Menopause Overview

Menopause, or the cessation of menstrual bleeding, occurs on the average at age 51.4 years. However, one can go through menopause as early as age 35 or as late age 57.

Perimenopause precedes menopause and can occur anywhere from 8-15 years before the menopause. This life transition manifests itself in a number of ways which can include weight gain, mood fluctuations, fatigue, decreased libido among others. It may or may not be accompanied by sweating or hot flushes. During this time, menstrual cycles become much more irregular.

Many of these symptoms resolve within 6-8 months after cessation of menstruation, however, 40% of women have symptoms over a lifetime. This condition occurs because of the depletion of the egg supply in the ovary. The end result of these changes is a decrease in production of the body’s primary estrogen.

Concurrent with or sometime thereafter, testosterone production begins to decrease, which can further the previously mentioned symptoms. This is generally treated by the addition of molecular testosterone.

There are many treatments available to women which can lessen the severity of symptoms associated with menopause.

Treatment
The classic treatment of the menopause has been focused on the maintenance of bone stability and the prevention of osteoporosis. The secondary goal was primarily the control of hot flushes. There are many medications available to women for treatment. All of them prevent bone loss, but may or may not control hot flashes.

Customized Hormonal Therapy
Many women require customized hormonal therapy to treat the myriad of symptoms that accompany the perimenopause and menopause. A detailed assessment of the patient’s family history, general medical history, and physical condition can be carried out along with testing of hormone levels.

Therapy can then be customized based on whether or not a woman has a functional uterus, and therapeutic doses can be adjusted based on the clinical response of certain markers which allows for the safe use of hormone replacement therapy. It should be emphasized that this type of hormone replacement therapy is useful in the maintenance of general health and well-being if applied early in life. However, in all probability no type of hormonal therapy will prevent chronic diseases if applied to older patients with less than healthy lifestyles and large numbers of chronic disease processes.

Alternatives to Hormone Replacement Therapy
Alternatives to hormone replacement therapy have been tried to treat menopausal symptoms. Psychoactive agents can at times block hot flushes and depression but have little effect on other symptoms. Most herbal preparations have been evaluated by placebo-controlled trials are not effective in the treatment of menopausal symptoms.

Lifestyle modifications such as the maintenance of normal body weight, obtaining adequate sleep, avoiding smoking, alcohol intake, and excessive caffeine, seems to improve menopausal symptoms as does the participation in an adequate exercise program and the use of relaxation therapy such as meditation or yoga.

Menopause is Normal
Finally, it should be remembered that the menopause is a normal psychological life transition, not a disease process. In choosing to treat menopausal symptoms, one was simply using pharmacology to alter the aging process. These types of therapies not only improve our physical and mental well-being but enhance the quality of life.
 

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