Menopause Health Article

Symptoms

About 20% of women in the United States experience menopause with few symptoms. All others report a variety of complaints throughout perimenopause; some mild, some severe enough to interfere with work or daily activities.

There are a variety of symptoms a woman may experience in perimenopause:

• changes in the menstrual cycle, resulting in long cycles and missed periods
• hot flashes
• night sweats
• insomnia
• mood swings/irritability
• memory or concentration problems
• vaginal dryness
• heavy bleeding
• fatigue
• depression
• hair changes
• headaches
• heart palpitations
• sexual disinterest
• urinary changes
• weight gain

Diagnosis

The clearest indication of menopause is the absence of a period for one year. It is also possible to diagnose menopause by testing hormone levels. One important test measures the levels of follicle-stimulating hormone (FSH), which rise steadily as a woman ages.

Treatment of specific symptoms should be handled as they manifest and are reported.

Hormone replacement therapy

The standard treatment for menopause has been hormone replacement therapy, primarily with estrogen. Hormone replacement therapy can treat menopausal symptoms by boosting the estrogen levels enough to suppress symptoms while also providing protection against heart disease and osteoporosis, which causes the bones to weaken. Experts disagree on whether HRT increases or decreases the risk of developing breast cancer.

There are two types of hormone treatments: hormone replacement therapy (HRT) and estrogen replacement therapy (ERT). HRT is the administration of estrogen and progesterone; ERT is the administration of estrogen alone. Only women who have had a hysterectomy (removal of the uterus) can take estrogen alone, since taking this "unopposed" estrogen can cause uterine cancer. The combination of progesterone and estrogen in HRT eliminates the risk of uterine cancer.

Most physicians do not recommend HRT until a woman's periods have stopped completely for one year. This is because women in early menopause who still have an occasional period are still producing estrogen; HRT would then provide far too much estrogen. One way of determining if HRT may be necessary is to measure FSH levels yearly beginning at age 50. When these levels are at or greater than 20 U/l, a postmenopausal hormone program may be recommended.

Many doctors believe that every woman (except those with certain cancers) should take hormones as they approach menopause because of the protection against heart disease, osteoporosis, and uterine cancer and the relatively low risk of breast cancer. Heart disease and osteoporosis are two of the leading causes of disability and death among post-menopausal women. Research in 2000 and 2001 has been challenging the effectiveness of estrogen in preventing heart disease, as well as colorectal cancer and Alzheimer's disease. No substantial study has proven that estrogen is a sound preventative.

Women are poor candidates for hormone replacement therapy if they:

• have ever had breast or endometrial cancer
• have a close relative (mother, sister, grandmother) who died of breast cancer or have two relatives who got breast cancer before age 40
• have had endometrial cancer
• have had gallbladder or liver disease
• have blood clots or phlebitis

Some women with liver or gall bladder disease, or who have clotting problems, may be able to go on HRT if they use a patch to administer the hormones through the skin, bypassing the liver.

Women would make good candidates for HRT if they:

• need to prevent osteoporosis
• have had their ovaries removed
• have significant symptoms

In some women, taking hormones can eliminate hot flashes, vaginal dryness, urinary incontinence (depending on the cause), insomnia, moodiness, memory problems, heavy irregular periods, and concentration problems. But side effects of treatment include bloating, breakthrough bleeding, headaches, vaginal discharge, fluid retention, swollen breasts, and nausea. There can also be an increased risk of gall bladder disease and blood clots. Up to 20% of women who try hormone replacement stop within nine months because of these side effects. However, some side effects can be lessened or prevented by changing the HRT regimen.

The decision should be made by a woman and her doctor after taking into consideration her medical history and situation. Women who choose to take hormones should have an annual mammogram, breast exam, and pelvic exam and should report any unusual vaginal bleeding or spotting (a sign of possible uterine cancer).