Transcript Menopause - University of San Francisco

Menopause
I.
II.
III.
IV.
Why is understanding menopause
important?
The basics: Perimenopause
The basics: Menopause
The change - A misunderstood period of
life
I. Why is understanding menopause
important?
A. Numbers:
% Increase in US population aged over 55
Source: US Bureau of the Census, International Database
B. Menopause is related to health

increased risk for developing two significant
diseases: osteoporosis and heart disease
II. The Basics: Perimenopause
A.


Overview:
Years immediately preceding and following the last menstrual
period -
during this time the following processes are occurring within a
woman's body:

ovaries release eggs less regularly

ovaries gradually produce less estrogen and other hormones

fertility decreases

menstrual cycles shorten, there are fewer ovulations, and more
cycle irregularity
B. Perimenopausal symptoms






mood changes
changes in sexual desire
difficulty in concentrating
joint and muscle aches, frequent urination
similar symptoms as experienced with premenstrual
syndrome (PMS)
Treatment of symptoms
 low-dose birth control pills
III. The Basics: Menopause
Overview:
A.
Cause?

1)
2)
Decreasing # of follicle cells –
Hypothalamatic changes in the brain cause ovaries to increase the #
of follicle cells recruited premenopausally, thereby rapidly depleting
the follicle cells
Result:
Most women enter & complete menopause between the ages 45-55
(mean age = 51),



Premature menopause –
B. Modes of induction
Natural menopause – ovaries begin to fail to
respond to the LH & FSH which are still
released
1)
Surgically induced menopause – total
hysterectomy, bilateral sapingooophorectomy, and/or chemotherapy
2)

Ovaries not present to respond to LH/FSH
C. Symptoms of menopause
Different for each woman!
Hot Flashes – a sensation of internally generated heat beginning
in the chest and moving to the neck & head or spreading
throughout the body

1)

Accompanied by increased heart rate, temperature, shallow
breathing, & sweating followed by chills
Early symptom of estrogen deficiency

Treatment:


Deep breathing, reduced stress
2)
Vaginal atrophy –


3)
4)
5)
6)
May impact sexual desire
Vaginal lubricants can help this, sexual activity
lessens the effect
Atrophy of the urinary tract & urinary
incontinence – diminished muscle tone
Sleep disturbance,
Increased weight
Changes in hair growth & skin (estrogen
effects collagen)
D. Menopause Management
1)
Lifestyle changes
Non-prescription options
2)
Vitamins & minerals
Vaginal lubricants & moisturizers
Acupuncture
Phytoestrogens (plant estrogens)





Watch out for “herbal alternatives” that claim to cure
cancer, prevent heart disease or reverse the effects of
osteoporosis…
3)
Hormone Replacement Therapy (HRT) –
medically supervised drug treatment of
menopausal women which involves
supplementing hormone levels
Benefits of EPT and ET






reduce the risk of osteoporosis.
relieve hot flashes and night sweats.
relieve vaginal & urinary atrophy.
improve cholesterol levels.
reduce the risk of cancer of the colon.
may reduce macular degeneration.
Women's Health Initiative (WHI) clinical trial – a turning point!
Researchers found combination
Risks of HRT

EPT and ET modestly increase risk of breast cancer while they are
being used; long-term use may pose the greatest risk.
EPT and ET may increase the risk for blood clots.
EPT and ET can have unpleasant side effects, such as bloating
and breast tenderness.
EPT and ET in pill form can raise level of triglycerides (a type of fat
in the blood).
ET may increase the risk of dementia.
ET increases the risk of stroke.
ET increases the risk of cancer of the uterus.

It's all in the timing: Age is an important factor:

ET –

For some women — such as those who experience moderate to
severe hot flashes or other menopausal symptoms —






http://www.nih.gov/PHTindex.htm
IV. The change – Currently, a
misunderstood period of life
A.
Cultural bias

Neglected as a research
area – we still don’t know
what triggers menopause or
how symptoms should be
treated best
B. Not simply “the end of the road” –
A time of freedom & empowerment




“Freed up & energized”
“To airbrush age off a woman’s face is to erase
woman’s identity, power and history.” Naomi
Wolf
“My fantasy of aging is to age well enough so
that younger women would think, “Gee, I wish I
were her age.” I want the stigma of aging to be
removed from women and for myself, I intend
to do it with as much panache as I can. I am
going to put everything I’ve got into it.” Claire
Braz-Valentine
“In my fifties, I feel ripely quiet. Life seems
simpler; I am more appreciative.” Ruth
Zaporah
For discussion



Why has medical research been slower to
understand the physiological dimensions of
menopause than other reproductive health
matters?
What can be done to continue to change
societal images of menopause, aging, and
older women?
How should menopause be viewed?