Speaking of Health – Menopause

By Gilda Morales, ANP, DC

Today’s column deals with a condition that every woman has to deal with at some time or another.  It is defined as cessation of the menses for 12 consecutive months in a non-pregnant woman over 40.  It is caused by the cessation of the female hormones, estrogen and progesterone, which directly affect ovulation by the ovaries.  A woman can also undergo surgical menopause with complete hysterectomies involving removal of the ovaries.

There is a period preceding menopause, called perimenopause, which marks a transition period where a woman experiences changes in their menstrual cycle.  Periods become more irregular and even absent for months at a time.  The average age of menopause is 51 years of age, but it may occur earlier in Hispanic women.  The best way to predict the age that a woman may undergo menopause is to compare the age that one’s mother or older sisters experienced menopause.  Smoking can also accelerate the onset of menopause by two years.

Menopause is a natural occurrence, but the effects of menopause on a woman’s health are the problem.  Most notably, the loss of estrogen leads to osteoporosis, or bone loss.  As such, women should start preventive measures to slow the progression of osteoporosis, including starting weight-bearing exercise, such as walking or light resistance exercise, avoid smoking and excessive alcohol intake, taking calcium 1200 mg daily, preferably from a healthy diet, adequate vitamin D, usually 800 to 1,200 units daily, and have a bone density exam done to check for osteopenia, the precursor to osteoporosis, versus full-blown osteoporosis.

One of the most annoying complaint from women who are menopausal are the well-known “hot flashes,” which is described as a sudden feeling of heat, most commonly over the face, neck and chest, which lasts about 3 to 4 minutes and is unpredictable.  Unfortunately, these symptoms may last from 4 to 10 years, and are more common in overweight women.  There may also be an increase in heart disease, thinning of the skin, hair loss and brittle nails, as well as a decrease in breast size.  There are also emotional and mental symptoms that may occur during menopause including, depression, anxiety, and sleep disturbances.

Hormone replacement therapy for menopausal symptoms is usually effective, but the benefits have to be weighed against the risks and should be reserved for women with severe hot flashes, sleep disturbances and mood disorders.  The American Congress of Obstetricians and Gynecologists recommends that the smallest dose for the shortest time should be given, and hormone therapy comes with it’s own list of potential symptoms, including breast tenderness, vaginal bleeding, bloating and headaches.  In higher doses, blood clots, strokes, breast cancer, gallstones, and high blood pressure are common side effects.  Paroxetine or Paxil, in low doses of 7.5 mg per day, has also been approved by the FDA for treatment of hot flashes, and other medications such as Gabapentin and clonidine, have shown promise.