Menopause

1. Menopause • Why is understanding menopause important? • The basics: Perimenopause • The basics: Menopause • The change - A misunderstood period of life

2. I. Why is understanding menopause important? A. Numbers: % Increase in US population aged over 55 Source: US Bureau of the Census, International Database

3. B. Menopause is related to health • increased risk for developing two significant diseases: osteoporosis and heart disease

4. II. The Basics: Perimenopause • Overview: • Years immediately preceding and following the last menstrual period - • during this time the following processes are occurring within a woman's body: • ovaries release eggs less regularly • ovaries gradually produce less estrogen and other hormones • fertility decreases • menstrual cycles shorten, there are fewer ovulations, and more cycle irregularity

5. B. Perimenopausal symptoms • mood changes • changes in sexual desire • difficulty in concentrating • joint and muscle aches, frequent urination • similar symptoms as experienced with premenstrual syndrome (PMS) • Treatment of symptoms • low-dose birth control pills

6. III. The Basics: Menopause • Overview: • Cause? • Decreasing # of follicle cells – • Hypothalamatic changes in the brain cause ovaries to increase the # of follicle cells recruited premenopausally, thereby rapidly depleting the follicle cells • Result: • Most women enter & complete menopause between the ages 45-55 (mean age = 51), • Premature menopause –

7. B. Modes of induction • Natural menopause – ovaries begin to fail to respond to the LH & FSH which are still released • Surgically induced menopause – total hysterectomy, bilateral sapingo-oophorectomy, and/or chemotherapy • Ovaries not present to respond to LH/FSH

8. C. Symptoms of menopause • Different for each woman! • Hot Flashes – a sensation of internally generated heat beginning in the chest and moving to the neck & head or spreading throughout the body • Accompanied by increased heart rate, temperature, shallow breathing, & sweating followed by chills • Early symptom of estrogen deficiency • Treatment: • Deep breathing, reduced stress

9. Vaginal atrophy – • May impact sexual desire • Vaginal lubricants can help this, sexual activity lessens the effect • Atrophy of the urinary tract & urinary incontinence – diminished muscle tone • Sleep disturbance, • Increased weight • Changes in hair growth & skin (estrogen effects collagen)

10. D. Menopause Management • Lifestyle changes

11. Non-prescription options • Vitamins & minerals • Vaginal lubricants & moisturizers • Acupuncture • Phytoestrogens (plant estrogens) • Watch out for “herbal alternatives” that claim to cure cancer, prevent heart disease or reverse the effects of osteoporosis…

12. Hormone Replacement Therapy (HRT) – medically supervised drug treatment of menopausal women which involves supplementing hormone levels

13. Benefits of EPT and ET • reduce the risk of osteoporosis. • relieve hot flashes and night sweats. • relieve vaginal & urinary atrophy. • improve cholesterol levels. • reduce the risk of cancer of the colon. • may reduce macular degeneration. Women's Health Initiative (WHI) clinical trial – a turning point! • Researchers found combination

14. Risks of HRT • EPT and ET modestly increase risk of breast cancer while they are being used; long-term use may pose the greatest risk. • EPT and ET may increase the risk for blood clots. • EPT and ET can have unpleasant side effects, such as bloating and breast tenderness. • EPT and ET in pill form can raise level of triglycerides (a type of fat in the blood). • ET may increase the risk of dementia. • ET increases the risk of stroke. • ET increases the risk of cancer of the uterus. • It's all in the timing: Age is an important factor: • ET – • For some women — such as those who experience moderate to severe hot flashes or other menopausal symptoms — http://www.nih.gov/PHTindex.htm

15. IV. The change – Currently, a misunderstood period of life • Cultural bias • Neglected as a research area – we still don’t know what triggers menopause or how symptoms should be treated best

16. B. Not simply “the end of the road” – A time of freedom & empowerment • “Freed up & energized” • “To airbrush age off a woman’s face is to erase woman’s identity, power and history.” Naomi Wolf • “My fantasy of aging is to age well enough so that younger women would think, “Gee, I wish I were her age.” I want the stigma of aging to be removed from women and for myself, I intend to do it with as much panache as I can. I am going to put everything I’ve got into it.” Claire Braz-Valentine • “In my fifties, I feel ripely quiet. Life seems simpler; I am more appreciative.” Ruth Zaporah

17. For discussion • Why has medical research been slower to understand the physiological dimensions of menopause than other reproductive health matters? • What can be done to continue to change societal images of menopause, aging, and older women? • How should menopause be viewed?