MENOPAUSE

The menopause marks the time in a woman's life when her menstruation stops and she is no longer fertile (able to become pregnant). In the UK the average age for the menopause is 52 (National Health Service), while in the USA it is 51 (National Institute of Aging). About one fifth of women in India experience menopause before the age of 41, a study found. The menopause is a normal part of like - it is a milestone, just like puberty - it is not a disease or a condition. Even though it is the time of the woman's last period symptoms may begin many years earlier. Some women may experience symptoms for months or years afterwards. According to Medilexicon's medical dictionary, the menopause is the "Permanent cessation of the menses due to ovarian failure; termination of the menstrual life." (menses = shedding of blood during a woman's menstrual period). The peri-menopause is the 3 to 5 year period before the menopause when a woman's estrogen levels begin to drop. Let's recap the meaning of these two words: Menopause - when periods (menstruation) stop forever. Peri-menopause - the years before the menopause when estrogen levels start to drop. .

What are the symptoms of menopause and perimenopause?

Experts say that technically the menopause is confirmed when a woman has not had a menstrual period for one year. However, the symptoms and signs of menopause generally appear well before the one-year anniversary of the final period. They may include: Irregular periods - this is usually the first symptom; menstrual pattern changes. Some women may experience a period every two to three weeks, while others will not have one for months at a time. Lower fertility - during the peri-menopausal stage of a woman's life her estrogen levels will drop significantly, lowering her chances of becoming pregnant. Vaginal dryness - this may be accompanied by itching and/or discomfort. It tends to happen during the perimenopause. Some women may experience dyspareunia (pain during sex). The term vaginal atrophy refers to an inflammation of the vagina as a result of the thinning and shrinking of the tissues, as well as decreased lubrication, caused by a lack of estrogen. About 30% of women experience vaginal atrophy symptoms during the early post-menopausal period, while 47% do so during the later post-menopausal period. There are cases of women who experience vaginal atrophy more than a decade after their final period. The majority of postmenopausal women are uncomfortable talking about vaginal dryness and pain and are reluctant to seek medical help, a study found. Hot flashes (UK term: hot flushes) - this is a sudden feeling of heat in the upper body. It may start in the face, neck or chest, and then spreads upwards or downwards (depending on where it started). The skin on the face, neck or chest may redden and become patchy, and the woman may start to sweat. The heart rate may suddenly increase (tachycardia), or it may become irregular or stronger than usual (palpitations). Hot flashes generally occur during the first year after a woman's final period.

Night sweats - if the hot flashes happen in bed they are called night sweats. Most women say their hot flashes do not last more than a few minutes. Disturbed sleep - sleeping problems are generally caused by night sweats, but not always. Sleep disturbance may be caused by insomnia or anxiety. Difficulty falling asleep and staying asleep increase as women go through menopause, this study revealed. Urinary problems - women tend to be more susceptible to lower urinary tract infections, such as cystitis. Having to urinate may also occur more frequently. Moodiness - this often goes hand-in-hand with sleep disturbance. Experts say that most mood disturbances are triggered by poor sleep. Problems focusing and learning - Some women may also have short-term memory problems, as well as finding it hard to concentrate on something for long. A very large study found that women may not be able to learn as well shortly before menopause compared to other stages in life. More fat building up in the abdomen. Hair loss (thinning hair). Loss of breast size If left untreated, these symptoms will usually taper off gradually over a period of two to five years. However, some women may experience symptoms for much longer. Most women who experience vaginal dryness, itching or discomfort may find symptoms either persist or get worse with time if left untreated.

What causes the menopause and peri-menopause?

The hormones estrogen and progesterone regulate menstruation - more specifically, estrogen regulates menstruation while progesterone is more involved with preparing the body for pregnancy. When the ovaries start producing less of these two hormones the peri-menopause will start. In fact, by the time a woman is in her late 30s the ovaries start producing less progesterone and estrogen. By the time she is n her 40s the post-ovulation spike in progesterone becomes less emphasized. A woman's fertility starts to decline a long time before she may notice any menopausal or peri-menopausal symptoms. As time passes and the ovaries produce less and less estrogen and progesterone the ovaries eventually shut down completely and the woman no longer has any more menstrual periods. The vast majority of women experience a gradual change in menstrual activity, while some go on normally until they suddenly stop. Some women may experience premature menopause - their ovaries fail earlier than they are supposed to (before the age of 45). Ovarian failure can occur at any age - but very rarely - and often the doctor and patient will never find out why. Some women who experience ovarian failure may still have periods and some degree of fertility for a while. Premature menopause may be caused by: Enzyme deficiencies Down's syndrome

 Turner's syndrome Addison's disease Hypothyroidism Removal of the ovaries (bilateral oophorectomy surgery) Radiotherapy to the pelvic area Chemotherapy Hysterectomy surgery (the uterus - womb - is surgically removed) Some infections - such as mumps or TB (tuberculosis), malaria and varicella. However, in all cases risk of ovarian failure is extremely small. Genetic factors - scientists have been able to identify genetic factors that influence the age at which natural menopause occurs in women, as explained in this article. Being a twin - twins are more likely to have a premature menopause than other women, a study found.

How is menopause diagnosed?

A GP (general practitioner, primary care physician) should be able to diagnose menopause or perimenopause if he knows the age of the patient, has information about her menstrual patterns, and receives feedback from her on her symptoms. Apart from a blood test which can measure levels of FSH (follicle-stimulating hormone), there is no definitive test to diagnose menopause or peri-menopause. FSH blood levels rise when a woman is in the menopause. However, as FSH levels tend to fluctuate a lot during the menopause and peri-menopause, a FSH blood test may provide a little data, but may not be that helpful for a diagnosis. Under certain circumstance a doctor may order a blood test to determine the level of estradiol (estrogen). As hypothyroidism (underactive thyroid) can cause menopause-like symptoms, the doctor may order a blood test to determine the woman's level of thyroid-stimulating hormone.

What is the treatment for menopause or perimenopause?

According to the National Health Service, UK, only about 10% of women seek medical advice during the menopause. Many women require no treatment. However, if symptoms are affecting the woman's daily life she should see her doctor. The kind of treatment the patient should have depends on her symptoms, her medical history, as well as her own preferences. Available treatments include: HRT (hormone replacement therapy) or HT (hormone therapy) - this is very effective for many of the symptoms that occur during the menopause, including vaginal dryness, vaginal itching, vaginal discomfort, urinary problems, bone-density loss, hot flashes and night sweats. HRT tops up the woman's levels of estrogen. However, as with many treatments, HRT has its risks and benefits: Benefits of HRT Effectively treats many troublesome menopausal symptoms. Helps prevent osteoporosis. Lowers colorectal cancer risk (cancer of the colon or rectum)

Risks of HRT Raises breast cancer risk Raises ovary cancer risk Raises uterine cancer risk (cancer of the womb) Raises coronary heart disease risk Raises stroke risk HRT was found to slightly accelerate loss of brain tissue in areas important for thinking and memory among women aged 65 and over, according to a study. Dr. Robert Reid, Professor Ob/Gyn, Chair of the Division of Reproductive Endocrinology and Infertility, Queen's University stated that "Not all women need HT, but many with troublesome symptoms were needlessly scared away from that option due to misunderstandings about the actual risks associated with it." Older women who take hormone therapy to relieve menopausal symptoms may get the added benefit of reduced body fat if they are physically active, a study revealed. OTHER TYPES OF TREATMENTS Low-dose antidepressants - SSRIs (selective serotonin reuptake inhibitors) have been shown to decrease menopausal hot flashes. Drugs include venlafaxine (Effexor), fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalopram (Celexa) and sertraline (Zoloft). Omega 3s - Researchers from the Universite Laval's Faculty of Medicine found that Omega-3s ease psychological distress and depressive symptoms often suffered by menopausal and perimenopausal women. Gabapentin (Neurontin) - this medication is effective in treating hot flashes. It is commonly used for treating seizures (epilepsy). Clonidine (Catapres) - can be taken either orally as a pill or placed on the skin as a patch. It is effective in treating hot flashes. The drug is commonly used for treating high blood pressure (hypertension). However, unpleasant side-effects are common. Osteoporosis treatments - please see the article "What is osteoporosis?" which has a section on treatments. Vaginal estrogen - may be applied locally using a tablet, ring or cream. This medication effectively treats vaginal dryness, discomfort during intercourse, as well as some urinary problems. A small amount of estrogen is released and absorbed by the vaginal tissue. Soybeans - soy aglycons of isoflavone (SAI), a group of soybean constituent chemicals, have been shown to promote health in a rat model of the menopause, according to a study by scientists at National Chiayi University, Taiwan. Exercise - a study found that slow exercise is better for post-menopausal women than fast exercise.

Complications
After the menopause it is common for the following chronic conditions to appear. Chronic, in medical English, means long-term, continuous (as opposed to "acute").

Cardiovascular disease - a drop in estrogen levels often goes hand-in-hand with an increased risk of cardiovascular disease. Heart disease is not exclusively a male problem, it is the main cause of death among both men and women. In order to reduce the risk of developing cardiovascular disease a woman should quit smoking, try to keep her blood pressure within normal levels, do plenty of regular exercise, sleep at least 7 hours each night, and eat a well-balanced healthy diet. Osteoporosis - a woman may lose bone density rapidly during the first few years after menopause. The lower a person's bone density gets the higher their risk is of developing osteoporosis.Absolute risk of a second clinical fracture is highest in the five years after any first clinical fracture for postmenopausal women, a study found. Urinary incontinence -Menopause causes the tissues of the vagina and urethra to lose their elasticity, which can result in frequent, sudden, strong urges to urinate, followed by urge incontinence (involuntary loss of urine). Stress incontinence may also become a problem - urinating involuntarily after coughing, sneezing, laughing, lifting something, or suddenly jerking the body as may happen when we temporarily lose our balance. Low libido - this is probably linked to disturbed sleep, depression symptoms, and night sweats, a study found. Overweight/obesity - during the menopausal transition women are much more susceptible to weight gain. Experts say women may need to consume about 200 to 400 fewer calories each day just to prevent weight gain - or burn of that number of calories each day with extra exercise. The chances of becoming obese rises significantly after the menopause, according to this article. Breast cancer - women are at a higher risk of breast cancer after the menopause. However, as this article explains, regular exercise after menopause significantly reduces breast cancer risk.

Self help
Unless your symptoms are severe, you may find that some changes in your lifestyle and diet are all you need to deal with the symptoms. Hot flashes and night sweats Do plenty of exercise. Avoid wearing tight clothing. Make sure the bedroom is not hot. Try to reduce your levels of stress. Remember the following commonly trigger symptoms for susceptible people: spicy food, caffeine, smoking, and alcohol. Sleep disturbance Exercise regularly. However, do not exercise too late during the day. Exercising too late may keep you awake longer.

Go to bed and get up at the same time each day - even during weekends. Cut out all drinks and foods that contain caffeine. Learn how to do deep breathing, guided imagery, and progressive muscle relaxation. Moodiness Make sure you do not get tired - get plenty of rest. Do regular exercise. If you can, do strenuous exercise - check with your doctor whether this is OK for you. Practice yoga. Make sure you have a well qualified trainer. Vaginal discomfort and dryness Get some OTC (over the counter) water-based vaginal lubricants or moisturizers. Stay sexually active. Urinary incontinence Practice pelvic floor muscle exercises - Kegel exercises. If you practice three or four times a day you will most probably notice a difference after a few weeks. This review of studies explains that women suffering from urinary incontinence can benefit from pelvic floor muscle training. Overweight/obesity and osteoporosis prevention Eat a well balanced diet that includes plenty of vegetables, fruits, wholgrains, good quality fats, fiber, and unrefined carbohydrates. Try to consume 1,200 to 1,500 milligrams of calcium and 800 IUs of vitamin D per day. Do plenty of exercise. Make sure you sleep at least 7 hours each night.

Nutrition for older persons

Ageing and nutrition: a growing global challenge
Both the number and the proportion of older persons - defined as aged 60 and over - are growing in virtually all countries, and worldwide trends are likely to continue unabated. In 2002 there were an estimated 605 million older persons in the world, nearly 400 million of whom were living in low-income countries. Greece and Italy had the highest proportion of older persons (both 24% in 2000). By 2025, the number of older persons worldwide is expected to reach more than 1.2 billion, with about 840 million of these in low-income countries. In order to achieve the ultimate goal of health ageing and active ageing, WHO has developed a policy framework, which focuses on such areas as: The challenge of a sex-differential imbalance

preventing and reducing the burden of disabilities, chronic disease and premature mortality; reducing the risk factors associated with noncommunicable diseases and functional decline as individual age, while increasing factors that protect health; enacting policies and strategies that provide a continuum of care for people with chronic illness or disabilities; providing training and education to formal and informal carers; ensuring the protection, safety and dignity of ageing individuals; enabling people as they age to maintain their contribution to economic development, to activity in the formal and informal sectors, and to their communities and families.

Women comprise the majority of the older population in virtually all countries, largely because globally women live longer than men. By 2025, both the proportion and number of older women are expected to soar from 107 to 373 million in Asia, and from 13 to 46 million in Africa. This pattern involves its own special nutritional needs, emphases and patterns of malnutrition, including for example the incidence of osteoporosis in older women. Osteoporosis and associated fractures are a major cause of illness, disability and death, and are a huge medical expense. It is estimated that the annual number of hip fractures worldwide will rise from 1.7 million in 1990 to around 6.3 million by 2050. Women suffer 80% of hip fractures; their lifetime risk for osteoporotic fractures is at least 30%, and probably closer to 40%. In contrast, the risk is only 13% for men. Women are at greater risk because their bone loss accelerates after menopause. Prevention is possible with hormone therapy at menopause. Lifestyle factors especially diet, but also physical activity and smoking are also associated with osteoporosis, which opens the way for primary prevention. The main aim is to prevent fractures; this can be achieved by increasing bone mass at maturity, by preventing subsequent bone loss, or by restoring bone mineral. Particularly important are adequate calcium intake and physical activity, especially in adolescence and young adulthood.