Sunday, January 15, 2006

menopause (climacteric, "change of life")

Menopause, or climacteric, is the transitional phase between reproductive and nonreproductive ability. Menopause occurs when there has not been menstrual flow for one year. During menopause, which usually lasts 12 to 18 months, there is a gradual decline in ovarian function. Menopause usually occurs between ages 45-55, with 50 percent of women experiencing it between 45 and 55, 25 percent before 45, and 25 percent after.
Ovulation ceases gradually and with it menstruation and reproduction. This change usually occurs gradually, menstruation decreases or is very heavy and irregular for a time before the menses stops permanently. The uterus, the vagina, and vulva decrease in size. As ovarian function decreases so does the production of estrogen and progesterone. The endocrine imbalance may lead to fatigue, nervousness, sweating, palpitations, severe headaches, and hot flashes. These may be mild and infrequent or last as long as two minutes, occurring every 10 to 30 minutes around the clock. Sometimes they are severe enough to interfere with sleep.
Women have varying emotional reactions to menopause. The idea that menopause is inevitably accompanied by emotional and psychological problems has been rejected in recent years as the "menopause myth." Some view it as a loss of role, particularly women whose interests were focused entirely on children and the home. Some are concerned about changes in the marital relationship, continued sexual satisfaction, or the husband's response to aging. Feelings of depression are common among women experiencing menopause. These women require factual information and sometimes counseling to maintain a good attitude and productive life. Peer support groups can be helpful.
Women should be counseled about contraception because the menstrual cycle and ovulation are irregular. Oral contraceptives are reliable but there is an increase in the incidence of blood clots and cancer. Yearly physical examinations are recommended due to the higher incidence of uterine cancer. Bleeding after menopause, menstrual periods that become heavier, and bleeding after intercourse or douching require the attention of a physician.
Hot flashes and excessive perspiration that may occur are associated with lack of estrogen, increased luteinizing hormone, increased prostaglandins, and high levels of follicle-stimulating hormone. Estrogen deprivation may cause urinary frequency, painful urination, joint and muscle pain, cardiovascular disorders, and osteoporosis.
Estrogen is often the treatment of choice. Other methods that have proven effective are vitamin E, ginseng and B-complex vitamins. Good sources of vitamin E are vegetable oils, soybeans, spinach, peanuts, and wheat germ. Good dietary sources of B complex vitamins are whole grains, Brewer's yeast, wheat germ, yogurt, liver, and milk.
The advantages and disadvantages of estrogen therapy have been debated for many years. Studies suggest an increased risk of endometrial cancer associated with the administration of estrogen. The benefits and the risks need to be discussed before therapy is started. It is desirable to use the lowest dose possible to relieve symptoms. During estrogen therapy women should be examined at least every six months. The examination should include breast exam, pap smear, and blood pressure check.
Menopause does not mean the end of an active sexual life. An active sexual life maintains pliability of the vaginal tissue. Sexual function does not depend on the release of ova or hormones, women can enjoy sexual activity during the climacteric and after menopause. The loss of estrogen causes the vagina to lose its elasticity and become shorter and narrower. Vulvar changes include flattening of the labia, thinning of pubic hair, and shrinking of the introitus. This may lead to dyspareunia (painful sexual relations) .
Dyspareunia is treated by local applications of a vaginal cream. Vaginal infections are common because the lack of estrogen causes the vaginal secretions to become more alkaline. Vaginal infections are treated according to the causative organism but frequently respond to vinegar douching. Menopause may be artificially induced in cases of specific diseases by irradiation of the ovaries, surgical removal of both ovaries, or hysterectomy. When the uterus is removed but the ovaries are left in place menstruation ceases, but the ovaries continue to function until the age of climacteric has been reached.
Many women view the "change of life" negatively. This negative image is reinforced by the media, books, health professionals, and the general public. Education preceding the onset of menopause can help dispell many myths and misconceptions. Women need to be informed about what menopause is, how it affects reproductive and sexual ability, and what can be done to make it more comfortable.
See also DYSPAREUNIA; OSTEOPOROSIS; VAGINITIS.
Calkins, E., et al. The Practice of Geriatrics. Philadelphia: W. B. Saunders Co., 1986.
Scherer, J. C. Introductory Medical-Surgical Nursing. Philadelphia: J. B. Lippincott Co., 1982.

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