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Changes in life - Menopause

What is Menopause?

Menopause is the time in a woman's life when her period stops and she can no longer become pregnant. It is a normal change in a woman's body. A woman will know she has reached menopause when she has not had a period for 12 months in a row (and there are no other causes, such as pregnancy or illness, for this change). This happens for most women after age 45.

Menopause is sometimes called, "the change of life." In the years leading up to menopause, a woman’s ovaries slowly make less and less of the hormones estrogen and progesterone. You might not be aware of the changes happening in your body. Or, you might have symptoms as you near menopause. Many women wonder if these symptoms are normal, and many are confused about how to treat their symptoms.

You will feel better by learning all you can about menopause and talking with your doctor about your health and your symptoms. If your symptoms are causing you discomfort or concern, your doctor can teach you about treatment options and help you to make wise choices.

What are the Symptoms of Menopause?

Menopause affects every woman differently. Your only symptom may be your period stopping. You may have other symptoms, too. Many symptoms at this time of life happen because you are getting older. But some are due to menopause. It’s not always possible to tell if symptoms are related to aging, menopause, or both. Some changes you might notice as you near menopause include:

  • Change in pattern of periods (They can be shorter or longer, lighter or heavier, or there may be more or less time between periods.)
  • Hot flashes (sometimes called hot flushes), night sweats (sometimes followed by a chill)
  • Trouble sleeping through the night (with or without night sweats)
  • Vaginal dryness
  • Mood swings, feeling crabby, or crying spells
  • Trouble focusing, "fuzzy thinking," or forgetfulness
  • Hair loss or thinning on your head or more hair growth on your face

Does Menopause Cause Bone Loss?

Both men and women lose bone as they grow older. But dropping estrogen levels around the time of menopause also leads to bone loss in women. Estrogen helps to build and maintain bone. After menopause, bone loss speeds up for several years as estrogen levels rapidly decrease. Bone loss can cause bones to weaken. Weak bones can break more easily. When bones weaken a lot, the condition is called osteoporosis (OSS-tee-oh-puh-ROH-suhss).

How Do I Manage Symptoms of Menopause?

Many women do not need any special treatment for menopause. Eating healthy foods and keeping physically fit are important to feeling your best in the years leading up to menopause and beyond. But women who are bothered by some menopausal symptoms might want to try treatment. Several treatment options, including menopausal hormone therapy (MHT), are available depending on your symptoms and other factors. Talk to your doctor about the risks and benefits of treatment so you can choose what’s best for you. There is no one treatment that is good for all women.

  • Hot flashes. Some women report that eating or drinking hot or spicy foods, alcohol, or caffeine, feeling stressed, or being in a hot place can bring on hot flashes. Try to avoid any triggers that bring on your hot flashes. Dress in layers, and keep a fan in your home or workplace. If you are bothered by hot flashes or night sweats, ask your doctor about MHT. MHT works best at treating hot flashes and night sweats. If MHT is not an option for you, ask your doctor about trying antidepressant or epilepsy medicine. There is proof that these can relieve hot flashes for some women.

  • Vaginal dryness. A water-based, over-the-counter vaginal lubricant (like K-Y® Jelly) can be helpful if sex is painful. A vaginal moisturizer (also over-the-counter) can provide lubrication and help keep needed moisture in vaginal tissues. Really bad vaginal dryness may need MHT. If vaginal dryness is the only reason for considering MHT, an estrogen product for the vagina is the best choice. Vaginal estrogen products (creams, tablet, ring) treat only the vagina.

  • Problems sleeping. One of the best ways to get a good night's sleep is to be physically active. But, don’t exercise close to bedtime. Also avoid large meals, smoking, and working right before bedtime. Caffeine and alcohol should be avoided after noon. Drinking something warm before bedtime, such as herbal tea (no caffeine) or warm milk, might help you to feel sleepy. Keep your bedroom dark, quiet, and cool, and use your bedroom only for sleeping and sex. Avoid napping during the day, and try to go to bed and get up at the same times every day. If you wake during the night and can't get back to sleep, get up and read until you’re sleepy. Don't just lie there. If hot flashes are the cause of sleep problems, treating the hot flashes will usually improve sleep.

  • Mood swings. Some women report mood swings or "feeling blue" during the menopause transition. Women who had mood swings (PMS) before their periods or postpartum depression after giving birth may have more mood swings around the time of menopause. These are women who are sensitive to hormone changes. Often the mood swings will go away with time. If a woman is using MHT for hot flashes or another menopause symptom, sometimes her mood swings will get better, too. Also, getting enough sleep and staying physically active will help you to feel your best. Mood swings are not the same as depression.

  • Trouble focusing, “fuzzy thinking,” forgetfulness. Some women complain of these symptoms in midlife. But studies suggest that natural menopause has little effect on memory or other “brain” functions. Also, recent studies suggest that women should not use MHT to protect against memory loss or brain diseases, including dementia, and Alzheimer’s disease. Getting enough sleep and keeping physically active might help improve symptoms. But if memory problems are really bad, talk to your doctor right away.

Can Menopausal Hormone Therapy (MHT) Help Treat My Symptoms?

If used properly, menopausal hormone therapy (MHT) (once called hormone replacement therapy or HRT) can be very good at relieving moderate to severe menopausal symptoms and prevents bone loss. But MHT also has some risks, especially if used for a long time.
MHT can help with menopause by:

  • Reducing hot flashes and night sweats, and related problems such as poor sleep and irritability
  • Treating vaginal symptoms, such as dryness and discomfort, and related effects, such as pain during sex
  • Slowing bone loss
  • Possibly easing mood swings and mild depressive symptoms (MHT is not an antidepressant and is not effective in treating depression.)

For some women, MHT may increase their chance of:

  • Blood clots
  • Heart attack
  • Stroke
  • Breast cancer
  • Gall bladder disease

When deciding whether or not to use MHT, you and your doctor need to talk about the potential benefits and risks. Also ask about other treatment options. For example, lower dose estrogen products (vaginal creams, rings, and tablets) instead of MHT are a good choice for women who are only bothered by vaginal symptoms. And other drugs can help many women with bone loss. This information will help you decide if MHT is right for you. If you decide to try MHT, use the lowest dose that helps for the shortest time you need it.

Who Should Not Take Menopausal Hormone Therapy (MHT) for Menopause?

Women who:

  • Think they are pregnant
  • Have problems with vaginal bleeding
  • Have had certain kinds of cancers (such as breast and uterine cancer)
  • Have had a stroke or heart attack
  • Have had blood clots
  • Have liver disease
  • Have heart disease

MHT can also cause these side effects:

  • Vaginal bleeding
  • Bloating
  • Breast tenderness or swelling
  • Headaches
  • Mood changes
  • Nausea

Be sure to see your doctor if you have any of these side effects while using MHT.

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