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 Medical Self-Care: Women's Health: Menopause 
 
Menopause is when a woman’s menstrual periods stop altogether. It signals the end of fertility. A woman is said to have gone through menopause when her menstrual periods have stopped for an entire year. "The change", as menopause is often called, generally occurs between the ages of 45 and 55. It can, though, occur as early as 35 or as late as 65 years of age. It can also result from the surgical removal of both ovaries. The physical and emotional signs and symptoms that go with "the change" usually span 1-2 years or more (peri-menopause). They vary from woman to woman. The changes themselves are a result of a number of factors. These include hormone changes such as estrogen decline, the aging process itself and stress.

Physical signs and symptoms associated with menopause are:

  • Hot flashes - sudden waves of heat that can start in the waist or chest and work their way to the neck and face and sometimes the rest of the body. They are more common in the evening and during hot weather. They can hit as often as every 90 minutes. Each one can last from 15 seconds to 30 minutes - five minutes is average. Seventy-five to eighty percent of women going through menopause experience hot flashes, some more bothered by them than others. Sometimes heart palpitations accompany hot flashes.
  • Irregular periods - this varies and can include:
    • Periods that get shorter and lighter for two or more years.
    • Periods that stop for a few months and then start up again and are more widely spaced.
    • Periods that bring heavy bleeding and/or the passage of many or large blood clots. This can lead to anemia.
  • Vaginal dryness - this results from hormone changes. The vaginal wall also becomes thinner. These problems can make sexual intercourse painful or uncomfortable and can lead to irritation and increased risk for infection.
  • Loss of bladder tone which can result in stress incontinence (leaking urine when you cough, sneeze, laugh or exercise).
  • Headaches, dizziness.
  • Skin and hair changes. Skin is more likely to wrinkle. Growth of facial hair, but thinning of hair in the temple region.
  • Muscles lose some strength and tone.
  • Bones become more brittle, increasing the risk for osteoporosis.
  • Risk for a heart attack increases when estrogen levels drop.
  • Emotional changes associated with menopause:
  • Irritability.
  • Mood changes.
  • Lack of concentration, difficulty with memory.
  • Tension, anxiety, depression.
  • Insomnia which may result from hot flashes that interrupt sleep.

Treatment

Treatment for the symptoms of menopause varies from woman to woman. If symptoms cause little or no distress, medical treatment is not needed. Self-Care Procedures (See next column) may be all that is required. Hormone replacement therapy (HRT) can reduce many of the symptoms of menopause. It also offers significant protection against osteoporosis and heart disease. The risk for heart attacks, for example, is reduced by 50% with HRT. Each woman should discuss the benefits and risks of HRT with her doctor. (See Osteoporosis on page 45 and Chest Pain on page 16).

Medication to treat depression and/or anxiety may be warranted in some women. Also, certain sedative medicines can help with hot flashes.

Questions to Ask

Do you have any of these?

  • Extreme pain during intercourse.
  • Pain or burning when urinating.
  • Thick, white or colored vaginal discharge.
  • Fever and/or chills
.
Yes:See Doctor
No

Do you have heavy bleeding with your periods or pass many small clots or large ones which can leave you pale and very tired?

Yes:Call Doctor
No

Have you begun menstrual periods again after going without one for six months?

Yes:Call Doctor
No

Are hot flashes severe, frequent or persistent enough that they interfere with normal activities?

Yes:Call Doctor
No

Do you have risk factors for osteoporosis?

  • Family history of osteo-porosis.
  • Small bone frame.
  • Thin.
  • Fair skin (Caucasian or Asian race).
  • Had surgery to remove ovaries before normal menopause or menopause before 48 years of age.
  • Lack of calcium in diet.
  • Lack of weight-bearing exercise.
  • Alcohol abuse.
  • Hyperthyroidism.
  • Use of steroid medicine.
Yes:Call Doctor
No

If taking hormone replacement therapy (HRT), are you having any of the following?

  • Side effects.
  • Symptoms of menopause coming back.
Yes:Call Doctor
No
Self-Care

Self-Care Procedures

To reduce the discomfort of hot flashes, try these tactics:

  • Wear lightweight clothes made of natural fibers.
  • Limit or avoid beverages that contain caffeine or alcohol.
  • Avoid rich or spicy foods and avoid eating large amounts of food at one time.
  • Have cool drinks, especially water, when you feel a hot flash coming on and before and after exercising. Avoid hot drinks.
  • Keep cool. Open a window. Lower the thermostat when the heat is on. Use air conditioning and/or fans. Carry a small fan with you (hand or battery operated).
  • Try to relax when you get a hot flash. Getting stressed out over one only makes it worse.
  • Use relaxation techniques such as meditation, biofeedback or yoga.
  • Take 400 international units of vitamin E daily, but consult your doctor first.
  • If you suffer from night sweats, (hot flashes that occur as you sleep):
    • Wear loose fitting cotton nightwear. Have changes of nightwear ready.
    • Sleep with only a top sheet, not blankets.
    • Keep the room cool.

To deal with vaginal dryness and painful intercourse:

  • Don’t use deodorant soaps or scented products in the vaginal area.
  • Use a water soluble lubricant such as K-Y Jelly, Replens etc., to facilitate penetration during intercourse. Avoid oils or petroleum-based products. They encourage infection.
  • Ask your doctor about intravaginal estrogen cream.
  • Remain sexually active. Having sex often may lessen the chance of having the vagina constrict, help keep natural lubrication and maintain pelvic muscle tone. This includes reaching orgasm with a partner or alone.
  • Avoid using antihistamines unless truly necessary. They dry mucus membranes in the body.

To deal with emotional symptoms:

  • Exercise regularly. This will help maintain your body’s hormonal balance.
  • Talk to other women who have gone through or are going through menopause. You can help each other cope with emotional symptoms.
  • Avoid stressful situations as much as possible.
  • Use relaxation techniques. Examples include: Meditation, yoga, listening to soft music and massages.
  • Eat a healthy diet. Check with your doctor about taking vitamin/mineral supplements.
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