Menopause is the point in a woman's life when menstruation stops permanently,
signifying the end of her ability to have children. Known as the "change of life,"
menopause is the last stage of a gradual biological process in which the ovaries reduce
their production of female sex hormones--a process which begins about 3 to 5 years before
the final menstrual period. This transitional phase is called the climacteric, or
perimenopause. Menopause is considered complete when a woman has been without periods for
1 year. On average, this occurs at about age 50. But like the beginning of menstruation in
adolescence, timing varies from person to person. Cigarette smokers tend to reach
menopause earlier than nonsmokers.
The ovaries contain structures called follicles that hold the egg cells. You are born
with about 2 million egg cells and by puberty there are about 300,000 left. Only about 400
to 500 ever mature fully to be released during the menstrual cycle.The rest degenerate
over the years. During the reproductive years, the pituitary gland in the brain generates
hormones that cause a new egg to be released from its follicle each month. The follicle
also increases production of the sex hormones estrogen and progesterone, which thicken the
lining of the uterus. This enriched lining is prepared to receive and nourish a fertilized
egg following conception. If fertilization does not occur, estrogen and progesterone
levels drop, the lining of the uterus breaks down, and menstruation occurs.
For unknown reasons, the ovaries begin to decline in hormone production during the
mid-thirties. In the late forties, the process accelerates and hormones fluctuate more,
causing irregular menstrual cycles and unpredictable episodes of heavy bleeding. By the
early to mid-fifties, periods finally end altogether. However, estrogen production does
not completely stop. The ovaries decrease their output significantly, but still may
produce a small amount. Also, another form of estrogen is produced in fat tissue with help
from the adrenal glands (near the kidney). Although this form of estrogen is weaker than
that produced by the ovaries, it increases with age and with the amount of fat tissue.
At menopause, hormone levels don't always decline uniformly. They alternately rise and
fall again. Changing ovarian hormone levels affect the other glands in the body, which
together make up the endocrine system. The endocrine system controls growth, metabolism
and reproduction. This system must constantly readjust itself to work effectively. Ovarian
hormones also affect all other tissues, including the breasts, vagina, bones, blood
vessels, gastrointestinal tract, urinary tract, and skin.
Premenopausal women who have both their ovaries removed surgically experience an abrupt
menopause. They may be hit harder by menopausal symptoms than are those who experience it
naturally. Their hot flashes may be more severe, more frequent, and last longer. They may
have a greater risk of heart disease and osteoporosis, and may be more likely to become
depressed. The reasons for this are unknown. When only one ovary is removed, menopause
usually occurs naturally. When the uterus is removed (hysterectomy) and the ovaries remain,
menstrual periods stop but other menopausal symptoms (if any) usually occur at the same
age that they would naturally. However, some women who have a hysterectomy may experience
menopausal symptoms at a younger age.
Menopause is an individualized experience. Some women notice little difference in their
bodies or moods, while others find the change extremely bothersome and disruptive.
Estrogen and progesterone affect virtually all tissues in the body, but everyone is
influenced by them differently.
Hot flashes, or flushes, are the most common symptom of menopause, affecting more than
60 percent of menopausal women in the U.S. A hot flash is a sudden sensation of intense
heat in the upper part or all of the body. The face and neck may become flushed, with red
blotches appearing on the chest, back, and arms. This is often followed by profuse
sweating and then cold shivering as body temperature readjusts. A hot flash can last a few
moments or 30 minutes or longer.
Hot flashes appear to be a direct result of decreasing estrogen levels. In response to
falling estrogen levels, your glands release higher amounts of other hormones that affect
the brain's thermostat, causing body temperatures to fluctuate. Hormone therapy relieves
the discomfort of hot flashes in most cases. Some women claim that vitamin E offers minor
relief, although there has never been a study to confirm it. Aside from hormone therapy,
which is not for everyone, here are some suggestions for coping with hot flashes:
- Dress in layers so you can remove them at the first sign of a flash
- Drink a glass of cold water or juice at the onset of a flash
- At night keep a thermos of ice water or an ice pack by your bed
- Use cotton sheets, lingerie and clothing to let your skin "breathe"
With advancing age, the walls of the vagina become thinner, dryer, less elastic and
more vulnerable to infection. These changes can make sexual intercourse uncomfortable or
painful. Most women find it helpful to lubricate the vagina. Water-soluble lubricants are
preferable, as they help reduce the chance of infection. Try to avoid petroleum jelly;
many women are allergic, and it damages condoms. Be sure to see your gynecologist if
problems persist.
A popular myth pictures the menopausal woman shifting from raging, angry moods into
depressive, doleful slumps with no apparent reason or warning. However, a study by
psychologists at the University of Pittsburgh suggests that menopause does not cause
unpredictable mood swings, depression, or even stress in most women. For most women,
natural menopause is not a major crisis and does not influence their opinion of their
general health.
Good nutrition and regular physical exercise are thought to improve overall health.
Some doctors feel these factors can also affect menopause. Although these areas have not
been well studied in women, anecdotal evidence is strongly in favor of eating well and
exercising to help lower risks for CVD and osteoporosis.
Nutritional requirements vary from person to person and change with age. A healthy
premenopausal woman should have about 1,000 mgs of calcium per day. A 1994 Consensus
Conference at the National Institutes of Health recommended that women after menopause
consume 1,500 mgs per day if they are not using hormonal replacement or 1,000 mgs per day
in conjunction with hormonal replacement. Foods high in calcium include milk, yogurt,
cheese and other dairy products; oysters, sardines and canned salmon with bones; and
dark-green leafy vegetables like spinach and broccoli. In calcium tablets, calcium
carbonate is most easily absorbed by the body. If you are lactose intolerant, acidophilus
milk is more digestible. Vitamin D is also very important for calcium absorption and bone
formation. A 1992 study showed that women with postmenopausal osteoporosis who took
vitamin D for 3 years significantly reduced the occurrence of new spinal fractures.
However, the issue is still controversial. High doses of vitamin D can cause
kidney stones, constipation, or abdominal pain, particularly in women with existing
kidney problems. Other nutritional guidelines by the National Research Council
include:
Choose foods low in fat, saturated fat, and cholesterol. Fats contain more calories (9
calories per gram) than either carbohydrates or protein (each have only 4 calories per
gram). Fat intake should be less than 30 percent of daily calories.
Eat fruits, vegetables, and whole grain cereal products, especially those high in
vitamin C and carotene. These include oranges, grapefruit, carrots, winter squash,
tomatoes, broccoli, cauliflower, and green leafy vegetables. These foods are good sources
of vitamins and minerals and the major sources of dietary fiber. Fiber helps maintain
bowel mobility and may reduce the risk of colon cancer. Young and older people alike are
encouraged to consume 20 to 30 grams of fiber per day.
Eat very little salt-cured and smoked foods such as sausages, smoked fish and ham,
bacon, bologna, and hot dogs. High blood pressure, which may become more serious with
heavy salt intake, is more of a risk as you age.
Avoid food and drinks containing processed sugar. Sugar contains empty calories which
may substitute for nutritious food and can add excess body weight.
For people who can't eat an adequate diet, supplements may be necessary. A dietician
should tailor these to meet your individual nutritional needs. Using supplements without
supervision can be risky because large doses of some vitamins may have serious side
effects. Vitamins A and D in large doses can be particularly dangerous.
Exercise is extremely important throughout a woman's lifetime and particularly as she
gets older. Regular exercise benefits the heart and bones, helps regulate weight, and
contributes to a sense of overall well-being and improvement in mood. If you are
physically inactive you are far more prone to coronary heart disease, obesity, high blood
pressure, diabetes, and osteoporosis. Sedentary women may also suffer more from chronic
back pain, stiffness, insomnia, and irregularity. They often have poor circulation, weak
muscles, shortness of breath, and loss of bone mass. Depression can also be a problem.
Women who regularly walk, jog, swim, bike, dance, or perform some other aerobic activity
can more easily circumvent these problems and also achieve higher HDL cholesterol levels.
Studies show that women performing aerobic activity or muscle-strength training reduced
mortality from CVD and cancer.
The
nutrients mentioned above reflect the major nutritional supplements
that may help the condition. Please do remember however that
nutritional supplementation is an adjunct to medical treatment and in
no way replaces medical treatment.
