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Menopause

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Menopause
Summary
  • Menopause means "stopping menstruation", signifying the end of a woman's reproductive life.
  • Menopause generally occurs between the ages of 45 and 55 years.
  • Treatment options range from positive lifestyle changes, adoption of healthy eating habits, counselling and psychological support and hormone replacement therapies.
Description

Menopause means "stopping menstruation", signifying the end of a woman's reproductive life. Menopause generally occurs between the ages of 45 and 55 years1. Some women may experience uncomfortable or unpleasant symptoms as part of their Menopause.

Three terms are used to describe the different types of Menopause.

  • Premature Menopause: When the last period occurs before the age of 40. This may be due to hereditary factors, smoking, exposure to radiation or chemotherapy. An interruption in the blood supply to the ovaries, as may occur during certain surgical procedures, may be associated with premature Menopause.
  • Artificial Menopause: Often the result of medical intervention, for example if a woman has her ovaries surgically removed, or if there is radiation to her pelvis. Artificial Menopause may be deliberately induced. Certain drugs can cause a menopausal state that is reversible if the medication is stopped.
  • Natural Menopause: is Menopause caused by advancing age. Most women experience 'natural' Menopause. As women age, hormone levels change. Onset of Menopause is a gradual process as oestrogen and progesterone levels decline (with fluctuations in a number of other hormones)2. At Menopause, oestrogen and progesterone production has stopped.  

After Menopause, oestrogen is still produced, but in a far less active form (called oestrone). Conversion of certain sex hormones to oestrone occurs in the kidneys, liver and fat cells. For this reason, very thin women may experience more severe menopausal symptoms3.


Signs & Symptoms

Symptoms of Menopause vary in type and severity. Onset may be gradual or sudden. The most common menopausal symptom is hot flushes. Other symptoms include insomnia, mood changes, vaginal dryness, palpitations, muscle and joint pain and night sweats. The risk of developing osteoporosis is increased after Menopause4. Fluctuations in the menstrual cycle are often the earliest sign of approaching Menopause. There may be changes in the frequency or volume of menstruation. If any of the following occur, contact your Doctor:5 bleeding which occurs one year after the last menstrual period, bleeding after sex, persistently heavy periods, mid-cycle bleeding or bleeding between periods or pain, if never experienced before.

  • Management

    Always consult your Doctor for diagnosis and advice. In no way is this information intended to replace the advice of a medical practitioner. Treatment options range from positive lifestyle changes, adoption of healthy eating habits, counselling and psychological support and hormone replacement therapies. Non-drug plant oestrogen therapies are also currently available. Discuss possible treatment approaches with your health professional.

    • Perform a breast self examination monthly. Have a mammogramevery 2 years, or as recommended by your medical practitioner.
    • Have an internal gynaecological examination yearly and a Pap smear at least every second year, or as recommended by a medical practitioner.
    • Do weight bearing exercise regularly (30 minutes every second day) to help maintain bone strength.
    • Maintain bodyweight in the middle to upper level of ideal weight.
    • Have a cholesterol check.  


    Lifestyle

    Diet Hints
    • Menopause causes symptoms that are related to decreased levels of oestrogen in the body. Soybeans are a rich dietary source of phytoestrogens (plant oestrogens). Soybeans contain particularly high levels of the phytoestrogen known as isoflavone, which is able to bind to Oestrogen receptors and mimic some of oOestrogen's actions in the body6. Diets rich in phytoOestrogens have been found to alleviate hot flushes caused by Menopause7. There is also evidence that Soybean products can increase the bone mineral density (which is an indicator of bone strength) in post-menopausal women8. The isoflavones in soybeans possess anti-cancer properties. Soy consumption among Asian women is associated with decreased rates of breast and uterine cancer, which is likely to be a result of the cancer-preventing properties of isoflavones9.
    • Caffeine may block the absorption of calcium and other minerals. Coffee, spicy foods and alcohol may aggravate hot flushes10.
    • A vegetarian diet consisting mainly of whole grains, seeds and nuts, vegetables and fruits may help to minimise menopausal symptoms11.
    • Essential fatty acids found in cold pressed oils and fish may help relieve some menopausal symptoms 12. Cold-pressed nut and seed oils are sources of vitamin E. Vitamin E has been used to help control hot flushes13.
    • Eating calcium-rich foods during Menopause is important because calcium absorption is decreased. Dairy foods, fortified soy products, canned fish with bones and green leafy vegetables are good sources of calcium.  


    Vitamins/Minerals/Herbs

    Nutritional supplements may be of use if dietary intake is inadequate.

    • Vitamin D and calcium may prevent bone density decreases associated with osteoporosis after menopause14.
    • Black cohosh (Cimicifuga racemosa) may be an effective herb for menopausal symptoms, particularly in relieving hot flushes and vaginal dryness.15 16
    • Tribulus and withaniaMetagenics Seminar Series, Feb-Mar 1999. Understanding the causes of Hormonal Disturbances in Women, p145. Health World Ltd, Brisbane. are androgen promoting herbs which may help to support adrenal gland function and promote ovarian androgen synthesis. Tribulus may provide symptomatic relief for hot flushes, night sweats, depression and insomnia17.
    • Magnesium may assist with improving and maintaining bone integrity. Research demonstrates that supplemental magnesium can increase bone density in many women and prevent bone loss in others18.
    • Evening Primrose Oil may help relieve symptoms of hot flushed and skin dryness19.
    • Phytoestrogenic supplements such as soy-based supplements, red clover and linseed may be of benefit.
    • St. John's Wort (Hypericum performatum) may relieve anxiety, depression and irritability20.
  • Pharmacist's Advice

    Ask your Pharmacist for advice.

    1. Follow the Diet Hints.
    2. If needed, your Pharmacist will suggest some pain relieving tablets or capsules. Ask your Pharmacist if you can take these tablets.
    3. Ask your Pharmacist for products which may help relieve the symptoms of hot flushesand vaginal dryness.
    4. A regular exercise programme can be useful to help tone muscles and improve blood circulation throughout the whole body22. Walking is one of the best.
    5. Have proper rest and try to get at least 15 minutes of sunlight a day to ensure vitamin D synthesis23.
    6. Ask your Pharmacist about cholesterol checks and bone density tests.
  • Notes

    References

    1. Trickey R. Women, Hormones and the Menstrual Cycle. Allen and Unwin, 1998.
    2. Poehlman ET, et al. Changes in energy balance and body composition at menopause: a controlled longitudinal study.; Ann-Intern-Med. 1995 Nov 1; 123(9): 673-5.
    3. Penwarden B. New concepts in menopausal hormone support. Metagenics Update, 8(2); April/May 1999, Health World Ltd.
    4. Prince RL, et al. The effects of menopause and age on calcitropic hormones: a cross-sectional study of 655 healthy women aged 35 to 90.; J-Bone-Miner-Res. 1995 Jun; 10(6): 835-42.
    5. Trickey R. Women, Hormones and the Menstrual Cycle. Allen and Unwin, 1998.
    6. Messina, M. & Messina, V. Soyfoods, soybean isoflavones, and bone health: a brief overview. J Ren Nutr 2000 Apr;10(2):63-68.
    7. PhytoOestrogens: Natural Hormone Replacement Therapy? [last updated 23 March 2000] American Health Consultants. Available at URL: http://www.ahcpub.com/ahc_root_html/hot/archive/atwh0199.html .
    8. Messina, M. Legumes and soybeans: overview of their nutritional profiles and health effects. Am J Clin Nutr 1999 Sep;70(3 Suppl):439S-450S.
    9. DerMarderosian, A. editor. Soy. The Review of Natural Products. Missouri (USA): 1998.
    10. Trickey R. Women, Hormones and the Menstrual Cycle. Allen and Unwin. Sydney 1998.
    11. Gursche S. Encyclopedia of Natural Healing, Natural Life Publishing Inc, USA, 1997, p944.
    12. Gursche-S, MH. Encyclopedia of Natural Healing, Natural Life Publishing Inc, USA, 1997, p944.
    13. Trickey R. Women, Hormones and the Menstrual Cycle. Allen and Unwin, 1998.
    14. Hunter, A. Complementary Medicine Treatments for Menopause. Current Therapeutics 2000;41(8):69-73.
    15. Trickey R. Women, Hormones and the Menstrual Cycle. Allen and Unwin. Sydney 1998.
    16. Lieberman S. A review of the effectiveness of Cimicifuga racemosa (Black Cohosh) for the symptoms of menopause. J of Women's Health, 7(5), 1998.
    17. Metagenics Seminar Series, Feb-Mar 1999. Understanding the causes of Hormonal Disturbances in Women, p141. Health World Ltd., Brisbane.
    18. Abraham GE. The importance of magnesium in the management of primary postmenopausal osteoporosis. J of Nutr Med, 2; 165-178, 1991.
    19. Hunter, A. Complementary Medicine Treatments for Menopause. Current Therapeutics 2000;41(8):69-73.
    20. Braun L. Menopause-natural options. Australian Pharmacist 2001 April; 20 (4):239-245.
    21. Gerhard M, et al. Peripheral arterial-vascular disease in women: prevalence, prognosis, and treatment; Cardiology. 1995; 86(4): 349-55.
    22. Krall EA; et al. Vitamin D receptor alleles and rates of bone loss: influences of years since menopause and calcium intake; J-Bone-Miner-Res. 1995 Jun; 10(6): 978-84.
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