menopausal transition. Check with your
At any age before natural menopause, an
doctor to see if you are pregnant or if
operation to remove both ovaries or the
there is another medical cause for your
uterus results in “surgical menopause.”
missed periods.
The medical term for the operation is
a hysterectomy (surgery to remove the
C H A N G E S I N H O R M O N E
uterus) or bilateral oophorectomy (surgery L E V E L P A T T E R N S
to remove both ovaries). Removing either
O V E R S I X M O N T H S
both ovaries or the uterus stops monthly
P r e m e n o p a u s e ( 1 8 0 d a y s ) periods right away. If the surgeon removes the uterus but is able to leave one or both ovaries, estrogen and progesterone might
still continue to be made for a while
longer. However, research suggests that,
P e r i m e n o p a u s e ( 1 8 0 d a y s ) after a hysterectomy, the ovaries may stop making these hormones sooner than might
normally be expected.
A woman who has either a hysterectomy
or both ovaries removed often faces more
intense menopausal symptoms than a
P o s t m e n o p a u s e ( 1 8 0 d a y s ) woman who reaches menopause naturally.
Removing both ovaries abruptly cuts off
hormone production. If you are having
this surgery, discuss how to manage your
symptoms with your doctor before your
Estrogen
Progesterone
FSH
LH
Excerpted from the September 1999 issue of the Harvard Women’s Health Watch, ©1999, President and Fellows, Harvard College.
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M E N O P A U S E : T I M E F O R A C H A N G E
operation. Without treatment, symptoms
may begin soon after surgery. Surgical
menopause also puts you at early risk for bone loss and heart disease. Stay in touch with your doctor as you recover.
Usually menopause happens naturally,
but some women develop symptoms of
menopause and stop having menstrual
cycles much earlier than expected. Before age 40, a menopause-like condition can
happen for no known reason, or it can be
caused by radiation treatment, some medi-
cines like those used in chemotherapy, an autoimmunity (some of a woman’s own
body cells attacking her ovary or ovaries), or genetic errors. Radiation can make
your ovaries stop working, as can some
become pregnant after the diagnosis.
treatments like chemotherapy for cancer.
The terms “premature ovarian failure”
In the past when menopausal symp-
or “primary ovarian insufficiency” are
toms developed before age 40, it was
now used to describe this condition.
referred to as “premature menopause.”
Women with this problem may experience
However, the term “premature menopause”
symptoms of menopause like hot flashes
is no longer considered scientifically
and vaginal dryness.
accurate. That’s because some women with
this condition have ovaries that produce
hormones irregularly and a return of
menstrual periods, and some can even
6
Signs OFTHEMENOPAUSAL
T R A N S I T I O N
Many things can happen in a woman’s body because of the changes in hormone patterns (see chart, Changes in Hormone Level Patterns, on page 5) that begin during the menopausal transition. Some women are bothered by only a few symptoms during perimenopause.
Others are very uncomfortable, while the rest hardly feel any different.
Scientists are trying to understand how the hormone changes during the menopausal transition may affect a woman’s periods and menopausal symptoms.
There are several common symptoms around this time of life, which may be caused by the shifting hormone levels of the menopausal transition. To learn more about managing these symptoms, see the chapter, What You Can Do for Hot Flashes and Other Menopausal Symptoms, starting on page 11.
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M E N O P A U S E : T I M E F O R A C H A N G E
Menstrual cycle changes. The first thing many women notice is a change in
their periods. They might start coming
farther apart or closer together. They might last longer or end sooner. The flow could be heavier or lighter.
Hot flashes and night sweats. Many women also start to be bothered by hot
flashes or flushes and/or night sweats.
The medical term is vasomotor symptoms.
During a hot flash, your face and upper
body begin to feel hot. Your skin gets
flushed or red because blood vessels close to the surface are expanding. You might
start sweating a lot, sometimes followed
by cold shivering. Some hot flashes leave you with only a slight feeling of warmth
or a light blush. Others may drench your
clothes. Night sweats are hot flashes with sweating that happen during your sleep.
They can be strong enough to wake you
Some studies suggest that as many as
up at night.
three-fourths of white women have hot
Hot flashes can happen several times
flashes and/or night sweats. A different study an hour, a few times a day, or just once or found that African-American women are
twice a week. They usually occur for just a more likely to report having hot flashes
few years and then stop, but about one
and night sweats than are Hispanic or white woman in every ten women might have
women. Japanese and Chinese women were
hot flashes into her sixties and seventies.
the least likely to report this symptom.
8
S I G N S O F T H E M E N O P A U S A L T R A N S I T I O N
Your skin and other tissues. As you OTHER CHANGES
age, your skin becomes drier. You might
Scientists are working to understand how
also start to lose fatty tissue and a protein hormonal changes lead to menstrual cycle
material known as collagen under your
irregularities, hot flashes, night sweats, and skin and also in the areas near your vagina vaginal changes. They are also trying to
and urinary tract. These losses can make
learn more about other changes around
your skin thinner and less elastic. If your the menopausal transition that you may
vaginal tissues are affected, these changes experience. Some may be the result of
can make them drier and more likely to
changes in the amounts of hormones
tear and become infected. Sexual inter-
made by your body as you go through
course may become painful.
menopause; some may be related to
growing older.
Sleep and fatigue. Many women report having problems sleeping and feeling tired, Sexuality. You might notice changes in especially in the years just before menopause your interest in having sex (called libido) or and during postmenopause. But, it is
in your ability to become sexually aroused.
difficult to know if sleep changes are
After menopause, some women say that
a part of growing older, the result of
freedom from concerns about pregnancy lets hormone changes, or both.
them feel more open to sex and
Sometimes, it is night sweats that wake
more relaxed in general. Other
you in the middle of the night, or it might women report losing interest
be that you have to go to the bathroom.
in sex. If such changes
Either way, once awake, you can then have bother you, talk to a
trouble getting back to sleep. Perhaps you doctor to make sure there
can’t fall asleep in the first place, or you is no other cause. For
find yourself waking too early in the morn-example, medicines, such
ing. When this happens over and over, you as those prescribed to treat
will become very tired. And feeling tired high blood pressure, depression, and
can affect everything you do during the day.
cholesterol problems, might play a role.
9
M E N O P A U S E : T I M E F O R A C H A N G E
of the tongue” problem—you can’t think of a familiar word, or you can’t remember the name of someone you know. Then a couple
of hours later the missing word just pops into your head. Or you walk into another
Mood. There is some evidence that stress, room for something and, once there, can’t a history of depression, and poor general remember what you wanted. Both middle-health are more likely to contribute to
aged men and women describe short-term
mood changes, anxiety, and irritability
memory problems. Problems like these are
during mid-life than do hormonal
probably normal, but other types of memory fluctuations. So, while women at mid-life loss might not be. For example, forgetting are sometimes portrayed as having extreme where you put the car keys is normal, but mood swings, this may not be a true picture.
forgetting how to drive the car is not.
The specific connection of mood to the
Mid-life is a time that may bring new or
hormone changes of menopause is not clear.
greater sources of stress, and this stress can also add to memory problems. Stress is
Physical changes. Mid-life is a time how the body responds to changes (both
when you may see changes in your body,
good and bad) and challenges in order to
especially in its shape and makeup. Your
prepare to protect itself if needed. Some joints or muscles might ache or feel stiff.
experts suspect that when you have a lot
Your waist might be getting thicker, and
going on in your life, it can be harder to you could be gaining weight. Shifts in your remember as much as you once did.
body makeup such as the loss of muscle
Although mild, short-lived stress actually and increases in fatty tissue also take place.
may improve learning in some situations,
Muscle helps us burn a lot of calories, so the complicated sources of stress in mid-life losing muscle mass over time can make
might interfere with your learning some-
it harder to burn off calories and easier thing new in the first place. So, sometimes, to gain weight.
it’s not that you forgot things that happened Memory. Often, people start worrying recently, it’s that your brain never recorded about their memory as they get into their it as something to remember.
forties and fifties. Sometimes, it’s that “tip 10
W H AT Y O U
C A N D O F O R
ot
H Flashes
AND OTHER
MENOPAUSAL
SYMPTOMS
Check with your doctor if you
experience a troubling change in how you feel.
Symptoms that might seem like the menopausal transition, even hot flashes, night sweats, and irregular periods, may have other causes.
Menopause is a natural stage of life. It is not something that you must take medicine for. If your doctor says you are in the menopausal transition and the symptoms are not bothering you, you don’t have to do anything about them. If your symptoms are making you very uncomfortable, there are things you can do to relieve your discomfort. Your treatment should be chosen based on your own symptoms and health risks. What your sister or friend does may not be the right choice for you. Talk to your doctor about the best approach for you.
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M E N O P A U S E : T I M E F O R A C H A N G E
Whatever approach you choose, if you
some triggers for your hot flashes which
decide to treat your menopausal symptoms, you could then try to avoid.
remember that it is not a permanent
There are also lifestyle changes you can
decision. At every checkup, talk with
try. Exercise can improve your quality of life your doctor about your symptoms or
and may help with hot flashes. It will also concerns. Find out if there have been
help reduce your risk of heart disease and any new research findings or different
osteoporosis. Stopping smoking and losing treatments. If you are using menopausal
weight might lower your risk of hot flashes.
hormone therapy, maybe you need a higher
Studies in small groups of women suggest
dose for more relief, or maybe you want
that slow, deep breathing, known as relax-to try a lower, perhaps safer dose. Discuss ation breathing, may also help reduce hot whether you still need to treat your
flashes.
menopausal symptoms.
What is relaxation breathing?