Menopause FAQ.

Q: WHAT IS MENOPAUSE?

A: Menopause, often referred to as "the change of life," is the natural transition out of childbearing years. Menopause in women is the reverse of puberty.

Q: WHEN DOES MENOPAUSE USUALLY BEGIN?

A: Menopause symptoms like hot flashes and irregular menstrual cycles can begin for women in their late 30s or early 40s during the perimenopause phase of a woman's life. Natural menopause is typically complete in the late 40s or early 50s.

Q: WHAT IS PERIMENOPAUSE?

A: Perimenopause is the phase before menopause when ovarian hormone production begins to decline and fluctuate. Typically, perimenopause is the period about three or four years before menopause, though some women can begin the perimenopause phase of their life many years before menopause.

Q: WHAT IS SURGICAL MENOPAUSE?

A: Surgical menopause is the term used to describe menopause that happens as the result of hysterectomy and bilateral oophorectomy (where both ovaries are removed). Women who begin menopause as the result of surgical intervention often suffer the effects of menopause more drastically than women going through natural menopause. And, the younger the woman is, the more problems she will likely encounter.

Q: CAN A WOMEN BECOME PREGNANT DURING PERIMENOPAUSE?

A: Yes, though pregnancy is less likely since ovulation, when women can conceive, become more irregular. Until a women goes one full year without a period, she should consider herself fertile and continue using birth control methods.

Q: AT WHAT TIME DO I CONSIDER MYSELF POSTMENOPAUSAL?

A: Most clinicians place the postmenopausal phase at one full year after the last menstrual cycle. Postmenopause is a time when most of the distress of the menopausal changes have faded. At postmenopause, hot flashes and other symptoms of menopause are more mild and less frequent and energy and emotional levels stabilize.

Q: WHAT ARE THE SYMPTOMS OF MENOPAUSE?

A: Symptoms of menopause may include hot flashes, night sweats, insomnia, vaginal dryness, aching joints and muscle problems, anxiety, irritability, depression and mental fatigue. Decreased libido, headaches, migraines, heart palpitations, urinary tract infections, weight gain, hair loss and incontinence are also symptoms of menopause.

Not every woman will experience these symptoms or at the same severity. Women going through surgical menopause experience most of these symptoms in a more severe fashion than women going through menopause naturally.

Q: WHAT HAPPENS DURING MENOPAUSE?

A: During menopause, the ovaries gradually produce lower levels of estrogen and progesterone. After menopause, the estrogen levels in woman are about one-tenth the level before menopause and progestin levels are near non-existent.

Q: WHAT DO ESTROGEN AND PROGESTERONE DO IN THE BODY?

A: Estrogen is known as a 'female hormone’ and plays a key role in shaping the female body. One of estrogen's primary roles is to promote the growth of cells in the breast and uterus and estrogen affects many aspects of women's physical and emotional health. Progesterone is the second most important female hormone. Progesterone is primarily responsible for regulating the reproductive cycle.

Q: IS HORMONE REPLACEMENT THERAPY SAFE?

A: No. The results of conclusive research prove that hormone replacement therapy is not safe. The use of synthetic estrogen and progestin is linked to increased risks of heart disease, breast cancer, uterine cancer and ovarian cancer, strokes and blood clots. Women should thoroughly investigate these risks and discuss all concerns with her physician before deciding to use a synthetic hormone replacement therapy.

Q: WHY ARE SYNTHETIC HORMONES PRESCRIBED FOR MENOPAUSE?

A: Doctors often recommended hormone replacement therapy (either estrogen alone or in combination with progestin) to relieve menopause symptoms. Doctors also prescribed hormone replacement therapy to prevent long-term conditions such as osteoporosis and heart disease. With recent results from the Women's Health Initiative, a trial sponsored by the National Institutes of Health, showing elevated health risks of hormone replacement therapy, many doctors are not as inclined to place women on hormone replacement therapy.

Q: WHAT WERE THE RESULTS OF THE WOMEN'S HEALTH INITIATIVE STUDY?

A: According to these results, estrogen used in combination with progestin increases the risk of both heart disease and breast cancer, strokes and blood clots. The Women's Health Initiative concluded definitively that hormone replacement therapy places women at a significantly elevated risk for breast cancer. The study found a 26 percent increase in breast cancer risk for women taking hormone replacement therapy. The study also showed that, contrary to prevailing belief, hormone replacement therapy also placed women using hormone replacement therapy at a higher risk - 29 percent - for heart disease. The Women's Health Initiative study on the combination of estrogen and progestin halted five years into the eight-year study because researchers determined that the risks to women in study outweighed any benefits. The arm of the trial studying estrogen alone continues and the results of that portion of the study are not yet known.

Q: DOES HORMONE REPLACEMENT THERAPY PREVENT OSTEOPOROSIS?

A: Yes and no. Although hormone replacement therapy has shown to slow bone loss, those effects are not permanent and stop when women discontinue hormone replacement therapy. Because of the risks, hormone replacement therapy is no longer recommended for the prevention of osteoporosis.

Q: IS THERE A LINK BETWEEN OVARIAN CANCER AND HORMONE REPLACEMENT THERAPY?

A: Yes. A recent study following over 44,000 postmenopausal women during a 20-year span concluded that estrogen use increases the risk of ovarian cancer. In this study, women who used estrogen alone for 10-19 years were twice as likely to develop ovarian cancer than women who did not use postmenopausal hormones. For women who used estrogen for 20 or more years, the risk of ovarian cancer increased to three times that of women who did not use postmenopausal hormones. Because most studies have followed women using estrogen alone, there are currently not enough data to assess the potential effects of the estrogen-progestin combination on ovarian cancer. More data is needed to determine the estrogen-progestin risk for ovarian cancer.

Q: ARE WOMEN USING HORMONE REPLACEMENT THERAPY AT RISK FOR OTHER HEALTH CONDITIONS?

A: Women who use estrogen combined with progestin are at increased risk for blood clots, gallbladder disease, stroke and inflammation of veins. Other studies show a link between hormone replacement therapy and endometrial cancer (cancer of the uterine lining).

Q: SHOULD WOMEN TAKE HORMONE REPLACEMENT THERAPY IF THEY HAVE A HISTORY OF CANCER?

A: NO! One of estrogen's primary roles is to promote the growth of cells in the breast and uterus. There is concern that synthetic estrogen promote further tumor growth.

Q: WHAT NATURAL ALTERNATIVES TO HORMONE REPLACEMENT THERAPY ARE AVAILABLE?

A: There are many natural alternatives to help women as they go through menopause. Black cohosh and don quai are highly effective favorites among women choosing natural hormone replacement therapy. Estrogen-containing foods like soy products, whole-grain cereal, seeds, certain fruits and vegetables are also beneficial for reducing menopause symptoms. Healthy lifestyle - smoking cessation, regular exercise, and good nutrition - is also incredibly important for menopausal women to reduce the risks of heart disease, osteoporosis and certain types of cancer.