MEDICAL SURFARI: EMBRACING MENOPAUSE

In a series of four articles this month, I'lll address some of the short-term disturbances related to the menopause transition and some of the major health issues that post-menopausal women face.

The word menopause has a Greek origin, as the prefix "meno" is derived from the root word "men-", meaning month, and the latter half of the word "pause" comes from the Greek word "pausis", meaning cessation or stopping. Menopause is the change in a woman's monthly physiology that results in the decreasing function of the ovaries and eventually an end to menses (periods).

For millions of women this stage of life signals an end to childbearing years and a new stage of life that can be equally as rich and rewarding. (Menopause may be natural, artificial or premature and with this event there are many menopause-related changes that may have lifestyle consequences or which may affect the ability to achieve optimum health.) Although each woman is unique, there are many issues common to all women during and after the menopausal experience.

When it comes to menopause, one size does not fit all. Some women may be entirely without symptoms while others may feel as if their bodies have become possessed by some demonic force. Although women who experience menopause-related changes may feel that they are alone in experiencing "strange symptoms", there are approximately 25 million women worldwide who reach menopause each year. In the United States and Canada that averages out to about four thousand women per day who experience some variation of menopause-related changes.

As menopause approaches there are fluctuations in the levels of hormones produced by the ovaries and these fluctuations lead to normal short-term physical changes that may include irregular menstrual patterns and sudden warm feelings with a sense of blushing that are often referred to as "hot flashes".

Others may experience night sweats, fatigue and irritability, vaginal dryness, headaches, dizziness and a racing heart rate. It is also not unusual for some women to experience nausea, constipation, increased gas, aches and pains and fluctuation in sexual desire or response. Your physician can advise you about the best way to manage these effects. Prolonged or very heavy bleeding or bleeding after intercourse may signal problems and should be evaluated by a physician.

These effects are a result of age-related changes in the ovaries that result in lower levels of estrogens and progesterone. It is certainly important to understand that during this "menopause transition" with fluctuating hormones, a midlife woman may still be able to get pregnant. Generally, after twelve consecutive months have passed without a period, the possibility of pregnancy is exceedingly unlikely.

The average age when women naturally begin menopause is about 50, although some women begin the process as early as in their late thirties, and rarely as late as in their sixties. There are many factors that determine when this change will begin and, in part, this is related to genetics.

There does not seem to be a correlation between the time of a woman's first period and her age at menopause. Menopause does not seem to be influenced by race, height, number of children or whether or not one has used oral contraceptives; however, cigarette smoking may speed up the process by as much as two years and certainly the surgical removal of the ovaries will bring on artificial menopause. Women who have had a hysterectomy, or uterus removed but not the ovaries, prior to experiencing natural menopause should continue to produce hormones and consequently will not experience artificial (surgical) menopause.

Since women have the potential to live 80 or more years, the post-menopausal phase of a woman's life may be as much as one-third or more of her adult life. Therefore, a solidly good understanding of menopause and its effects is critical to optimize health and lifestyle so that a woman's senior years can be as rich and rewarding as they ought to be.

In a series of four articles this month I'll be addressing some of the short-term disturbances related to the menopause transition and some of the major health issues that post-menopausal women face.

World Wide Web Resources

The North American Menopause Society (NAMS)

www.menopause.org/about.htm

The web site by the NAMS provides excellent, basic information about menopause and answers to frequently asked questions on the topic.

Mayo Clinic Women's Health Center

www.mayohealth.org/mayo/common/htm/womenpg2.htm

This is a very informative site about a variety of women's health issues, including menopause, osteoporosis, gynecologic conditions, and reproductive health issues.

Dr. Scott Gibbs is a neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702.