What doctors officially call menopause is an event - namely, the point at which you get your last menstrual period. This permanent cessation of menstruation is usually marked by 12 consecutive months of having no periods. Most women experience menopause from 40 to 58 years of age, with a median age of 51.4 years.

In women, the ovaries produce the female hormones estrogen and progesterone. Estrogen and progesterone control a woman's periods and other processes in her body. As a woman approaches menopause, her ovaries gradually makes less and less of these hormones.

Perimenopause, also known as the climacteric, includes the time before menopause when hormonal and biological changes and physical symptoms begin to occur. This period lasts for an average of three to five years.

A hot flash is a feeling described as suddenly being hot, flushed and uncomfortable, especially in the face and neck. Hot flashes come in bursts or flushes that usually last a few seconds to a few minutes. They are caused by changes in the way blood vessels relax and contract and are thought to be related to the changes in a woman's estrogen levels.

A woman can have irregular periods for several months to years before her periods finally stop. Any vaginal bleeding that develops after a year of no periods is abnormal and should be evaluated by a doctor.

As estrogen levels fall, the vagina's natural lubricants decrease. The lining of the vagina gradually becomes thinner and less elastic (less able to stretch). These changes can cause sex to be uncomfortable or painful. They can also lead to inflammation in the vagina known as atrophic vaginitis. These changes can make a woman more likely to develop vaginal infections from yeast or bacterial overgrowth and urinary tract infections.

Sleep often is disturbed by nighttime hot flashes. A long-term lack of sleep can lead to changes in moods and emotions. The chemical changes that happen during menopause do not increase the risk of depression. However, many women experience major life changes during their middle age including menopause and sleep disturbances, which can increase the risk of developing depression.

Some women report irritability or other mood changes. Irritability is commonly caused by poor sleep resulting from nighttime hot flashes. A number of women, however, do not feel irritable.

As estrogen levels drop and remain low during menopause, the risk of developing osteoporosis increases. The risk is greatest for slender, white or light-skinned women. You can help prevent osteoporosis by getting enough vitamin D through sunlight or a daily multivitamin, eating a diet rich in calcium and performing regular exercise. Women should start taking these actions well before menopause begins. This is because women begin to lose bone mass as early as age 30 but fractures resulting from osteoporosis don't occur until 10 to 15 years after menopause.

Before menopause, women have lower rates of heart attack and stroke than men. After menopause, however, the rate of heart disease in women continues to rise and equals that of men after age 65.

Because women can still become pregnant while they are perimenopausal, doctors may do a pregnancy test when a woman's periods become irregular, infrequent or light. In some cases, a blood test for levels of follicle-stimulating hormone (FSH) may be recommended. FSH levels are normally high in menopause, so high FSH levels can help to confirm that a woman is in menopause.

Perimenopause usually lasts three to five years but it can take as few as two years or as many as eight years for some women. The changes in the body that occur during menopause last for the rest of a woman's life. However hot flashes usually improve over time, becoming less frequent and less severe

Menopause is a natural event and cannot be prevented. Medications, diet and exercise can prevent or eliminate some symptoms of menopause and enhance a woman's quality of life as she grows older.

The Gabapentin (Neurontin) moderately effective in treating hot flashes. Gabapentin's main side effect is drowsiness. Taking it at bedtime may help improve sleep while decreasing hot flashes.

All postmenopausal women who have osteoporosis or are at risk of osteoporosis should take calcium and vitamin D supplements. The usual recommended supplemental dose is 1,000 milligrams of calcium carbonate (taken with meals) or calcium citrate daily. It is best to take this as 500 milligrams twice a day. Women also need 800 international units of vitamin D daily.

Etidronate (Didronel), alendronate (Fosamax) and other similar drugs are the most effective medicines that can be used to both prevent and treat osteoporosis. They increase bone density and decrease the risk of fractures.

Calcitonin - hormone produced by the thyroid gland and helps the body keep and use calcium. A nasal spray form of this drug is used to help prevent bone loss in women at risk. Doctors may prescribe calcitonin to help relieve pain from fractures due to osteoporosis.

The use of soy products in the diet such as tofu may have benefit for some women. Soy has small amounts of phytoestrogens (plant estrogens) that may help relieve hot flashes. Researchers speculate that the soy-based diet of Japanese women plays a role in preventing hot flashes. However, it's not clear whether Japanese women have fewer hot flashes or whether they report this problem less often.

There is no relation between the time of a woman's first period and her age at menopause. The age at menopause is not influenced by a woman's race, height, number of children or use of oral contraceptives.

Terms interpreting

Anxiety

• A state of uneasiness and apprehension, as about future uncertainties.


• Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.

Chlorella

• Chlorella is a genus of single-celled green algae, belonging to the phylum Chlorophyta. It is spherical in shape, about 2 to 10 nm in diameter, and is without flagella. Chlorella contains the green photosynthetic pigments chlorophyll-a and -b in its chloroplast. It depends on photosynthesis for growth and multiplies rapidly, requiring only carbon dioxide, water, sunlight, and a small amount of minerals..

Estrogen

• Any one of a group of hormones synthesized by the reproductive organs and adrenal glands in females and, in lesser quantities, in males. The estrogens cause the thickening of the lining of the uterus and vagina in the early phase of the ovulatory, or menstrual, cycle; in lower animals cyclical estrogen secretion also induces estrus, or "heat". The estrogens are also responsible for female secondary sex characteristics such as, in humans, pubic hair and breasts, and they affect other tissues including the genital organs, skin, hair, blood vessels, bone, and pelvic muscles..

Menopause

• The period marked by the natural and permanent cessation of menstruation, occurring usually between the ages of 45 and 55.

PMS

• Premenstrual syndrome.

Perimenopause

• The time period prior to menopause that may last 10 to 15 years, even beginning in one's 30s. It is associated with decreased ovarian function and decreasing estrogen levels.

Progesterone

• Steroid hormone secreted by the female reproductive system that functions mainly to regulate the condition of the endometrium (see uterus), preparing it to accept a fertilized egg. If the egg is not fertilized, the level of progesterone drops, the uterine lining breaks down, and menstruation ensues. If the egg is fertilized, the placenta produces progesterone, whose effects include preparing the mammary glands for lactation..

Biopsy

• Bone marrow aspiration, also called bone marrow sampling, is the removal by suction of fluid from the soft, spongy material that lines the inside of most bones. Bone marrow biopsy, or needle biopsy, is the removal of a small piece of bone marrow.

Climacteric

• A period of life characterized by physiological and psychic change that marks the end of the reproductive capacity of women and terminates with the completion of menopause.


• A corresponding period sometimes occurring in men that may be marked by a reduction in sexual activity, although fertility is retained.

Depression

• In psychiatry, a symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection.

Estrogen

• Any one of a group of hormones synthesized by the reproductive organs and adrenal glands in females and, in lesser quantities, in males.

Hormone

• A substance, usually a peptide or steroid, produced by one tissue and conveyed by the bloodstream to another to effect physiological activity, such as growth or metabolism.

Osteoporosis

• A disease in which the bones become extremely porous, are subject to fracture, and heal slowly, occurring especially in women following menopause and often leading to curvature of the spine from vertebral collapse.

Premenstrual syndrome

• The syndrome occurs in several distinct forms: emotional upheaval, including anxiety, irritability, insomnia, depression, forgetfulness, confusion, and lethargy; cravings for sweets, increased appetite, and intolerance to sugar (headache, heart palpitations, fatigue, and fainting); and fluid retention symptoms with weight gain, puffiness of hands and feet, breast swelling and tenderness, and abdominal bloating and tenderness. Some women suffer with symptoms of all these forms, others only a few..

Progesterone

• A drug prepared from natural or synthetic progesterone, used in the prevention of miscarriage, in the treatment of menstrual disorders, and as a constituent of some oral contraceptives.


• A female hormone that acts on the inner lining of the uterus and prepares it for implantation of the fertilized egg.

Stress

• A state of extreme difficulty, pressure, or strain.


• A physical and psychological response that results from being exposed to a demand or pressure.

Testosterone

• A white crystalline steroid hormone, C19H28O2, produced primarily in the testes and responsible for the development and maintenance of male secondary sex characteristics. It is also produced synthetically for use in medical treatment.

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