Menopause: definitions, timing, and symptoms in women

Menopause

Attention: To all women experiencing menopause, going to experience menopause in the future and knowing closely somebody going through menopause -- get informed!

Defining menopause

Nobody can escape death and taxes. This is a rather common saying revealing the unavoidability of one's fiscal obligations towards the state and the inability to avoid their own death. In the case of women, this equation contains a third variable -- menopause. "Love it or loathe it, the menopause affects all women worldwide" (Currie, 2006).

Menopause is traditionally perceived as the stage in a woman's life when she is no longer fertile and able to give birth to children. In a more professional formulation, menopause represents "the transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether" (National Center for Biotechnology Information, 2010).

Two important concepts refer to perimenopause and postmenopause. Each of these is defined by the time frames. Perimenopause as such represents the period before the actual menopause, when the menstruation of the woman becomes irregular, and it can last up to several years. The average duration of perimenopause is of four years, but it can be as low as a few months, or as long as ten years (Web MD, 2011).

Postmenopause generically refers to the period after menopause, but a clear definition of the concept is quite difficult to obtain. A special case of postmenopause women is represented by patients who have had their ovaries removed through surgery and are as such unable to have another period (Mills, 2011).

2. When it appears

Menopause is associated with the middle of the woman's life, yet it appears at different ages for the women. Perimenopause usually occurs within the 40s, but it can even occur as early as the 30s. The duration of the perimenopause also varies from one woman to the other. From a medical standpoint, it is considered that perimenopause is completed when the woman does not have menstruation for twelve consecutive months. From this point on, menopause is installed (Mayo Clinic, 2011).

In terms of menopause, this occurs normally between 45 and 55 years and it can last five years, or even more, depending on each woman (National Center for Biotechnology Information, 2010). Postmenopause is installed when the symptoms of menopause are completed and it lasts throughout the rest of the woman's life.

3. Symptoms of menopause

As with any other aspect of menopause, the symptoms experienced by women at menopause vary and generalizations might be difficult to be made. Still, these exist within the literature and present the more common manifestations of menopause. Sana Loue and Martha Sajatovic (2007) for instance argue that these symptoms can be classified into three specific categories:

Vasomotor symptoms

Genitourinary symptoms and Other systemic symptoms.

The vasomotor symptoms are the more common ones and they are present in about 10 per cent of the women experiencing premenopause, to increase to an 80 per cent presence in the menopausal women. These symptoms include hot flashes, night sweats, disturbances of sleep as well as palpitations.

The hot flashes are the more common and bothering symptoms; they are described as a sensation of excessive heating which starts from the upper body and spreads to the face. The severity and frequency of the hot flashes differ, but they can last an average of four minutes and can even occur hourly. The most bothersome flashes are those during the night, when the sleep of the woman is disturbed and she becomes irritable, fatigued or even experiences decreased memory. An estimated one tenth of the women describe the hot flashes as interfering with their normal activities and some women find them so disturbing that they seek medical attention.

Hot flashes can be precipitated by factors such as coffee, stress or hot beverages, but differences also exist based on the cultural background of the woman, the lifestyle or the socio-economic conditions. A study conducted by a University of California Davis on 16,000 women generated findings such as the following:

African-American women experience more hot flashes than the Caucasian women

Asian and Hispanic women experience fewer hot flashes compared to other groups

"Japanese women [living] in Japan report very few hot flashes and Mayan women in Mexico do not report any menstrual irregularity. This lower prevalence of hot flashes may be due to increased intake of dietary phytoestrogens and decreased meat consumption" (Loue and Sajatovic, 2007).

As mentioned before, aside from the vasomotor symptoms, the menopausal women also experience genitourinary symptoms and other systemic symptoms. The genitourinary symptoms include vaginal dryness -- the more common --, vaginal irritation, pain with intercourse (dyspareunia), higher urinary frequency or even pain with urination (dysuria). Finally, in terms of the other systemic symptoms which might occur, these include irritability, arousal or the opposite, reduced sexual desire, fatigue or even decreased cognitive abilities (Loue and Sajatovic, 2007).

4. Diet of the woman on menopause

The issue of diet and menopause has been relatively little studied, however it is believed that a lower intake of meat might decrease the starting age of menopause (Rouen, 2009). From the perspective of the woman at menopause however, studies did not indicate the existence of a specific diet, but the specialists militate for a healthy and balanced nutrition, formed from complex carbohydrates, protein and fats (Alexander and Knight, 2005).

Opinions more specific than that have however been forwarded and these are commonly present on websites specialized in health and women's issues. Some of the recommendations forwarded through these sources include:

Recommendations to increase the intake of soy, water, teas with antioxidants and calcium

Recommendations to decrease consumption of caffeine, aspartame (artificial sweetener), highly glycemic foods and alcohol

Recommendations for a scheduled eating program, rich in protein, fruits and vegetables (Magee).

Two particular dietary concerns of women on menopause include the usage of foods to address the symptoms and the dietary considerations to weight loss during menopause. In terms of dietary considerations to control the symptoms, some suggestions exist, yet most of them have yet to be scientifically proven. In this order of ideas, Elaine Magee states that soy might be good to reduce hot flashes; fresh fruit and vegetables might add new estrogen within the body; beans might decrease the appetite; dairy and calcium rich aliments support the bone structure and are essential for aging women; and flaxseeds might reduce the cholesterol and the risks of developing tumors.

In the case of weight loss, this is a common problem for women at menopause who experience a lower rate of metabolism and a digestion process which slows down. In this context, women come to gain more weight and find it more difficult to lose it. Louise O'Connell has approached the issue and created a set of dietary recommendations for menopausal women striving to lose weight. These include:

Snacking on fruit such as red grapes, blueberries, nuts or apples

Launches such as avocado salad with bacon, fish, salads or pasta salads

Dinners based on ingredients such as chicken, tofu, vegetables, roast beef, potatoes or noodles.

5. Attitudes towards menopause

The attitudes towards menopause vary from one culture to another, but also from one woman to another. On the one hand, there are the women who embrace menopause and perceive it as a new stage in their life in which they are free. Most of the stress from their life is overcome and they are now able to enjoy life's little pleasures. They do not have to worry about pregnancy, the monthly bleedings have stopped -- as have the cramps --, they do not have to bear and raise children and, in post menopause, they are free from hot flashes and night sweats. With this newfound sense of freedom, women come to experience new things.

"Some women experience what they call post menopause zest in the post stage. The stormy, tumultuous time is behind them and a sense of calm washes over them. Free of PMS, cramps, bleeding, child bearing, child raising, fear of pregnancy, hot flashes and nights sweats the older woman often feels a unique freedom and an energy that is new to them. They do wacky things like join Red Hat Societies or wear purple. Some join organizations and take up causes to help improve the world. Some claim to finally have time to be themselves" (Menopause Insight).

Some women however also experience negative perceptions regarding menopause, and these are often associated with aging; others are neutral. Still, more attitudes towards menopause are positive, or revealing a trend from neutral to positive. The attitudes of women towards menopause can be linked to features outside the process itself, and pertaining to elements such as the social and economic background of the women (Sommer and co-editors, 1999).

7. Treatment of menopause

As it has been mentioned throughout a previous section, some of the women experiencing the symptoms of menopause characterize them as highly bothering and generative of inabilities to function properly. In order to avoid them, several treatments are available. The more common treatment is represented by the hormone therapy, which virtually means the chemical replacement of the lost hormones. The therapy can be used to treat hot flashes and it is only recommended for the women starting menopause, not the women which started menopause several years before. Tests are still being conducted to assess the risks of hormone therapy, but it is recommended that women do not use it for more than five years. Also, women selected for hormone therapy should have low baselines for strokes, blood clots or breast cancer.

For those who do not qualify or wish to avoid hormone therapy, some alternative treatments exist. These are commonly based on mild antidepressants and they address issues such as hot flashes or mood swings, but also other symptoms as well.

Aside medical treatments, menopause can be better managed by the women though a series of changes in their lifestyles. Some of the more notable suggestions in this sense include acupuncture; the avoidance of coffee, alcohol or spicy foods; more exercise; the practicing of Kegel exercises or various relaxation techniques, such as yoga or meditation (National Center for Biotechnology Information, 2010).

References:

Alexander, I.M., Knight, K.A., 2005, 100 questions & answers about menopause, Jones & Bartlett Learning

Currie, H., 2006, Menopause, Class Publishing Ltd.

Loue, S., Sajatovic, M., 2007, Encyclopedia of aging and public health, Springer

O'Connell, L., The menopause diet, Good to Know, http://www.goodtoknow.co.uk/diet/268782/The-menopause-diet-plan last accessed on November 18, 2011

Magee, E., Managing menopause symptoms through diet, Medicine Net, http://www.medicinenet.com/script/main/art.asp?articlekey=59895 last accessed on November 18, 2011

Mills, D., 2011, Post-menopause -- what happens after the change, Women to Women, http://www.womentowomen.com/menopause/postmenopausal.aspx last accessed on November 18, 2011

Rouen, P.A., 2009, Study of women veterans in menopause, ProQuest

Sommer, B., Avis, N., Meyer, P., Ory, M., Madden, T., Kagawa-Singer, M., Mouton, C., O'Neill, N., Adler, S., 1999, Attitudes towards menopause and aging across ethnic / racial groups, Psychosomatic Medicine, Vol. 61

2010, Menopause, National Center for Biotechnology Information, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001896 / last accessed on November 18, 2011

2011, Menopause, Healthy Women, http://www.healthywomen.org/condition/menopause last accessed on November 18, 2011

2011, Perimenopause, Mayo Clinic, http://www.mayoclinic.com/health/perimenopause/DS00554 last accessed on November 18, 2011

2011, Perimenopause, Web MD, http://www.webmd.com/menopause/guide/guide-perimenopause last accessed on November 18, 2011

Post menopause, Menopause Insight, http://www.menopauseinsight.com/post-menopause / last accessed on November 18, 2011