“The Change”: Not So Mysterious After All

Pamela Merritt

Menopause is a natural stage of a woman's reproductive life, a condition women go through as they grow older. Knowing the facts and having resources will help women prepare for, rather than dread, that change.

My grandmother often spoke of women going through "the change," but she refused to elaborate — she simply said that "the change" was something women suffer through if they are blessed to live long enough. This mysterious condition left my grandmother exhausted from lack of sleep. I remember seeing her rhythmically fanning her face while sipping ice water and fussing that someone must have turned the heat up. When I asked what "the change" was, exactly, she would reply that I should just keep on living and then I'd understand. Her reluctance to discuss "the change" reinforced my perception that it was an unavoidable condition women suffered through but preferred not to talk about.

The ‘change' my grandmother spoke of is menopause, which is not an ordeal but a natural stage of a woman's reproductive life. Recent news that hormone replacement therapy (HRT), when used as a treatment for menopause, is linked to an increased risk of women having an irregular breast scan highlights why menopause and treatment options for menopause are worthy of discussion. The alarming results of the new study join those of several others linking certain hormone replacement therapies with an increased risk of breast cancer, endometrial cancer and/or increased risk of heart disease. For all the studies linking HRT to increased health risks there are other studies pointing to the benefits of such therapies for menopausal women. These conflicting reports on the benefits and risks of hormone replacement therapy (HRT) illustrate the challenge of selecting a treatment with acceptable risks and identifiable benefits.

Menopause is a stage of a woman's reproductive life; a natural condition women go through as they grow older. It is often defined as the changes a woman experiences either just before or after she stops menstruating. Women are born with a finite number of eggs stored in the ovaries and the ovaries also produce the hormones estrogen and progesterone, which regulate menstruation and ovulation. Menopause usually occurs after the age of 40 when the ovaries no longer produce an egg every month and menstruation ceases.

Menopause can actually be broken up into three stages – perimenopause, menopause and postmenopause. Perimenopause begins several years before menopause as the ovaries gradually produce less and less estrogen. The perimenopause stage extends until the ovaries no longer release eggs and at that point menopause begins. The decrease in estrogen production accelerates in the final years of perimenopause and many women will begin to experience the symptoms of menopause. Menopause begins when a woman has her last menstrual period. The ovaries no longer release eggs and they stop producing most of their estrogen. Menopause is diagnosed when a woman has not had a period for 12 consecutive months. Postmenopause applies to the years after menopause and most menopausal symptoms ease for women during the postmenopause stage.

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Menopause is often explained through the symptoms associated with it which include but are not limited to hot flashes, fatigue, insomnia, irregular periods, a racing heart, depression, muscle and joint pain, headaches, bladder control problems, vaginal dryness and changes in a woman's sex drive. All women do not experience the full range of symptoms. There are also health implications related to menopause. Menopausal women are at risk for osteoporosis, heart disease and problems with bladder and bowel function.

HRT was once widely recommended to women to treat menopause, manage menopausal symptoms and prevent osteoporosis and heart disease. HRT is used to supplement the body with either estrogen, a combination of estrogen and progesterone or a combination of estrogen and androgen (a form of testosterone). Estrogen helps regulate how the body uses calcium and maintain healthy cholesterol levels. Progesterone is used if a woman still has her uterus to help her body shed endometrial cells and thus reduce the risk of developing endometrial cancer.

We now know that HRT carries with it an increased risk for breast cancer. The new study published in the Archives of Internal Medicine shows that HRT (combined estrogen and progesterone therapy) increases the risk of an abnormal breast scan or biopsy and that more breast cancers were diagnosed in those taking HRT despite the fact that mammograms were more likely to miss tumors in that group.

That doesn't mean short-term use of HRT is no longer an option. Women with severe menopausal symptoms may benefit from taking HRT for a few years and all women should include the new research in their decision making process. All women over 40 should get yearly mammograms regardless of whether they take HRT or not.

What these new findings do mean is that an understanding of menopause and how it fits into a woman's reproductive life should include an understanding of the risks and benefits of treatment options. There are resources available to help women prepare to discuss menopause with their healthcare provider, research alternatives to HRT and gain a better understanding of all the options before deciding what is best for them.

Our Bodies Ourselves has published a new book on menopause that is an excellent resource with excerpts from the book and links to additional resources on menopause and women's health online. The Midlife and Menopause section is an informational gold mine with several links to excerpts from the book. The book is also helps readers understand research results and relative versus absolute risk (excerpt available online). Our Bodies Ourselves: Menopause explores the role diet, weight, stress, exercise and family history play in menopause in a comprehensive woman centered way unburdened by commercial bias.

Menopause may be a change of life but it is a natural transition. Knowing the facts and having resources to help us make sense of the change will help women prepare for, rather than dread, that change.

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