Table of Content
- What is Menopause
- What Causes Menopause
- Stages of Menopause
- Symptoms of Menopause
- Diseases Associated with Menopause
- Psychological Disorders
- Physiological Diseases
- Osteoporosis & Menopause
- Breast Cancer & Menopause
- Neurological Diseases
- Plastic Surgery
What is Menopause?
Menopause is a natural stage of a woman’s life at her late 40s or early 50s. It marks the end of her periods as she stops* having menstruations completely. Usually a woman is confirmed to be going through menopausal cycle when she has not been experiencing menstruation for at least 12 consecutive months1. Her body’s altered hormonal balance will cause both physical and mental changes that may make her go through stress difficulties, fatigue, heavy sweating, heart palpitations and some more complications. Some women have to face more severe clinical conditions like Depression, Insomnia, Heart diseases, Osteoporosis, Breast Cancer etc. This article will focus on some of the basics on Menopause, the diseases associated with it and the varied treatment options.
What Causes Menopause?
As mentioned earlier, a woman enters menopause when she is no longer capable of having a child. All women are born with a limited number of eggs to be fertilized in order to make another life. At a certain time of life, this supply of eggs ends; this disrupts body’s normal hormonal level; especially estrogen and progesterone hormones which are responsible for regulating many physiological balances. This imbalance changes the women’s body and they go through lots of complications (see Symptoms of Menopause). There are other reasons that can play a role in the hormonal imbalance which will be discussed below along with the natural reasons.
Natural Cause of the Hormonal Imbalance: In a woman’s body, pituitary gland releases follicle stimulating hormone (FSH) and luteinizing hormone(LH). These act on the ovaries to release the egg every month and secrete the sex hormones – oestrogen and progesterone. These hormones act on the lining of the womb and prepare it for pregnancy in case the egg gets fertilized by the sperm. As the woman ages, there comes a time when there is no supply of egg anymore, this causes the body to show an abnormal response to the FSH and LH and changes the production of Estrogen and Progesterone.
Oophorectomy: When a woman’s ovaries are removed (Oophorectomy), even if the uterus is intact, the woman will immediately experience a menopause which is both sudden and total; this is known as surgical menopause.
Other Reasons: Menopause can also occur when the ovaries are damaged by specific treatment such as chemotherapy or radiotherapy.
Stages of Menopause
Premanopause: The time and years of a woman’s life before her last period is known as Premanopause. Gradually levels of reproductive hormones become more erratic and lower, and the effects of hormone withdrawal are present.3
Perimenopause: Perimenopause means “around the menopause”, refers to the menopause transition years, a span of time both before and after the date of the final episode of flow. According to the Centre for Menstrual Cycle and Ovulation Research Perimenopause a six to ten year phase ending 12 months after the last menstrual period marked by a 20-30% increase* in the estrogen level.2
Timeline of the Phases of Menopause
Post Menopause: Post menopause means the rest of the time in a woman’s life after her last menstruation.
Symptoms of Menopause
Due to imbalance between the estrogen and progesterone level a woman faces several complications and symptoms, such as:
- Mood Swing
- Bone Loss
- Heart Palpitations
- Sore Breasts
- Dry hair and hair loss
- Sensitive skin
- Vaginal dryness
- Heavy Sweating, especially at night, hot flashes.
- Prolapse resulting in loss of libido and painful sexual intercourse
Diseases Associated with Menopause
Menopause is a natural phenomenon in a woman’s life. In the United States about 1.3 million women reach menopause annually1. Although there is nothing to be scared about this phase, some clinical conditions related to the hormonal imbalance in this phase may arise. It is very important to be aware of those conditions because some of these diseases need to be addressed right away after diagnosis. This article will focus on the most prevalent and common diseases associated with Menopause.
Menopause & Depression
According to the Investigators from the Harvard Study of Moods and Cycles, the highest risk of occurrence of this disease is among women who are entering the perimenopausal and menopausal phase. They have studied premenopausal women aged 36-44 years with no history of major depression and followed up these women for 9 years to detect new onsets of major depression. The result suggested that women entering perimenopause have two times higher risk of developing depression than women who has no sign of menopausal symptoms yet1.
Another extensive study (8 years) conducted by Freeman and colleagues and involving 231 women without depressive histories who were about to enter menopause came up with the following results4:
- Using the Center for Epidemiological Studies of Depression scale, the researchers found that the probability of a high depression score (more than 16) was 4-fold greater during the menopausal transition than during the premenopausal phase.
- Hormones associated with the depression are follicle-stimulating hormone and luteinizing hormone and estradiol.
Possible Causes of Depression during Menopause
- The reason behind the depression attack is probably due to the increased level of testosterone hormone in women undergoing menopausal period. Besides this, the overall effects of hormone imbalance may make a woman feel very uncomfortable; that may cause this disease.
- Women who had to undergo surgical removal of ovaries know that they cannot have babies anymore; that may be another factor for the onset of depression.
- A clinical history of having depression attack in an early life may aggravate the risk too.
Menopause & Insomnia
About 40-50% women complain about lack of sleep during their menopausal transitions. It should be addressed seriously because insomnia may give rise to other symptoms like anxiety, stress, tension, and depressive symptoms. According to the Medical Research Council National Survey of Health, women who were transitioning into menopause were more likely to report severe sleep difficulty than women who were premenopausal.
Possible Causes of Insomnia during Menopause
- Estrogen Deficiency
- Increased Luteinizing Hormone
- Decrease* in the Hormone Progesterone
- Decrease* in Melatonin
Heart Diseases & Menopause
According to American Heart Association (AHA) about 35,000 American women under 50 have a heart attack each year and an overall increase* in heart attacks among women is seen about 10 years after menopause. 5
However menopause is not directly related to the cardiovascular diseases. There are certain risk factors may increase* the risk of these diseases during Menopausal period. Such as:
- High Fat Diet or other unhealthy habits
- High blood pressure
- High LDL (low density lipoproteins) or Low HDL (high density lipoproteins)
- Family history of heart disease
The actual reason behind this association has not been pointed out, but according to AHA, low level of estrogen hormone during menopausal period may be the primary factor. Estrogen is believed to help the body to keep blood vessels flexible. Since its level may decline during menopause, blood vessels will face an increased pressure on their walls frequently but will be unable to cope up with that high volume of blood effectively; resulting in high blood pressure, stroke and other heart diseases.
See Treatment Approaches for Heart Diseases during Menopause
Osteoporosis & Menopause
There is a direct relationship between the lack of estrogen6,7,8 after menopause and the development of osteoporosis. After menopause, bone resorption (breakdown) outpaces the building of new bone. According to National Osteoporosis foundation9
- 80% osteoporosis patients in America are women.
- Approximately one in two women over age 50 will break a bone because of osteoporosis.
- A woman’s risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer.
Possible Cause of Osteoporosis during Menopause
National Osteoporosis Foundation stated that there are multiple reasons why women are more likely to get osteoporosis than men, including:
- Estrogen hormone plays a role in protecting bones. During menopause, the level of estrogen decreases* sharply, which can cause bone loss and thus Osteoporosis.
- Women have thinner bones therefore vulnerable to bone loss.
Breast Cancer & Menopause
Unlike the above mentioned diseases, breast cancer may cause due to the hormone therapy used to manage the menopausal symptoms.
According to a WHI (Women’s Health Initiative) study, the women taking EPT (estrogen progesterone therapy) had a higher risk of developing breast cancer compared with those who didn’t take hormones10. In this study, women who took EPT had an increase* in breast density (as seen on their mammograms). Lean women or women with dense breasts who take EPT may be at particularly high risk of breast cancer.
Dealing with the Breast Cancer in Menopausal Period
The study showed that discontinuation can halt the progression of increasing* breast density. The risk of breast cancer from EPT is increased only in current and recent users. Within 3 years of stopping the hormonal therapy a woman can minimize the risk of breast cancer10.
Schizophrenia & Menopause
- Social withdrawal
- Memory impairment
- Hostility or suspiciousness
- Deterioration of personal hygiene
- Flat, expressionless gaze
- Deteriorated cognitive power
Possible Cause of Schizophrenia during Menopause:
One theory suggests that the hormone estrogen may play a role in the pathophysiology of schizophrenia among the women with menopause.
Schizophrenia requires full medical attention along with the hormonal therapy. Women who develops early signs of this disease should immediately seek for medical help.
Tremors & Menopause
Due to the fluctuations of hormones in the body, women in menopausal transition may encounter Perimenopausal anxiety, shaking and tremors13. These symptoms are often the first sign of perimenopause, therefore some women may get terrified as they think have developed a severe disease instead of entering into menopausal transition period.
Possible Cause of Tremors during Menopause:
- Imbalanced levels of estrogen and progesterone hormones.
- Physiological and psychological changes during mid-life.
A stroke or “Brain Attack” occurs when the brain is cut off from its blood supple. This can happen due to blood clot or from an injury to an artery within the neck. There are two types of stroke. If blood clot blocks an artery to the brain, it is known as Ischaemic stroke, but if a blood vessel ruptures inside the brain, that is known as Haemorrhagic Stroke. The warning signs of a possible stroke are: sudden vision disturbance, slurred speech and being unable to move one side of the body.
Possible Cause of Strokes during Menopause:
- Lack of sufficient Estrogen due to menopausal hormone imbalance.
- Smoking and excess alcohol consumption.
- Race. An African-Caribbean descent has a higher risk than Caucasian woman.
- Family history of strokes.
- Other associated diseases like diabetes and severe heart conditions like arryhtmia, Atherosclerosis etc.
According to the International Dermal Institute, menopause not only affects the internal body, it affects the skin as well14. During menopausal transition period a strong decline in the Estrogen and ?-Estradiol level may cause the exhibition of the skin condition named “Hot Flash”. Hot flashes are intense feelings of warmth in the skin, particularly of the face, accompanied sweating. In addition to that, the adrenal glands and ovaries of post-menopausal women secrete increased androgens which may cause the appearance of facial hair14. Other skin symptoms include: Saggy skin due to the redistribution of the body fat in absence of sufficient estrogen, oily skin, wrinkles, age spots and thinner skin. Women at this period may need to use sunblock more often as their skin became more sensitive to the UV rays of the Sun as Collagen and Elastin, two essential elements for repairing skin damages get reduced* with reduction* of Estrogen hormone.
Possible Cause of Skin Problems during Menopause:
- Deficiency of Estrogen
- Redistribution of body fat- more accumulation in the thighs and less* presence around the eyes.
- Increase* in the Malanocyte production in the absence of sufficient estrogen; may cause age spots
Although it is not possible to completely halt the aging symptoms due to hormonal imbalance, but eating vitamin rich food, fruits, keeping skin protected from the sun rays and oral hormone therapies may slower the process. Some women also undergo plastic surgery, which helps them to have a radiant skin and look a lot younger.
See Plastic Surgery to find more about treating skin conditions.
Hair Loss & Menopause
Women who are at menopausal period are more prone to thin hair and hair loss. Normally a person may lose* around 100 hair strands a day, but aged women with menopause have a much higher rate of hair fall. Also their hair grow thinner due to less* protected hair follicles.
Possible Cause of Skin Problems during Menopause:
- The hormones estrogen and testosterone have the most important influence on hair growth. During the menopause, levels of Estrogen decrease*. Therefore women start to have thinner hair, and due to comparatively higher level of testosterone, they also start to have facial hair15.
- Certain diseases and
- Certain medication.
Treatment of Depression with Menopause
According to the findings from the Women’s Health Initiative (WHI) Observational Study, major de¬pression increases* the risk of first heart attack (odds ratio [OR] = 3.9), stroke (OR = 2.7), and diabetes (OR = 2.23)4. Therefore treatment of depression during menopause is a very important issue. Several medications along with the hormone replacement therapy may be the best option.
Hormone Replacement Therapy
The effects and risks of hormone replacement therapy (HRT) on mood in menopausal depression vary depending on the diagnosis, the menopausal status (whether there are hot flashes), the dose and preparation of estrogen and progesterone, and the duration of treatment. However different studies have shown that only exogenous Estrogen therapy may be beneficial while the other hormone put the body to a higher risk of complications.
Antidepressants with HRT
Fluoxetine and HRT: Liu and colleagues4 found that HRT with 0.625 mg of conjugated estrogen and 5 mg of progesterone combined with 20 mg of fluoxetine for 2 months was more effective in reducing* symptoms than HRT alone in 123 women with menopausal depression.
Sertraline and Estrogen: In a study of sertraline (50 to 150 mg), women older than 60 who received estrogen replacement therapy (without progesterone) had greater global improvement, better* quality of life, and less* anxiety than women who received sertraline but not estrogen replacement therapy.
Other effective antidepressants are TCA, such as nortriptyline or desipramine; or an SNRI, or dual receptor reuptake inhibitor, such as mirtazapine, venlafaxine, or duloxetine.
Treatment of Insomnia with Menopause
Hormone Replacement Therapy (HRT)
Estrogen/ Progesterone: The current recommendations are to use low doses and to use for not much longer than the first 5 years following menopause5. Low dose protocols have been effective in reducing* vasomotor symptoms. According to the National Sleep Foundation estrogen therapy alone may prove very effective for some women as estrogen helps to reduce* hot flashes at night, urinary complications and vaginal symptoms. Some women also reported to sleep better* after taking birth control* pills.
Treatment Approaches for Heart Diseases with Menopause
Several good habits and certain medication can help you to avoid and manage heart disease during and after menopause; examples include:
- Avoiding smoking.
- Maintaining a healthy body weight
- Exercise throughout the week.
- Healthy diet
- Treating and controlling medical conditions
- Hormone Replacement Therapy: Hormone therapy used to be widely prescribed therapy for managing the menopausal complications. However, recently investigations conducted by WHI (Women’s Health Initiative) have shown that HRT may increase* the risk of heart disease, gallbladder disease, dementia, and breast cancer. In response to that the U.S. Preventive Services Task Force (USPSTF) in May of 2012 recommended against using hormone replacement therapy to prevent chronic diseases, including osteoporosis, dementia or heart disease12. Nowadays doctors are advising patients to adopt other treatment approaches of prevention, such as lifestyle changes, and cholesterol- and blood pressure-lowering drugs.12
Treatment Approaches for Osteoporosis with Menopause
Most common medication, supplements and lifestyle changes recommended to be used to treat* osteoporosis are:
- Calcium and vitamin D supplements: Calcium helps to keep the bone integrity and Vitamin D helps to absorb calcium. It is better* to take pills that that have a combination of both of these.
- Medications such as risedronate, ibandronate, raloxifene, alendronate, zoledronic acid: to slow bone loss, increase* bone density, and reduce* the risk of spine and non-spine fractures.
- Calcitonin: slows bone loss and increases* spinal bone density in women who have osteoporosis. Women report that it also eases pain associated with bone fractures
- Weight-bearing exercises
- Hormone therapy (HT) is believed to be useful in preventing or alleviating the increased rate of bone loss that leads to osteoporosis. It is generally recommended for postmenopausal women who undergo an early menopause, have a low bone mass or have other risk factors for osteoporosis. However caution should be taken as HT may increase* chances of other diseases such as
- Breast cancer
- Gallbladder disease
- Blood clots
- High blood pressure in some women
However it was found that estrogen alone does not have so many drawbacks like the other hormonal therapies, therefore women who have had their uterus removed by hysterectomy are prescribed with estrogen alone.
Treatment Approaches for Tremors with Menopause
The symptoms of tremors can be managed by maintaining
- A healthy diet, avoiding caffeine,
- Physical fitness with exercise,
- Controlling body weight,
- Limiting alcohol,
- Not smoking, and
- Trying to get adequate sleep and rest.
Treatment Approaches for Strokes with Menopause
A sudden stroke may take away a woman’s life. Maintaining the following set advice is highly recommended:
- Reducing* the risk of a stroke by changing lifestyle; quit smoking, exercise, eating fresh vegetables and fruits.
- Keeping high blood pressure.
- Hormone replacement therapy (HRT)
HRT is a popular form of treatment for menopausal symptoms but it does have its side effects which include the risk of a stroke and other heart diseases. Therefore it can be prescribed only its benefits outweigh the risk of the patient’s condition.
Treatment Approaches for Hair Loss in Menopause
Hormone therapy can be a useful option for treating hair condition as a major cause of hair fall during menopause is lower level of Estrogen. However, a number of home remedies can be employed alongside herbal or conventional remedies to treat* hair problems in women too.
- Using gentle shampoo
- Avoid dying hair too frequently as this may cause hair to become unhealthy and more likely to fall out.
- Applying a scalp massage regularly can stimulate extra blood flow to the scalp, which may prevent further hair loss.
- There are certain foods which can improve* the quality of hair. Protein and iron rich foods (found in red meats) are good for strengthening hair. Vitamin C, found in citrus and other fruit, is also beneficial
- Taking care of the personal stress because stress can negatively affect the whole body.
- Try to sleep well at night, as this is another factor which might cause you to lose* your hair.
- Regular Exercising. This will help to reduce* stress, improve* sleep and circulation of blood to the scalp to help you keep your hair on.
- Herbal remedies like the Black Cohosh along with hormone therapy may become useful in treating hairfall15. Soy isoflavones are also beneficial for stabilizing menopause symptoms at all stages of the menopause. It can be found in remedies such as Menosan Menopause Support*15.
Plastic or Cosmetic Surgery
The number of women over 50 years who go through cosmetic surgery is increasing* dramatically every year16. While the cells in younger women’s skin are replenished every 26 to 28 days, post-menopausal women replenish their cells every 50 days, which gives skin a duller, more sallow appearance. 16 According to the Mail Online,
- There is about 78 percent increase* in the number of women over 50 coming in for skin peels and a 63 per cent rise in dermal filler injections.
- There is a 54 percent rise in the numbers asking for laser treatment to thread veins and a 36 per cent growth in laser hair removal.
Plastic or cosmetic surgeries help the women to avoid taking high doses of hormone therapies. As they feel they are looking better*, this reduces* some anxiety and also helps to control* their depression which can be very deep during menopausal transition. However looking better* is not the only reason why plastic surgery is so popular. It can address to a women’s vaginal atrophy issue. Vaginal atrophy or Vulvo vaginal atrophy occurs due to the reduced* level of estrogen during menopausal period and are characterized with vaginal burning*, irritation, and discharge, painful sexual intercourse; thereby negatively affecting a woman’s life. Sometimes Labiaplasty; a plastic surgery procedure where excessively large labia minora is reduced* can give some comfort to the women with menopause related vaginal issues.
Menopause is just another phase in a woman’s life. It may come with many complications due to the changes in the hormone levels; thus making it harder to get adjusted. Some women even face serious complications that may endanger their lives and the hormonal replacement therapies may possess serious side effects. Yet this phase is controllable – there are many other approaches including medications, physical exercise, diet and other lifestyle changes. Consult with your doctor if you are feeling very stressed dealing with your menopausal phase; because the easier you accept this time, the better* you handle your life.
- Menopause and Mood Disorders. http://emedicine.medscape.com/article/295382-overview. updated Apr 12, 2012
- Prior, Jerilynn. “Perimenopause”. Centre for Menstrual Cycle and Ovulation Research (CeMCOR). Retrieved 10 May 2013.
- Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ (2012). “Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging.”Fertility and Sterility 97 (4): 398–406. doi:10.1016/j.fertnstert.2012.01.128. PMID 22341880.
- Special Issues in Menopause and Major Depressive Disorder. http://www.psychiatrictimes.com/bipolar-disorder/special-issues-menopause-and-major-depressive-disorder. Published on September 11, 2013.
- Menopause and Heart Disease. http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Menopause-and-Heart-Disease_UCM_448432_Article.jsp.
- National Institute on Aging. Health Information. Publications. Age Page. Osteoporosis: The Bone Thief. Accessed 3/14/2011.
- North American Menopause Society. Menopause Guidebook: Helping Women Make Informed Healthcare Decisions Around Menopause and Beyond. Accessed 3/14/2011.
- American Congress of Obstetricians and Gynecologists. Publication. Patient Education: Osteoporosis. Accessed 3/14/2011.
- Menopausal Hormone Therapy and Cancer Risk. http://www.cancer.org/cancer/cancercauses/othercarcinogens/medicaltreatments/menopausal-hormone-replacement-therapy-and-cancer-risk.
- Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of Estrogenplus Progestin in healthy Postmenopausal Women. JAMA 2002;288:321-323.
- Cause of Perimenopausal Anxiety, Shaking & Tremors. http://www.ehow.com/facts_4967909_cause-perimenopausal-anxiety-shaking-tremors.html
- How Does Menopause Affect the Skin? http://www.dermalinstitute.com/us/library/12_article_How_Does_Menopause_Affect_the_Skin_.html
- Hair loss and menopause: Hair loss can occur because of the menopause. http://www.ehow.com/facts_4967909_cause-perimenopausal-anxiety-shaking-tremors.html
- Turning back the clock: How cosmetic procedures in women over 50 have soared by nearly 70 per cent in a year. http://www.dailymail.co.uk/femail/beauty/article-1323881/Cosmetic-procedures-women-50-soared-nearly-70-cent-year.html#ixzz38QnqqWTD