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What is menopause?

Menopause, also called climacteric, means "change of life," when the woman's ovaries stop producing ova (eggs) and her menstrual bleeding decreases and eventually ceases, all of which are a result of her body's marked decrease in the production of the female hormones called estrogens and progesterone. The diagnosis is established when amenorrhea (bleeding cessation) persists for one year.This natural event in a woman's life usually begins between the ages of 40 and 55, but the average age is about 51. During this stage, the woman can no longer get pregnant because her ovaries no longer "manufacture" eggs.

What do estrogens do?

Estrogens are a group of female hormones necessary for the reproduction and for the development of the breasts, uterus, external genitalia and the bodily changes associated with puberty. Estrogen also prevents heart disease and osteoporosis (loss of calcium within the bones, causing the bones to be thin, weak, brittle and fragile and susceptible to fractures). This hormone also helps preserve normal sexual libido and maintain normal vaginal lining and lubrication.

Do all women get pre-menopausal symptoms?

Not all women have pre-menopause in the same manner. Some do not have symptoms at all, while the others have moderate to severe debilitation symptoms. Others go "crazy" with their violent mood swings and personality changes, and drive their husband and children crazy.

Do men undergo menopause?

Yes, men also undergo the change of life at about the same age as women, but usually preceeded by minimal or subtle symptoms. Many of them experience this middle-age crisis and start acting a bit weird, like in dressing and behaving like twenty-some year olds, or developing sudden interest in text-messaging, motorcycles, or buying a sports car, etc. Some become a bit moody or a little depressed, but majority have indiscernible changes. Others undergo male menopause without even knowing it.

What are the symptoms of pre-menopause?

In women, the symptoms are more pronounced and could include hot flashes skin flushing, and profuse sweating which affect 75% of women. Most have hot flashes for about a year, and 25% to 50% for more than 5 years. Some of the other symptoms include chills following the hot flashes, irritability, vaginal dryness, decreased sexual drive or interest, fatigue, insomnia, depression, headache, anxiety, nervousness, constipation or diarrhea, muscles aches, palpitation, irregular menstrual, depression, insecurity (with self-pity), mood swings which may extend to "borderline insanity" as a woman once described it to me. Some get upset and hot tempered, impatient, super-sensitive to noise and loud music, and simply "hard to get along with," according to children, husbands, friends of pre-menopausal women. If this happens to men to the same degree, we, too, will be hard to live with.

Can these women control themselves?

No, because their behavior is caused and controlled by the hormonal chemicals (or lack thereof) in their body. The drop in the level of female hormones during pre-menopause makes some women feel like their being deprived of a drug they used to take, causing severe withdrawal symptoms. We, husbands and children of these pre-menopausal women, must recognize the "pain and torture" our wives or mothers are subjected to during this pre-menopausal period, and should be very understanding, patient, forgiving, and fully supportive of them during this agonizing and trying phase in their life. They are the victims of this "change in life" and we are the natural casualties. Since this phase is only temporary, these women return to their normal selves after their body has adjusted to the change, which time varies in different women from one to three years. Luckily, many women only have mild pre-menopausal symptoms.

What is the treatment for pre-menopausal symptoms?

Women should accept menopause as a normal and natural part of their life, and that pre-menopausal symptoms, if present, are temporary and that natural menopause in most women does not need any treatment. Discussing with a physician the physiology of menopause, the concerns, fears and stresses related to this phase of every woman's life helps a lot in alleviating or somewhat minimizing the symptoms. If severe psychologic problem occurs, psychotherapy, antidepressants and mild sedatives, might be indicated. Fortunately, most women do not have severe symptoms.

Estrogen Replacement Therapy (ERT), also called Hormone Replacement Therapy (HRT), relieves hot flashes, profuse sweating, vaginal dryness and irritation, and other symptoms, and also reduces the risk of osteoporosis and heart disease. Fosamax (Alandronate Sodium) once-a-week tablet is used as a part of a regimen for the prevention and treatment of osteoporosis. Preliminary clinical data seem to suggest that ERT may also help prevent Alzheimer's disease and decrease the risk of cancer of the colon. Estrogen, when given alone, increases the risk of cancer of the uterus, hence in ERT estrogen is combined with progesterone or testosterone to decrease the risk. On the other hand, ERT has been suspected to increase the incidence of liver tumors, gall bladder diseases, blood clot formation and uterine cancer. Estrogen use has also been linked to cancer of the breast, but experts say the medical evidence is still inconclusive. Some of the side effects of ERT include vaginal bleeding, nausea, vomiting, abdominal bloating, breast tenderness and uterine cramps. Every woman should, therefore, confer at length with her gynecologist to fully discuss and understand the individual merit, risks and benefits of Estrogen Replacement Therapy. Self medication, for convenience and/or to save money, is not only very dangerous, but could be a lot more expensive and more inconvenient in the long run.

Any alternative to ERT?

Yes, a healthier lifestyle is a good alternative, or even in conjunction with ERT. This includes diet rich in fish, vegetables, fruits, whole grain high fiber, and avoiding those foods high in saturated fats (pork, beef, eggs, dairy products) and those high in trans-fatty acids (hard margarines, shortening, commercial baked goods). Abstinence from smoking, caffeine (regular coffee and cola drinks), reducing salt and excessive alcohol intake, and daily physical exercises are vital part of a healthy life style. A glass or two of red wine with dinner, green tea, daily multivitamin with added vitamin E, B and C, some plant estrogens (phytoestrogens), found in soy beans, flax seeds, whole wheat, berries, cimicifuga racemosa or block cohosh, isoflavones from tofu, and acupuncture have been used to minimize the symptoms of pre-menopause. Success with acupuncture varies. Meditation, Yoga, and other relaxation techniques as a part of stress management, have likewise been found to be of great benefit, not only for pre-menopausal women, but for all of us in general.

©2003Raoul R. Diez, M.A.O.D.