woman’s FERTILITY. Though researchers understand
the cascade of physiologic events that results in
menopause, the triggering factors remain a mystery
though many researchers believe a key triggering
mechanism is the loss of viable eggs (ova). Doctors
consider a woman to have reached menopause
when she has experienced one continuous year (12
contiguous months) without menstrual periods.
However, the common perception of menopause
encompasses the period of time, often years, pre-
ceding menopause. Some people call this time PERI-
MENOPAUSE(“around menopause”).
Though menopause is a natural life shift, not a
health condition or disorder, many women experi-
ence discomforts as their bodies rebalance after
HORMONElevels shift. Most notable among these
discomforts are HOT FLASHES, irregular menstrual
periods or abnormal vaginal bleeding, and mood
changes. Not all women experience all or even
any of these discomforts; some women experience
additional or different discomforts such as joint
pain and HEADACHE. The transition of menopause is
a uniquely individual passage.
Indications of Menopause
The most defining indication of menopause is the
discontinuation of menstruation. In most women
this occurs as a gradual process during which
menstrual periods become increasingly irregular
both in timing and quality. A woman may have
three periods that are three weeks apart and last
eight or nine days each, have one three-day
period six weeks later, then not have another
period for four months. This pattern may extend
over three to five years, during which a woman
typically experiences other indications that her
hormone levels are fluctuating and dropping.
Such indications commonly include
- vaginal dryness and painful sexual intercourse
- hot flashes and night sweats
- tendency to cry, mood swings, and irritability
- difficulty sleeping
- diminished ability to concentrate and memory
difficulties - decreased LIBIDO(sex drive)
- anxiety or DEPRESSION
Some women barely notice any of these indica-
tions and other women find that they interfere
with nearly all aspects of their lives. There are few
clinical answers to explain the broad range of
experience, nor to predict what course a particular
woman’s menopause experience will take. There
is some indication that a woman tends to have an
experience similar to her mother’s, though
whether the reasons are cultural or physiologic
remains unknown.Relieving Menopause Discomforts
There are numerous approaches to relieving the
discomforts of menopause, some of which are clin-
ical and others that are alternative and lifestyle. The
more a woman understands the changes that are
occurring in her body and the natural course they
represent, the more effectively she can cope with
their effects and choose methods of relief that are
appropriate for her health status and her degree of
discomfort. Many women find the most effective
solutions involve a mix of methods, and that the
mix changes as menopause progresses.
Hormone replacement therapy (HRT) For the
last half of the 20th century doctors treated
menopause with hormone replacement therapy
(HRT), hormone supplementation to elevate the
levels of ESTROGENSand PROGESTERONEin the BLOOD
circulation. The intent of HRT was to bring up
these levels enough to relieve discomforts without
restoring the menstrual cycle. Doctors also
believed HRT helped protect a woman from CAR-
DIOVASCULAR DISEASE(CVD) and OSTEOPOROSIS, two
conditions that can have dire consequences as a
woman ages. The foundation for this belief was
the sharp rise in incidence of HEART ATTACKand the
high rate of osteoporosis among women after
menopause who did not take HRT. It seemed that
women who took HRT were less likely to have
either condition. Many American women took
HRT for the last half of their lives.
However, extensive clinical studies began to
show in the early 2000s that contrary to these
popular perceptions, HRT did not have a protec-
tive effect against CVD and had perhaps a limited
protective benefit for osteoporosis. Further, HRT
significantly increased the risk for some types of
HORMONE-DRIVEN CANCERS, such as BREAST CANCER
and ENDOMETRIAL CANCER. In 2002 health agenciesmenopause 301