irritability, insomnia, and nervousness can be caused by reduced estrogen.
  • The night sweats are a sleep disturbance factor and exacerbates fatigue and irritability.
  • Sometimes women may feel dizzy, have tingling (stinging) and feel the beat of his heart, which seems to throb hard.
  • Urinary incontinence, inflammation of the bladder and the vagina and pain during intercourse due to vaginal dryness may also be symptoms.
  • Sometimes a painful sensation in the muscles and joints arises.
  • Osteoporosis (the intense thinning of the bones) is a major health problem that is caused by menopause. Thin white women and those who smoke, ingest excessive amounts of alcohol, take corticosteroids, ingest small amounts of calcium or have a sedentary lifestyle has an increased risk of suffering from this disease. During the first 5 years after the menopause, they lose up between 3% and 5% of bone mass per year, and then between 1% and 2% per year. Consequently, fractures may occur even in elder people, without no injuries. The bones that fracture the most are the vertebrae (which causes bending and back pain), femur (hip) and the bones of the wrists.
  • The risk of cardiovascular disease increases more rapidly after menopause, due to the decrease of estrogen. A woman who has suffered an ovariectomy and therefore have premature menopause, who do not do an estrogen replacement therapy has twice the probability to suffer from cardiovascular disease than a pre-menopausal woman of the same age. Postmenopausal women who take estrogens suffer much less from cardiovascular disease than those who do not take any. For example, among postmenopausal patients suffering from coronary artery disease, those who take estrogens have on average a greater life expectancy. These advantages are due in part to the favorable effects of estrogen on the amount of cholesterol. The reduction of estrogen leads to an increase in the so called bad cholesterol (low density lipoproteins LDL -) and a decrease in the so-called good cholesterol (high-density lipoproteins - HDL).

 

Treatment

The symptoms are treated up by restoring estrogen levels on similar numbers to the pre-menopausal.

The main objectives of estrogen replacement therapy are as follow: 

  • Relieve symptoms such as hot flashes, vaginal dryness and urinary disorders
  • Preventing the onset of osteoporosis
  • Prevention of atherosclerosis and coronary artery disease

Estrogens are presented in non-synthetic form (natural, eg phytoestrogens) or synthetic (produced in the laboratory). The synthetic estrogen is a hundred time more potent than the natural one and therefore it is not recommended for menopausal women, since with very low doses of natural estrogen they already prevent hot flashes and osteoporosis. On the other hand, very high doses may cause problems such as an increase tendency to suffer from migraines.

The estrogen is administered in the form of tablets or adhesive bands skin (transdermal estrogen). They can also be placed in the vagina in the form of cream when the main reason for their use is to prevent the vaginal wall surface to become thin (which reduces the risk of infections and urinary incontinence) and prevent pain during intercourse. Part of the administered estrogen is absorbed and drives in the blood, particularly as the vaginal lining improves. 

Due to the side effects of estrogens, involving long-term risks, along with the advantages, the woman and her doctor must balance the advantages and the disadvantages before deciding the administration of estrogen replacement therapy. Side effects include nausea, breast discomfort, headache and changes of state of mind.
Postmenopausal women who take estrogen without progesterone have an increased risk for endometrial cancer (cancer of the lining of the uterus). The incidence is 1 to 4 in 1000 women per year. This increase is closely related to the dose and the duration of treatment. If a woman has an abnormal bleeding from the vagina, can make up a biopsy (obtaining a tissue sample for examination under a microscope) of the inner lining of the uterus for determining whether is endometrial cancer or not. Women suffering from this disease and who are taking estrogen usually have a good prognosis: about 94% survive during 5 years. The administration of progesterone along with estrogen, virtually eliminate the risk of endometrial cancer and reduce it even more in women that are not taking estrogen (a woman who extracted the uterus can’t develop this cancer). Progesterone does not seem to deny the beneficial effects of estrogen on cardiovascular disease. 

An important question is whether the estrogen increases the incidence of breast cancer. However, there is no link, obviously, no association between substitution therapy with estrogen and breast cancer. The risk of cancer increases when women take estrogens for more than 10 years. The woman with high risk of developing breast cancer should not take estrogen. However, for women prone to osteoporosis and heart disease and those with little risk of developing breast cancer, the benefit gained thanks to therapy with estrogen widely compensate the prevention of possible risks. 

The risk of contracting gallbladder disease during the first year of treatment with estrogen replacement, is slightly larger. 
In general, estrogen replacement therapy is not prescribed for women who have or had breast cancer or advanced endometrial cancer, who have genital bleeding of unknown cause, who suffer from a serious liver disease or alterations in blood coagulation. However, sometimes, doctors administer estrogen to women who were treated of breast cancer in its early stage and suffer no recurrence for at least the past 5 years. In general, estrogen replacement therapy is not indicated in chronic liver disease or acute intermittent porphyria. 

Women who can not take estrogen may be prescribed with antianxiety drugs, progesterone, or clonidine to reduce the discomfort of the hot flashes. The anti-depressants also relieve depression, anxiety, irritability and insomnia. 

 

In replacement therapy, when is administered progesterone along with estrogen?

Progesterone is administered with the estrogen to reduce the risk of endometrial cancer. Typically, estrogen and progesterone are taken daily. This scheme causes an irregular vaginal bleeding during the first 2 or 3 months of treatment, but usually disappear completely in the course of a year. Alternatively, you can make up a cyclic scheme: a woman takes estrogen daily for about two weeks, progesterone with estrogen during the following days and then no hormone during the last days of the month. However, this scheme is less convenient because the bleeding is frequent on the days with no hormones taken. 

Synthetic progesterone is presented in different forms which can be administered orally or intravenously. The side effects of progesterone include abdominal bloating, discomfort in the breast, headaches, emotional instability and acne. It also has some adverse effects on cholesterol levels. 




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