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

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

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

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

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

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 –

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

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

Changes in hair growth & skin (estrogen effects collagen) 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)

D. Menopause Management Lifestyle changes

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…

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

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

Risks of HRT It's all in the timing: Age is an important factor: 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

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

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

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?