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Family Health Magazine
WOMEN'S HEALTH

Menopause
A natural part of a woman's life

At a certain point in a woman’s life, hormone changes stop the process of menstruation. This phase, called menopause, usually occurs between the ages of 45 and 55 although the timing varies. Understanding this process and related changes can help a woman cope with moving into the next phase of her life.

How does menopause happen?

In a woman’s mid-thirties, hormone production by the ovaries begins to decline. By her late forties, the process has sped up and hormone levels vary. Menstrual cycles become irregular, with unpredictable times of heavy bleeding. In her early to mid-fifties, a woman’s periods finally end altogether.

Abrupt menopause will be experienced after a hysterectomy or other surgery in which both ovaries are removed. This type of menopause is called induced menopause. Some forms of chemotherapy or radiation to the pelvis can also bring on menopause. When menstruation stops naturally before the age 40, it is called premature menopause.

What are the effects of the menopause transition?

Different women experience different symptoms of menopause. The most common include:

• hot flashes, which occur in more than 60 per cent of women
• night sweats and sleeplessness
• dryness of the vagina (birth canal)
• more frequent infections of the urine system
• headaches and joint pains
• depression
• reduced sex drive.

When hormone levels drop after menopause, increased thinning and weakening of the bones (osteoporosis) increases the risk of fracture. Women are also more at risk for heart disease and stroke once they lose the protective effect of the hormone estrogen.

How does menopause affect the sexual drive of women?

Lower estrogen levels make the delicate tissues of the vagina thinner, drier, and less able to produce secretions to comfortably lubricate intercourse. As a result, some women lose interest in sex. Estrogen therapy can restore secretions and tissue elasticity. Water-soluble lubricants or moisturizers for the vagina may also help. Some women actually feel liberated and have more interest in sex after menopause. They are relieved that child-rearing is ending and pregnancy is no longer a worry.

What should you do about menopause?

You don’t have to do anything about menopause. It is a natural process, not a disease requiring treatment. Small lifestyle changes can reduce bothersome symptoms of menopause and the risk of diseases like heart disease, osteoporosis and breast cancer. Sometimes, medication is needed. Many over-the-counter and prescription options are available. Depending on her experience, what helps ease menopause symptoms will vary from one woman to another.

Good nutrition

To prevent osteoporosis, you must get 1500 milligrams of calcium per day from the foods you eat and, if necessary, take calcium supplements. Good dietary sources of calcium are dairy products, canned fish with bones such as salmon, sardines and mackerel, and leafy green vegetables. One cup (250 millilitres) of milk provides 300 milligrams of calcium.

Vitamin D is also important since it helps the body absorb calcium. It is found in oily fish such as salmon and tuna as well as in milk and eggs. Most multivitamins contain the recommended 400 IU of vitamin D.

Avoid the saturated fat found in meat and butter. You can help keep your weight down by choosing olive oil, fish, leaner cuts of meat or poultry and low-fat dairy products instead.

Include plenty of fruit and vegetables, whole grain breads and cereals, lentils, beans and peas to provide vitamins and minerals and keep fibre intake high. Canada’s Food Guide to Healthy Eating (www.hc-sc.gc.ca/hpfb-dgpsa/onpp bppn/food_guide_rainbow_e.html) is a good source of nutrition information.

Physical activity and relaxation

• Weight-bearing exercise, such as walking, helps keep bones strong. Aerobic exercise which increases the heart rate is good for cardiovascular health.
• Aromatherapy, acupuncture, yoga and reflexology may promote relaxation and well-being.

For symptoms of menopause

Hot flashes and night sweats:

• Lifestyle changes. To keep body temperature cool, dress and eat to avoid being too warm. Avoid spicy foods, caffeine and alcohol. Sleep in a cool room. Reduce stress or manage it with deep breathing, meditation or massage.
• Non-prescription remedies. Phytoestrogens, estrogens found in plants, may relieve mild hot flashes. Dietary sources of phytoestrogens include soy foods, beetroot, parsley, root fennel and yams. Soy food products include tofu, tempeh, soy milk, and soy nuts. Phytoestrogens can also be taken as supplements. Remember, there is still little scientific evidence on the effectiveness of phytoestrogens. The risk of taking soy, especially the more concentrated forms such as isoflavone pills and powders, are not known. The natural health products black cohosh, wild yam, dong quai, and valerian root are also said to be good remedies for menopause symptoms. However, there is little information regarding how well they work.
• Prescription remedies. The antidepressants Effexor™, Paxil™ and Prozac™ have been moderately effective in relieving hot flashes in clinical studies. Neurontin™ (gabapentin) also appears to help. However, these products have not been approved for this use.

Dryness of the vagina:

• Vaginal lubricants (such as K-Y Jelly™) and moisturizers (such as Replens™) may help dryness of the vagina. They can be purchased without a prescription.
• Products that release small amounts of estrogen to the tissues of the vagina are useful for more severe dryness. Prescription products include Premarin™ vaginal cream, Vagifem™ vaginal tablets, and Estring™, a small plastic ring similar to a diaphragm.

Mood swings:

• Lifestyle behaviours, such as getting enough sleep and being physically active, are especially important in helping with mood swings.
• Relaxation exercises can provide some relief.
• Antidepressant or anti-anxiety drugs may be needed for more severe symptoms.

Insomnia:

• Over-the-counter sleep aids may help temporarily but should not be used on a regular basis.
• A glass of milk or a cup of yogurt before bed can bring on drowsiness.
• Morning or early afternoon is the best time for physical activity. Exercising later in the day may increase wakefulness at night.
• Taking a hot shower or bath immediately before going to bed can be relaxing.

Memory problems:

• Keep the brain active with mental exercises, such as reading and playing games.
• Taking good care of yourself by getting enough sleep and being physically active will also help.

Hormone therapy

Hormone therapy (HT) is designed to replace some of the hormones reduced by menopause. A woman who has had a hysterectomy can take estrogen (referred to as ET or estrogen therapy). A woman who still has her uterus should take a combination of estrogen and progesterone (called combined hormone therapy or EPT). Combining the two is necessary since taking estrogen alone increases the risk of cancer in the lining of the uterus. EPT can be taken cyclically or continuously. With a cyclic regimen, estrogen is taken every day and progesterone is taken for the last 12 to 14 days of the month. This type of regimen can cause monthly bleeding similar to a period. With a continuous regimen, estrogen and progesterone are both taken every day. This method may cause unpredictable bleeding for the first six to eight months.

There are a wide variety of prescription hormone preparations available. Hormones can be taken in pill form or applied to the skin as patches or gel. Products may contain estrogen, progesterone or a combination of the two. It is important to take the lowest dose of HT that effectively relieves symptoms.

HT may have side effects that include tender breasts, heavier periods, enlarged fibroids, retaining water, depression and irritability. If these side effects are bothersome, discuss changing the type or dose of estrogen or progesterone with your doctor.

The benefits of HT

• Relieves hot flashes, night sweats and dryness of the vagina
• Maintains muscle tone of the vagina, helping to reduce incontinence (passing urine unintentionally)
• Reduces risk of osteoporosis
• Reduces mood swings
• Relieves aches and pains in the joints.

The risks of HT

The Women's Health Initiative
In 1991, the National Heart, Lung and Blood Institute and other units of the National Institutes of Health launched the Women's Health Initiative (WHI). One of the largest studies of its kind ever done in the United States, it consisted of clinical trials, an observation study, and community prevention strategies. Altogether, the WHI involved more than 161,000 healthy, postmenopausal (after menopause) women.

According to the WHI results (see website www.whi.org), taking EPT slightly increased the risk of breast cancer in the long term. About 45 women in every 1000 over the age of 50, who are not using HT, will develop breast cancer over a 20 year time period. For those taking EPT, the number rises to 47 women per 1000 after five years of EPT, 51 after 10 years, and 57 after 15 years of EPT. The increased risk seems to disappear within five years of stopping EPT. Women on HT must take care to regularly check their breasts for changes and schedule mammograms.

HT may not be suitable for women who have recently had breast cancer. It increases the risk of developing a blood clot in a leg vein (deep vein thrombosis), which can be life threatening. The risk of gallstones and liver damage also increases in women who have been on HT for more than five years.

On the positive side, HT can protect against fractures due to osteoporosis and against colon cancer. Since it holds different risks and benefits for each woman, discuss your specific situation with your doctor. If you are on HT, choosing whether or not to stop and the best way to do so are also important considerations.

Menopause is a great time to make positive changes that can affect your health for the rest of your life. Good nutrition and physical activity can make the transition easier, while hormone therapy may also help. Your physician, health care provider or menopause educator can help guide you.