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Perimenopausal Bleeding and Bleeding After Menopause

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Chemotherapy: Treatment of cancer with drugs.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

High Blood Pressure: Blood pressure above the normal level. Also called hypertension.

Hormone: Substance made in the body that controls the function of cells or organs.

Hormone Therapy: Treatment in which estrogen and often progestin are taken to help relieve symptoms that may happen around the time of menopause.

Hysterectomy: Surgery to remove the uterus.

Lymph Nodes: Small groups of special tissue that carry lymph, a liquid that bathes body cells. Lymph nodes are connected to each other by lymph vessels. Together, these make up the lymphatic system.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined as the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Menstrual Periods: The monthly shedding of blood and tissue from the uterus.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Ovulation: The time when an ovary releases an egg.

Perimenopause: The time period leading up to menopause.

Polycystic Ovary Syndrome (PCOS): A condition that leads to a hormone imbalance that affects a woman’s monthly menstrual periods, ovulation, ability to get pregnant, and metabolism.

Polyps: Abnormal tissue growths that can develop on the inside of an organ.

Progesterone: A female hormone that is made in the ovaries and prepares the lining of the uterus for pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.

Radiation Therapy: Treatment with radiation.

Stage: Stage can refer to the size of a tumor and the extent (if any) to which the disease has spread.

Tamoxifen: An estrogen-blocking medication sometimes used to treat breast cancer.

Transducer: A device that sends out sound waves and translates the echoes into electrical signals.

Ultrasound Exam: A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

The Menopause Years | ACOG

Antidepressants: Drugs that are used to treat depression.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.

Estrogen: A female hormone produced in the ovaries.

Hormone: Substances made in the body that control the function of cells or organs.

Hormone Therapy: Treatment in which estrogen and often progestin are taken to help relieve symptoms that may happen around the time of menopause.

Hysterectomy: Surgery to remove the uterus.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined as the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Osteoporosis: A condition of thin bones that could allow them to break more easily.

Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Perimenopause: The time period leading up to menopause.

Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.

Urethra: A tube-like structure. Urine flows through this tube when it leaves the body.

Uterus: A muscular organ in the female pelvis. During pregnancy this organ holds and nourishes the fetus.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

How Long Does Menopause Last on Average

The menopausal transition, or simply “menopause,” is a normal part of female aging. Once you start the transition, you’ll probably want to know exactly how long symptoms will last.

While every woman is different, here’s what to expect on average.

About Menopause

All women experience menopause, with several different symptoms.The symptoms vary from woman to woman, and menopause is as unique a journey as the woman herself.

Menopause symptoms may include:

  • Hot flashes
  • Chills
  • Sleep problems / insomnia
  • Mood Swings / irritability
  • Pain during sex / vaginal dryness
  • Depression
  • Dry skin, dry eyes or dry mouth
  • Urinary urgency (a pressing need to urinate more frequently)

In few cases, women don’t have trouble with these symptoms. Once the menopausal transition is complete, you will no longer have to worry about periods or getting pregnant.

For most women, menopause is a relief that feels freeing in many ways. Getting through the transition, however, can be trying.

Knowing about how long your symptoms will last can help you focus on the light at the end of the tunnel. While you’re going through abrupt hot flashes and night sweats that keep you awake at night as well as irritability from lack of sleep, knowing that you’re just X amount of days from it being over can ease your mind.

 

Related Reading: Identify the Signs of Menopause [Infographic]

 

While there is no guarantee of exactly how long the transition will last, you can get a good idea of where you are on the journey by understanding the process and studying an average timeline.

The Average Timeline for Menopause

The menopause age range varies by more than a decade. The average age is 51, but menopause can start in women from their mid-40s to late 50s. Most women experience the menopause stage in this age range, while some report symptoms into their 60s.

Natural menopause happens in three stages:

  • Perimenopause
  • Menopause
  • Postmenopause

Sometimes perimenopause is confused with menopause. Perimenopause is when a woman starts to have hot flashes, night sweats and vaginal dryness. This can start as early as the 30’s or as late as the 60’s. This is considered either early or premature menopause and late menopause, and can occur for a variety of reasons, such as surgeries or hormonal changes.

Some women in perimenopause may also have the following symptoms:

  • Breast tenderness
  • Worsening of premenstrual syndrome (PMS)
  • Irregular periods or skipping periods
  • Periods that are heavier or lighter than usual

Additional symptoms may include:

  • Racing heart
  • Headaches
  • Joint and muscle aches and pains
  • Changes in libido (sex drive)
  • Difficulty concentrating, memory lapses (often temporary)
  • Weight gain
  • Hair loss or thinning

These symptoms are normal as part of the loss of estrogen production. However, if these are new symptoms after starting perimenopause, consult your doctor in order to rule out other health issues.

Menopause that occurs before the age of 45, regardless of the cause, is called early menopause. Menopause that occurs at 40 or younger is considered premature menopause. Perimenopausal symptoms and age will be as individual as each woman. Talk to your doctor if you’re not sure whether you’re beginning the menopausal transition. 

Contributing Factors 

Primary Ovarian Insufficiency (POI) is another cause of premature menopause. With POI, younger women under 40, who have occasional  or no periods, and elevated levels of follicle-stimulating hormone (FSH), will have fewer eggs in their ovaries. This means lower estrogen levels as well and can cause bone density issues.

According to the SWAN (Study of Women Across the Nation) study, smoking, either as a current smoker or former smoker, can also cause early onset of perimenopausal symptoms, such as hot flashes and night sweats, by at least two years. Being overweight, stressed, depressed, or anxious can also start the ball rolling early. Ethnicity also plays a factor. African American women have a longer period of hot flashes – almost 11 years, while Japanese and Chinese women had half the time of dealing with hot flashes.

How Long is Menopause?

The perimenopausal stage can last from 10 months to four years on average, but has been known to last up to 10 years. It involves the body gradually decreasing in estrogen production until the last year or two, when estrogen levels drop dramatically. Perimenopause officially ends when a woman does not have her period for 12 consecutive months. 

The woman is now at menopause. This is a point in time, rather than a period of time. The period of time after menopause is called postmenopause. Perimenopausal symptoms, such as hot flashes and night sweats may continue for another few months or even years after menopause has been reached. 

Other symptoms that may continue are sleep problems, cognitive issues, mood changes and muscle and joint pain. Vaginal dryness is a symptom that will continue and tends to get worse with age. Although, less than 30% of women experience it during perimenopause and only half experience it in postmenopause.

So, how long does menopause last? From the start of perimenopause to the final cessation of all menopausal symptoms, the average transition takes between two and 10 years. There are some women who go through the process more quickly or more slowly than the median time.

If you experience early or late menopause, you may need to add or subtract a year or two to this average timeline. Every woman should rely on medical professionals to assess symptoms, estimate the duration and prescribe treatments for symptom relief.

Do You Have Early or Late Menopause?

Figuring out if you’re going through the transition early or late can help you gain a better understanding of how long menopause will last. If you start having irregular periods in your mid-40s, you may be experiencing early or premature menopause.

Heavy bleeding, spotting, a period after a year of no periods, or periods that are noticeably longer or shorter than normal can all signal early menopause, especially in combination with other common menopausal symptoms. 

If you are 55 or older and still haven’t noticed menopause symptoms, your doctor may diagnose you with late-onset menopause.

Late menopause may actually have some health benefits, while early menopause could potentially cause problems. During menopause, the production of estrogen and progesterone by the ovaries declines. In early-onset menopause, this cessation may cause problems such as osteoporosis. The longer your ovaries produce estrogen and progesterone, the longer you can avoid osteoporosis.

If you’re still having periods in your late 50s and 60s, see your doctor. Each woman’s reproductive system is different, so don’t be alarmed until you’ve spoken to a doctor.

Treating Menopause Symptoms

You may experience one or several symptoms, or hardly any symptoms at all. You may not notice perimenopausal symptoms until you’ve almost reached the menopause phase. Your entire transition could finish in just a few years, or could last longer than a decade.

Everyone is unique, and there is no concrete answer. It takes seeing a primary doctor to evaluate your symptoms, locate where you are on the general timeline, and estimate how much longer you will have to put up with symptoms.

While you are combating symptoms for an unknown period of time, look into common forms of relief. If you have medical conditions exacerbating the symptoms of menopause, such as arthritis, chronic pain, anxiety or depression, your doctor can help address these issues to potentially reduce menopause symptoms.

Menopause is a normal part of life, and several tried-and-true treatment options exist to help control and tolerate common symptoms. You can maintain your desired lifestyle while experiencing menopause with a tailored treatment plan. We have expert women’s health services, if you are seeking a gynecologist in Phoenix. Talk to us about your symptoms and concerns, especially if your perimenopausal symptoms negatively affect your quality of life. We’re here to help.

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Kelly Roy is a specialist in surgical gynecology and advanced laparoscopy (and hysteroscopy). She is a long-time resident of Arizona and obtained her Bachelor of Science degree in Biomedical Engineering at Arizona State University before finishing her Doctorate of Medicine at the University of Arizona in 1997.

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Well known for her teaching and surgical ability, she is on the faculty at the residency program at both Banner University Medical Center and Saint Joseph’s Hospital in central Phoenix and is a Clinical Assistant Professor of Medicine at the University of Arizona College of Medicine, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

Read More About Dr. Kelly Roy, MD   |   WebMD Profile   |   Health.USNews.com Profile

Menopause | Health Navigator NZ

Menopause simply means the end of a woman’s menstrual periods. It is a significant hormonal milestone that offers a good opportunity to assess your health and plan for the next phase of your life.


Key points

  1. Menopause is a normal part of life; you are said to have reached menopause after 12 months in a row of no further periods.
  2. The usual age is between 45 to 55 years. The average in NZ is 52 years. 
  3. About 70% of women have significant symptoms with menopause and 40% will see a doctor because of their symptoms.
  4. Symptoms vary hugely in severity with some women having very little discomfort, while others are affected to the extent of being unable to carry out their normal everyday activities.
  5. In the long term, after menopause you are more at risk of developing osteoporosis (thinning of bones) and heart disease, though lifestyle measures help to reduce this risk. 
  6. Discuss ongoing symptoms or particular concerns with your doctor.

What happens during menopause?

During menopause your body stops preparing every month for a baby: your ovaries stop releasing eggs, they make less and less of the female hormones oestrogen and progestogen, and eventually, your periods stop.

The reduction in female hormones can cause symptoms such as hot flushes, mood swings, night sweats, anxiety, palpitations, depression, decreased libido, sleep problems and vaginal dryness. 

Read our FAQs about menopause

Types and stages of menopause

There are three types of menopause:

  • Natural menopause, which happens between the ages of 40 and 55 (usually late 40s or early 50s).
  • Early or premature menopause, which happens before 40 years of age. This can be due to genetics, is more common in women who smoke, who have been ill or had surgery or drug treatments that affect the blood supply to their ovaries, however it can also occur for no obvious reason.
  • Artificial menopause, which occurs when the ovaries have been removed or after cancer treatment.

Menopause can be divided into two stages:

  • Perimenopause: during the year or years before your periods stop completely (perimenopause) your periods will change; they may get shorter, longer, lighter or heavier. They may be closer together, or further apart. This may go on for a year or more. Eventually, your periods will stop altogether.
  • Postmenopause: a woman is considered “postmenopausal” one year after her last menstrual period.

What are the signs of menopause?

For some women, a change in their periods is all they notice as they go through menopause. However, because the female hormones affect other parts of your body, you may also have any of the following symptoms:

  • Hot flushes; these feel like someone has poured hot water into your veins. They can start in your face and neck and spread all over your body or be a sudden feeling of heat all over. Many people feel embarrassed and think others will notice, but it’s usually not noticeable.
  • Sweats, which often go with flushes and are common at night.
  • Loss of libido (sex drive).
  • Dryness in your vagina and around your urethra can lead to uncomfortable sex, bladder infections or wetting your pants sometimes.
  • Sleep problems.
  • Palpitations – your pulse or heart may feel like they are racing, or you may feel faint or dizzy from time to time or get ringing in your ears.
  • Mood changes – you may feel tired, irritable, depressed, tearful or angry; this can be from hormonal changes, because you are not sleeping well or because you are adjusting to change.
  • Skin – your skin may look more tired and be less firm, and the hair on your head, armpits and legs may get thinner.
  • Bones – you won’t feel it, but your bones may start getting thinner (osteoporosis). Much later you may break them more easily or start to get shorter (loose some of your height) or find it hard to straighten up.

Note: if you have very heavy periods or bleeding between your periods you must contact your doctor.

Looking after yourself during menopause

Menopause is a normal part of life. Allow yourself time to adjust to what you are experiencing and try to get support from others, especially from your partner and family. If they understand what you are going through it will help them know how they can best support you.

Don’t forget about contraception!

  • If aged less than 50 years, the general advice is you still need contraception for two years after your final menstrual period (FMP).
  • If you are aged 50 years or more when you reach menopause, you need to continue to use contraception for at least one year after your final period.

Read more about self-care for menopause

Seeking medical advice for menopause

If you have ongoing symptoms which are not relieved by self-care measures, see your doctor for advice. 

You may be offered hormone replacement therapy (HRT), now called menopause hormonal therapy (MHT) to reduce the menopausal symptoms. While this has been less popular over the last ten years, it is still one of the best treatments for menopausal symptoms and is considered safe for most women less than 60 years old.

For vaginal dryness, you can be offered a topical oestrogen cream which works well and comes as pessaries or cream. If you are at risk of thinning bones (osteoporosis) you may be given calcium supplements or other treatments.

Menopause is a good time to have a general health examination, including checks for your blood pressure, having a cervical smear, breast examination, mammogram and possibly a bone density scan. You should also discuss ways to look after your health over the coming years with your doctor.

Read more about menopause treatment and management Jean Hailes Women’s Health.

Learn more

Menopause section Jean Hailes Women’s Health, Australia
Menopause NHS Choices UK, 2014
The Australasian Menopause Society provides a range of educational material and resources on midlife and menopause for the benefit of women.
Will menopause affect my sex life? Australian Menopause Society











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Credits: Health Navigator Editorial Team.




Self-care for menopause

Going through menopause can make you feel as if you’re not in control of your own body, but there are ways to ease the symptoms. If you have tried the self-care options below and are still not getting the relief you need, talk to your doctor for further advice and treatment options.

Ways to ease symptoms of menopause:

  • Relaxation and stress-relief techniques, e.g. meditation.
  • Using a lubricant to combat vaginal dryness, or your doctor may prescribe an oestrogen-based vaginal cream.
  • Exercising regularly and keeping fit. Weight-bearing exercises (e.g. walking) are good for your bones. Doing pelvic floor exercises can help improve any incontinence.
  • Keeping your weight down and eating a diet low in fat, sugar and salt but high in calcium and fibre will help protect your bones, joints and heart.
  • Researchers are looking at whether eating phytoestrogens (natural oestrogens contained in foods such as soy, beans, grains and some fruit and vegetables) can help menopause symptoms. We don’t know yet. However, these foods are healthy and low-fat, so are generally good choices.
  • Stopping smoking.
  • Getting more sleep.
  • Some women may find some alternative therapies such as acupuncture, massage, homoeopathy or herbal remedies help. (It is recommended that you discuss with your doctor before taking ‘natural’ or ‘herbal’ remedies as some of these can interact with other medicines you may be taking, or can have unwanted side effects).
  • Counselling may help if you have trouble with mood changes.

Reducing your risk of osteoporosis & heart disease

In the long term, you can lower your chance of getting osteoporosis and of developing heart disease by:

  • Having a healthy lifestyle (e.g. good diet, regular exercise, staying in healthy weight range, not smoking, consuming alcohol only in moderation).
  • If you have particular risk for developing these conditions, your doctor may recommend additional measures.
  • Be well informed. It will help you understand why you are feeling the way you do and to decide whether or not you need treatment.

What makes menopause worse?

  • Being stressed, overtired and anxious.
  • Too much coffee, tea or alcohol.
  • Smoking.
  • Hot drinks and spicy foods can make the hot flushes worse.

Learn more

Menopause self help NHS, UK

Frequently asked questions about menopause

How do I know I am beginning menopause?

When you go through menopause, your periods will change and eventually stop. You may have some or all of the symptoms mentioned on the overview page. 

Menopause is diagnosed based on your symptoms and changes in menstruation. You do not need to have a hormonal test to “prove” you are menopausal.

Do I need to see a doctor if I’m going through menopause?

Menopause is a normal process that does not always require medical intervention. However, you may wish to discuss your symptoms with your doctor – especially if they are affecting your quality of life.

Your doctor may recommend tests if there is concern that physical changes are a sign of illness, such as thyroid disorder or if spontaneous menopause occurs at an early age.

How long does menopause last?

The average duration of menopausal symptoms is 5 years although some women will have symptoms for longer.

Will menopause affect my quality of life?

Menopause affects women in different ways and symptoms vary hugely in severity. Some women have very little discomfort, while others find their symptoms interfere with them carrying out their normal daily activities. 

While some women have a sense of loss at going through menopause, many others feel they get a new lease on life. They enjoy having no periods and no more worries about pregnancy. Many feel more confident and that they have ‘come into their own’.

If you are concerned that your quality of life is being affected by your menopause symptoms, try the measures listed on the self care tab or see your doctor for further advice. 

Are my symptoms normal?

Menopause can make you feel like you are loosing control of your body. Understanding what symptoms to expect may help reassure you that what you are experiencing is normal.  

Read more about symptoms of menopause on the overview page. 


Information for healthcare providers on menopause

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Clinical resources

Diagnosing and managing primary ovarian insufficiency BPAC, NZ, 2019
The Australasian Menopause Society provides a range of educational material and resources on midlife and menopause for the benefit of health professionals.
Information for health professionals – including Cochrane reviews, education, information sheets, GP & HP resources – The Australasian Menopause Society, 2013
A useful toolkit to guide clinicians with managing menopausal symptoms is now available:
A Practitioner’s Handbook for the management of the menopause – Monash University, Australia, 2014.

Continuing professional development

Podcast

Menopause – Anna Fenton Goodfellow Podcast, 2019

Anna Fenton discusses the management of menopause. Anna is a gynaecological endocrinologist at Canterbury DHB where she is clinical lead for bone densitometry. She is a member of the pharmacology and therapeutic advisory committee for endocrinology and is past president of the Australasian Menopause Society.

Webinar

1. Premature ovarian insufficiency – Dr Megan Ogilvie (20 minutes)

(PHARMAC seminars, 2019) 

2. Menopause and menopausal hormone therapy – (parts 1 & 2) Drs Megan Ogilvie and Stella Milsom (25 minutes + 34 minutes = 59 minutes)

(Goodfellow Unit Webinar, 2018)

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: 

 

Early menopause at 46 was a surprise. Now I realize it was also a gift.

I spent a chunk of this year crunching the numbers, like some kind of gynecological accountant. It boiled down to this: If I got to the end of July with no period, I had probably reached menopause. If I got to the end of August, I definitely had.

A few weeks before my 46th birthday in September, I reached the 12-month milestone, which officially made me a menopausal woman.

Menopause feels like the world is giving me nutrients back. Like both my body and my soul have been thanked for their hard work and given emeritus status and a big budget to simply explore.

I don’t feel wistful about this. With preteen children, my brain has long moved past childbearing years. But it’s surprising that my body followed, wrapping it all up far sooner than I expected. The average age for menopause is about 52, so reaching menopause between the ages of 40 and 45 is considered early menopause (younger than 40 is called premature).

But when hot flashes found me last year, I had a feeling I was on a different course than most other women my age. My periods had been erratic since my early 40s. Other things were happening, too. My sex drive was often lackluster, my moods were more noticeable and something unsettling was happening around my midsection.

My doctor first confirmed it wasn’t a problem with my thyroid. Then she tested the levels of my follicle-stimulating hormone. While not a perfect indicator, the test suggested I was well on my way through the transition.

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To get through it, I made a few changes. To combat weight gain and potentially uneven moods, I cut out my daily glass of wine (it helped). I also found a renewed love for running — something I’d been doing for 25 years but came to see as extra important for dealing with stress and keeping my bones strong now that estrogen wouldn’t be around to safeguard them as much.

Hot flashes? I kept wet washcloths in the freezer and draped one around my neck when a flash came (dealing with them in the middle of the night still continues to suck). And as for romance … there was no magic fix on that one, but my husband and I worked to spend more quality time together and have more honest conversations (having published a book this year about the power of honesty, I’m generally a fan of it and how it can spark intimacy).

I found some or other life hack for every symptom. And while I wasn’t sad — I had made my peace with shutting fertility down when my husband got a vasectomy shortly after our second child was born — I struggled with the incongruity of it happening so soon to me.

According to WomensHealth.gov, “natural” early menopause (not due to a hysterectomy or other condition) affects about 5 percent of women. I would never have bet on myself to be in this 5 percent because I’ve always been a late bloomer. I didn’t start my period until the end of my first year in high school, when I was 14. I didn’t date until I was about 20, get married until I was 33, have kids until I was 34.

As a writer who specializes in writing about honesty, this experience offers a chance to speak with candor about a thing so many people don’t want to talk about.

I’ve mostly had a sense that I belong at the tail end. Not only did a September birthday mean I was usually the youngest person in my class, I’m also the youngest of seven children. My brothers and sisters were getting married and tending to teething babies when I was still losing baby teeth. My parents were older, my siblings were older and I was the young one — meandering along the scenic route, a little out of step, though not unhappy to do things on my own schedule.

So how did I wind up in the express lane? How did I go from being young with older parents to being older with young children? My 10-year-old and 12-year-old are on the cusp of puberty, with mood swings and changing voices. They’re starting the thing I’m finishing. The timing feels rushed.

All during my year of calendar-watching, menopause still felt implausible, and even as I was very happy not to have to deal with periods, I found myself whispering to my ovaries, “I think you have the wrong 5 percent.

But several unopened boxes of tampons later, I’ve realized I don’t have a problem being in the atypical 5 percent. Because the atypical 5 percent is actually my comfort zone.

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I wouldn’t know how to function outside of a big, generationally anomalous family, where I sometimes identify more with my nieces than my sisters. And I’ve loved defying expectations and going my own way — whether it’s not changing my last name, working for myself or reversing traditional gender roles when my husband became a stay-at-home dad a dozen years ago. All told, the experience of zigging where others zag has been tremendous. I’ve found my greatest joys by skirting away from the expected.

That’s why I’m now thinking early menopause may be my greatest opportunity yet.

First, as a writer who specializes in writing about honesty, this experience offers a chance to speak with candor about a thing so many people don’t want to talk about. If the prevailing wisdom is, “Shhh, don’t talk about hot flashes,” you can bet I’m going to tell everyone about them. I believe we should talk openly about the things that happen with our bodies to combat shame, embarrassment and just plain disinformation.

Dealing with menopause right now also puts me squarely in my body at a time of pandemic threat, where taking care of your health is more important than ever. No symptom is going to escape my watch, and I’ll do what I can to keep myself and loved ones safe but active.

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The third thing is the most exciting though, and it came to me via an interview I got to do earlier this year with Lauren Hutton.

Hutton has continued to model into her 70s and has pushed for more media representation of vibrant older women. “If my life could stand for one thing, it would be to get women to change the way they feel about getting older,” she told me, noting the strength and wisdom that comes only with age. Something else she said stuck with me: “Women were evolved to think long-term care and taking care of the future.”

I’m not sure I fully understood it then, but I understand it now. So much of my life has felt like a series of short-term challenges, a to-do list of milestones and a great deal of maneuvering as a Gen X girl inside a giant sandwich of both caregiving, where I tend simultaneously to young children and aging parents, and generations, my own flattened between the might and size of the baby boomers and the millennials.

For me, the menopause milestone is the feeling of being lifted out of that sandwich and finally having a clear view to the question: What do I want this next part of my life to be? Something in me feels freed up to focus on generativity — or doing things to uplift the next generation.

Unlike the experience of breastfeeding, where the nutrients are literally being sucked right out of you to sustain someone else, menopause feels like the world is giving me nutrients back. Like both my body and my soul have been thanked for their hard work and given emeritus status and a big budget to simply explore.

The menopause milestone is the feeling of being lifted out of that sandwich, and finally having a clear view to the question: What do I want this next part of my life to be?

That’s meant small things, like building a Little Free Library for neighbors to contribute and borrow books; medium things, like joining a neighborhood group to have difficult conversations about race and then mobilize to create equity; and bigger things, like not being afraid to speak out anymore — whether calling out injustice or challenging the unchecked things people I work and socialize with say.

During a tumultuous year in which I’ve reckoned with both my mortality when hearing about so many people dying from the coronavirus and my white privilege when hearing about the far-reaching effects of systemic racism, I seem to have the emotional bandwidth to look beyond where I’ve been able to before. Being able to tap into this next phase of my life earlier than most feels like an unexpected and amazing gift.

So thanks, ovaries, for the express ride. I’ve got it from here.

Menopause – HealthyWomen

Overview

The change of life. The end of fertility. The beginning of freedom. Whatever people call it, menopause is a unique and personal experience for every woman. It’s a natural event that marks the end of fertility and childbearing years. Technically, menopause results when the ovaries no longer release eggs and decrease production of the sex hormones estrogen, progesterone and, to a lesser extent, androgen. Menopause is said to have occurred when a woman has not had a period for 12 months.

Menopause & the Reproductive Cycle

Reproduction
During the reproductive years, a gland in the brain generates hormones that cause an egg from the ovaries to be released from its follicle each month. As the follicle develops, it produces the sex hormones estrogen and, after ovulation, progesterone, which results in a thickened uterine lining. This enriched lining is prepared to receive and nourish a fertilized egg, which could develop into a fetus. If fertilization does not occur, estrogen and progesterone levels drop, the lining of the uterus breaks down and menstruation occurs.

Perimenopause
For reasons unknown, your ovaries gradually begin to function less efficiently during your mid-to-late 30s. In your late 40s, the process accelerates along with greater hormone fluctuations. This affects ovulation and levels of the hormones estrogen and progesterone. During this transition period, called perimenopause, you may experience irregular menstrual cycles and unpredictable episodes of menstrual bleeding. By your early to mid-50s, your periods will likely end.

Most women can tell if they are approaching menopause because their menstrual periods start changing. The “menopause transition” is a term used to describe this time, as is perimenopause.

Menopause
But menopause itself—as defined by health care professionals—is a woman’s final menstrual period, which can be confirmed after she goes 12 consecutive months with no period, and no other biological or physiological cause can be identified; it also may occur when both ovaries are surgically removed or damaged. Until that time, a woman in her late 40s or 50s may still be able to get pregnant, despite irregular periods.

Medical Intervention
Although the majority of women experience “natural” or spontaneous menopause, some women may experience menopause due to a medical intervention. Surgically removing both ovaries, a procedure known as bilateral oophorectomy, triggers menopause at any age. Induced menopause can also occur if the ovaries are damaged by radiation, chemotherapy or certain drugs. Some medical conditions also may cause menopause to occur earlier.

Naturally Occurring
Just as every woman’s body is unique, each woman’s menopause experience will be highly personal. In fact, some women experience no physical symptoms at all, except the end of their menstrual periods.

Early Menopause
Although the average age for menopause in the United States is 51, menopause can occur as early as your 30s and, rarely, as late as your 60s. However, there is no correlation between the time of a woman’s first period and her age at menopause. In addition, age at menopause is not influenced by race, height, the number of children a woman has had or whether she took oral contraceptives for birth control.

Early menopause is defined as occurring at any age younger than 45. Menopause that occurs in women younger than 40 is called premature menopause or premature ovarian failure and can occur naturally. But symptoms of premature menopause, such as irregular periods, may signal an underlying condition, so it is important to discuss any symptoms with your health care professional.

What influences the time of menopause? Genetics are a key factor. The age at which your mother stopped her periods may be similar to when you stop your menstrual periods. And women who smoke cigarettes experience menopause two years earlier, on average, than nonsmoking women.

Symptoms of Menopause

About four to eight years prior to natural menopause, typically in a woman’s late 40s, menopause-related changes may begin. One of the most common and annoying symptoms you may notice during your 40s is that your periods become irregular. They may be heavy one month and very light the next. They may get shorter or last longer. You may even begin to skip your period every few months or lose track of when your periods should start and end. These symptoms are caused by irregular estrogen and progesterone levels.

Levels of hormones vary erratically and may be higher or lower than normal during any cycle. For example, if you don’t ovulate one month—which is common for women in their late 40s—progesterone isn’t produced to stimulate menstruation, and estrogen levels continue to rise. This can cause spotting throughout your cycle or heavy bleeding when menstruation does start.

One note of caution: although irregular menstrual periods are common as you get closer to menopause, they can also be a symptom of uterine abnormalities or uterine cancer. See your health care professional as soon as possible if your periods stop for several months and then start again with spotting or heavy bleeding; if you have irregular spotting; if you have bleeding after intercourse; or if you start bleeding after menopause.

Be sure to mention any menstrual irregularities during regular checkups. Uterine biopsy and vaginal ultrasound and, occasionally, transabdominal ultrasound may be used to evaluate these symptoms and determine whether they are caused by abnormalities in the uterus. Irregular spotting can also be a symptom of cervical cancer, which may be picked up by a Pap or HPV test (see screening recommendations in Treatment section).

Other changes and signs of menopause include:

  • Hot flashes (sudden warm feeling, sometimes with blushing)
  • Night sweats (hot flashes that occur at night, often disrupting sleep)
  • Fatigue (probably from disrupted sleep patterns)
  • Mood swings
  • Vaginal dryness
  • Fluctuations in sexual desire or response
  • Difficulty sleeping
  • Achiness
  • Bladder issues like urinary tract infections or incontinence
  • Headaches

Menopause-Related Health Conditions
Although there is a wide range of possible menopause-related conditions, most women experiencing natural menopause only have mild disturbances during the perimenopausal years. However, you should be aware that there are at least two major health conditions that can develop in the post-menopausal years: coronary artery disease and osteoporosis.

Your body’s estrogen helps protect against plaque buildup in your arteries. It does this by helping to raise HDL cholesterol (good cholesterol), which helps remove LDL cholesterol (the type that contributes to the accumulation of fat deposits called plaque along artery walls). It also helps blood vessels dilate to promote better blood flow. As you age, your risk for developing coronary artery disease (CAD)—a condition in which the veins and arteries that take blood to the heart become narrowed or blocked by plaque—increases steadily. Heart attack and stroke are caused by atherosclerotic disease, in most cases.

Your body’s own estrogen helps prevent bone loss and works with calcium and other hormones and minerals to build bones. Your body constantly builds and remodels bone through a process called resorption and deposition. Up until around age 30, the body makes more new bone than it breaks down. But once estrogen levels start to decline, this process slows down.

By menopause, your body breaks down more bone than it rebuilds. In the years immediately after menopause, some women may lose as much as 20 percent of their bone mass in the first five to seven years following menopause. Although loss of bone density eventually levels out, in the years ahead, keeping bone structures strong and healthy to prevent osteoporosis becomes more of a challenge. Osteoporosis occurs when bones become too weak and brittle to support normal activities.

Not all women develop heart disease or osteoporosis. Many more things affect your heart and your bones than estrogen alone. For example, exercise improves your cardiovascular system—your heart, lungs and blood vessels—at any age. It can help decrease high blood pressure, a concern for half of women over age 60, and can help maintain bone mass. It can also help reduce weight gain, a major risk factor for heart disease, diabetes and many other health conditions common to older women.

You are never too old to begin or continue exercising. A simple walking routine for 30 minutes four to five days a week can provide health benefits. There are other exercise options. Talk to your health care professional about which ones fit your lifestyle and medical needs.

If your bones are strong and healthy as you enter menopause, you’ll have better bone structure to sustain you as you age. Bone loss varies from woman to woman. You can improve bone strength as you age by exercising regularly and making sure you get enough calcium in your diet or from supplements. Exercise also helps improve balance, muscle tone and flexibility, which can diminish with aging. Weakness in these areas can lead to more frequent falls, broken bones and longer healing periods.

Women today can expect to live as much as one-third of their lives beyond menopause. The years following menopause can be healthy years, depending on how you take care of yourself.

Diagnosis

Menopause is diagnosed when a woman who has a uterus has not had a menstrual period for one year.

Some of the more common signs of the menopause transition (a term that refers to the five or more years around the time of menopause) that may prompt a woman to seek consultation with a qualified health care professional include:

  • Hot flashes
  • Vaginal dryness
  • Urinary tract infections or painful urination
  • Stress incontinence (leaking of urine)
  • Night sweats
  • Insomnia
  • Headaches
  • Heart palpitations
  • Forgetfulness
  • Mood changes
  • Anxiety and irritability
  • Diminished concentration
  • Decreased sexual desire

Ask your health care professional about any changes you notice. And remember, menopause is not a disease; it is another life stage. (The changes listed above have not all been scientifically proven to be related to menopause.)

As part of the evaluation of symptoms that may be caused by menopause, your health care professional will carefully assess your symptoms and administer a thorough physical examination. You will also be asked to provide a complete medical history; be sure to include information about your family medical history.

Laboratory tests may include baseline serum chemistry studies, lipid evaluation and hormonal evaluation. Other tests may include:

  • Pap test
  • Mammography
  • Bone density screening
  • Assessment of the uterine lining, when indicated
  • Pelvic ultrasound screening, when indicated

Menopause is associated with consistently increased follicle stimulating hormone (FSH) levels. In perimenopausal women, elevated FSH levels are sometimes detected; however, this FSH elevation is often intermittent (and therefore unreliable), so the ultimate determining factor in knowing whether you have experienced menopause is if you have not had a period for 12 consecutive months.

Treatment

Menopause Management

Many women pay close attention to their gynecological health during their younger years and start to ignore it after menopause. Your wellness plan after menopause should include, at minimum, annual visits to a health care professional. These visits should include:

Discuss any unusual or uncomfortable symptoms with your health care professional. Keep track of medications that you take and ask your health care professional or pharmacist about potential drug interactions, if you are told to take a new medication. Be sure to discuss with your health care professional any alternative medical treatments or herbal products you use or may wish to use.

The Menopause Transition

As your body transitions into menopause (a process that typically lasts about four to eight years) you may notice some physical and emotional changes. The most common include:

  • Irregular menstrual periods
  • Hot flashes
  • Vaginal dryness
  • Urinary tract infections
  • Stress incontinence
  • Night sweats
  • Insomnia
  • Headaches
  • Heart palpitations
  • Forgetfulness
  • Mood changes
  • Anxiety and irritability
  • Diminished concentration

There are a variety of options available to relieve these symptoms, if you find they interfere with your lifestyle. Discuss your symptoms and your concerns with your health care professional to determine which options make the most sense for you.

The following tips may be recommended to relieve the most common menopausal symptoms:

Hot flashes. Although no one knows for sure what causes hot flashes, they’re believed to be the result of a narrowing of the temperature range that normally tells the brain to adjust your internal temperature. The pituitary gland in your brain increases the amount of follicle stimulating hormone (FSH) and luteinizing hormone (LH) aimed at the ovaries. Falling estrogen levels and the increase in FSH and LH levels disturb your body’s internal temperature. This creates instability in your vasomotor balance and results in a hot flash.

About 75 of every 100 women approaching or going through menopause have hot flashes, which usually last for about three to five years. Hot flashes may get more intense and more frequent around your last menstrual period and then taper off, usually stopping after one to five years. About 10 percent to 15 percent of women will have significant hot flashes that persist more than 10 years after the last menstrual period, although they do tend to get better over time. Some women continue to have hot flashes past age 70.

During a hot flash, you may experience a sudden sensation of heat in your face, neck and chest. You may sweat profusely and your pulse may become more rapid. Some women get dizzy or nauseous. A hot flash typically lasts about two to four minutes—which can seem like an eternity. For some women hot flashes are intolerable, occurring at inconvenient moments or at night, disrupting sleep.

There are a variety of strategies for coping with hot flashes. Hormone therapy (estrogen alone or estrogen plus progesterone) may be prescribed at an appropriate dose for an appropriate time. There are other medical options, as well as herbal remedies, but lifestyle strategies may be the easiest and quickest changes to try first:

  • Dress in layers that may be removed if you find you’re getting too warm.
  • Sleep in a cool room.
  • Drink plenty of water.
  • Avoid hot foods such as soups, spicy foods, caffeinated foods and beverages and alcohol, which can trigger hot flashes.
  • Try to decrease stress.
  • Exercise regularly.
  • Breathe deeply and slowly, if you feel a hot flash starting; rhythmic breathing may help to “turn down” the heat of a hot flash or prevent it from starting altogether.
  • Use a hand-held fan.

Insomnia. Sleep is often a casualty of menopause, whether it is interrupted by hot flashes (called night sweats when they occur at night) or difficulty falling or staying asleep. Hormonal ups and downs are partly responsible. Plus, as you age, your sleep patterns may change. Older people may sleep less, awaken earlier and go to sleep sooner or later than they did at younger ages.

Lifestyle changes for coping with insomnia include:

  • Sleep in a cool room to help relieve hot flashes that may be disturbing your sleep. In hot weather, you may want to lower your bedroom thermostat at night and use a small fan to keep air circulating. If you sleep in night clothes, keep a clean, dry change at bedside, so you can change quickly and get back to sleep. If you share your bed with a partner, consider using an electric blanket with dual controls.
  • Exercise regularly.
  • Set and keep a regular routine and hour for going to sleep.
  • Drink a glass of warm milk right before bedtime but avoid other foods.
  • Avoid alcoholic beverages or smoking before sleep.
  • Avoid watching TV in bed (some programs are anything but relaxing!).
  • Practice relaxation techniques like deep breathing.
  • Review any medications you are taking to see if they may cause sleeplessness.

Mood swings. For reasons still not well understood, declining and fluctuating estrogen levels during the menopausal transition can cause emotional highs and lows and irritability. Lack of sleep due to night sweats may also contribute to feeling irritable and depressed. Though your periods are coming to an end, you may continue to experience the symptoms of premenstrual syndrome (PMS). In fact, emotional symptoms may worsen for some women as they approach menopause. You may also notice that you’ve lost interest in sex. Declining estrogen and changes in estrogen/testosterone ratios in women at this time may lower your sex drive.

Lifestyle strategies for coping with mood swings and sexuality concerns include:

  • Make physical activity part of your schedule; exercise can improve mood and make you feel better about yourself.
  • Try relaxation techniques such as meditation or massage, which can be calming and reduce irritability.
  • Discuss your symptoms and what may be causing them with your partner; try different approaches to intimacy.

Vaginal dryness and frequent urinary tract infections. Estrogen, a natural hormone produced by the body, helps keep the vagina lubricated and supple. Following menopause, as estrogen levels decline, the vagina becomes drier and the vaginal wall thins. Sex may become painful. The wall of the urethra becomes thinner, too, as estrogen levels fall, and increases the risk of more frequent urinary tract infections. Urine leakage may become a problem as muscle support for the bladder and urethra weakens. (This may also occur from strain on tissues as a result of childbirth). Vaginal dryness and bladder symptoms can get worse over time.

Strategies for coping with vaginal dryness and frequent urinary infections include:

  • Use nonhormonal vaginal creams or gels (prescription or nonprescription).
  • If moisturizers and lubricants are not enough, vaginal estrogen (a prescription medication) is available as creams, rings or tablets. You can also try prasterone, a prescription form of the hormone dehydroepiandrosterone (known as DHEA) or an oral nonhormonal medication (ospemifene) that helps with painful sex.
  • Drink plenty of water to help your body stay hydrated.
  • Use long-lasting vaginal moisturizers.
  • Exercising to maintain muscle tone.

    Practice Kegel techniques to strengthen the pelvic floor muscles that support the bladder and urethra. Kegel exercises help firm the vaginal canal, control urine flow and enhance orgasm. To make sure you know how to contract your pelvic floor muscles correctly, try to stop the flow of urine while you’re going to the bathroom. If you can do this, you’ve found the right muscles. (You can ask your health care professional to check your Kegel tone at your next gynecological visit.)

    To do Kegel exercises, empty your bladder and sit or lie down. Contract your pelvic floor muscles for three seconds, then relax for three seconds. Repeat 10 times. Once you’ve perfected the three-second contractions, try doing the exercise for four seconds at a time and then resting for four seconds, repeating 10 times. Gradually work up to keeping your pelvic floor muscles contracted for 10 seconds at a time, relaxing for 10 seconds in between. Aim to complete a set of 10 exercises, three times a day.

  • Tell your health care professional about any medications you’re taking. Some may worsen vaginal dryness. Also, if you have a urinary tract infection, you may need antibiotics.

Heart palpitations. Some women in their late 40s are frightened by their hearts beating fast in their chests for no apparent reason. This symptom, called a heart palpitation, is caused by the heart beating irregularly or missing one or two beats. Though this symptom can be associated with several types of serious heart-related conditions, it is also common during the transition to menopause and typically is not related to heart disease. For example, a woman’s heart rate can increase seven to 15 beats during a hot flash.

If you think you are experiencing heart palpitations:

  • See your health care professional immediately if you have shortness of breath; pounding or irregular heartbeat; dizziness; nausea; pain in the neck, jaw, arm or chest that comes and goes; or tightness in the chest. Any could be a sign of a serious heart condition.
  • Ask your health care professional to rule out conditions that may cause heart palpitations, such as thyroid disorders.
  • Ask your health care professional about appropriate options for relieving heart palpitations, such as decreasing caffeine, and whether any medications are needed.

Forgetfulness or difficulty concentrating. During and after the menopause transition, many women are troubled to find they have difficulty remembering things, experience mental blocks or have trouble concentrating. Not getting enough sleep or having sleep disrupted can contribute to memory and concentration problems. Stress associated with major life changes—such as caring for aging parents or having your children leave home—can also interfere with sleep. However, the latest research shows memory declines during menopause are likely independent processes resulting in part from hormonal fluctuations rather than from stress or sleep deprivation. In fact, research shows memory loss during menopause is real and differs from the type of memory loss that results from aging in general.

Although the memory changes some women experience during the menopausal transition may be due in part to hormonal changes, it’s not recommended that women take HT to prevent memory decline, however.

Other strategies for coping with memory problems and lack of concentration include:

  • Recognize that these symptoms may be caused by menopausal changes and aging and don’t put pressure on yourself.
  • Rely on strategies for remembering things, such as developing daily reminder lists or messages to help get you through periods of forgetfulness.
  • Practice stress-reduction techniques, such as deep breathing exercises, yoga and meditation, and try to be physically active on a regular basis.

If you find the strategies you’ve tried don’t relieve your discomfort, ask your health care professional about medical options. Medical strategies to relieve various menopausal symptoms include:

Oral contraceptives. Oral contraceptives can help ease symptoms associated with menopause, including irregular periods and mood swings, among others. Typically, oral contraceptives are recommended to women who are still having periods. For many women in their 40s, oral contraceptives provide the added benefit of preventing pregnancy. Still, taking oral contraceptives close to menopause can make it difficult to determine when you have stopped menstruating. Women who smoke, have high blood pressure, experience migraines associated with aura or have diabetes, a history of gall bladder disease or blood clotting disorders should not use oral contraceptives. Discuss your health history with your health care professional and ask for guidance on this treatment option.

If you’re considering taking hormones other than oral contraceptives to manage menopausal symptoms, be aware that the doses of estrogen and progesterone typically taken to manage menopausal symptoms are not adequate to provide protection against an unwanted pregnancy. A woman who is still fertile must use contraceptives containing higher levels of hormones or use additional birth control methods in addition to hormone replacement.

Antidepressant medication. One antidepressant medication, paroxetine 7.5 mg (Brisdelle), is approved for treating hot flashes. This is a low-dose version of the antidepressant Paxil. Other antidepressants, such as venlafaxine (Effexor) and fluoxetine (Prozac) may offer some relief from hot flashes but are not FDA-approved for treatment of hot flashes.

Cardiovascular medication. Low doses of the blood pressure drug clonidine (Catapres) or the anti-seizure medication gabapentin (Neurontin) may also help ease hot flashes in some women. These drugs are not FDA-approved for hot flashes, however, and unpleasant side effects are common.

Menopausal Hormone Therapy

Estrogen therapy came on the market more than 75 years ago, and many women viewed it as the “fountain of youth.” Once prescribed as the first choice for the long-term prevention of osteoporosis and heart disease, as well as for short-term relief of menopausal symptoms such as hot flashes, hormone therapy is now only prescribed for the management of menopausal symptoms in women without certain risk factors, such as a history of breast cancer, coronary artery disease and a previous blood clot or stroke.

Hormone therapy comes in several forms: estrogen can be given alone or combined with progesterone or with a synthetic progestin. When combined with progestin, it is called hormone therapy (HT). It is given only to women who still have their uterus because progesterone reduces the risk of uterine cancer that comes with supplemental estrogen.

When given as estrogen alone, hormone therapy is called estrogen therapy (ET). It is typically given to women who no longer have a uterus.

Postmenopausal hormone therapy comes in a variety of forms: pills, creams, skin patches, vaginal rings and injections.

Some hormones are called “bioidentical,” meaning they are chemically, i.e., molecularly, identical to the substance as it occurs in your body. These hormones, however, don’t come from your body (or another woman’s body). Most bioidentical estrogens and progesterone come from soy (estrogen) or yams (progesterone).

They are also not “natural,” or in their natural state, when you take them. To create a hormone women can use, the plant or animal-based hormones are synthesized, or processed, through a several-step process in a laboratory.

There are two main types of bioidentical hormones: those that are approved by the U. S. Food and Drug Administration (FDA) and commercially available with a prescription, such as Estrace, Climara, Vivelle, EstroGel, Divigel and Estrasorb, and those that are produced on an individual basis for women, in compounding pharmacies. The North American Menopause Society does not recommend compounded hormone products.

A synthetic hormone is a mass-produced molecular compound created in the laboratory that act as estrogens but are not exactly the same. Prempro, for instance, is a combination of two synthetic hormones.

All hormones—synthetic and bioidentical—are made in the laboratory and work in the same way: by binding in a kind of lock-and-key process to special proteins on cell surfaces called receptors. Once a hormone locks onto these receptors, the messages from that hormone can be transferred to the cell.

Before deciding on any type of hormone therapy, a woman should discuss her personal health history with her health care professional, because studies, opinions and recommendations regarding HT have varied throughout the years.

In the 1970s, a study found that women who had a uterus and took estrogen therapy had an increased risk of developing cancer of the lining of the uterus. However, it was noted that the addition of progesterone or a synthetic progestin lowered the risk to that of women not taking estrogen.

In the 1980s and 1990s some studies appeared demonstrating that women who took estrogen therapy after menopause had reduced risks of heart disease and osteoporosis. However, the National Institutes of Health (NIH) suggested that a randomized, double- blind study be done to see whether estrogen really helped to prevent heart disease.

This NIH study, known as the Women’s Health Initiative (WHI), looked at two groups of women: women who had had a hysterectomy were given estrogen only (or a placebo) and women who went through natural menopause and had not had a hysterectomy were given estrogen and a synthetic progestin or a placebo.

The study was stopped early, in 2002, because, after about five years, women in the estrogen and progestin group had a very slight increase in cases of breast cancer, and no decrease in heart disease was noted. The estrogen-only study continued for about two more years. In that group, the data showed a statistically insignificant decrease in breast cancer and no decrease in heart disease.

Many women panicked when they heard about the increased risk in breast cancer. And many questions arose about the heart disease issue.

The WHI study was later found to be flawed for several reasons. Most notably, it looked at women starting hormone therapy between the ages of 50 and 79, with the average participant being 63 years old when starting therapy. Additionally, the increased risk of being diagnosed with breast cancer was seen only after five-plus years of therapy. Also, only one dosage of estrogen and progestin was used for the study. And the absolute risk noted was very small: eight women per 10,000 per year.

A number of additional studies looked at the relationship between hormone therapy and heart disease. Most indicate that hormone therapy must be started reasonably close to the time of menopause to have any heart benefits. If a woman goes through menopause very early—significantly before age 50—her risk of developing heart disease is quite high if she does not take hormone therapy. However, in a woman who undergoes a standard menopause, hormone therapy should not be initiated solely to prevent heart disease.

Much research also has been done regarding breast cancer and hormone therapy.

In Europe, studies show that micronized progesterone, not the synthetic variety, is not associated with any significant increased risk of breast cancer. More studies are ongoing. And there is now a new medication being used to protect the lining of the uterus during estrogen therapy, instead of using progesterone or progestins. This medication, bazedoxifene, is combined with estrogen in a drug called Duavee. Bazedoxifene is a cousin of tamoxifen, the medication used to treat breast cancer. No increased risk of breast cancer has been noted with its use, but studies are continuing.

Another concern about oral estrogen therapy is the slight increased risk of blood clots, as well as strokes. Europe studies show that transdermal estrogens, administered through patches or gels, do not increase the risk of blood clots. Some small studies show no increased risk of strokes with low-dose transdermal estrogens.

An 18-year follow-up of the WHI study shows no increased mortality from any diseases in the estrogen and progestin users, which is reassuring.

Also important: All studies on estrogen therapy show protection from osteoporosis.

So, what’s a woman to do?

The North American Menopause Society issued new guidelines on hormone therapy in 2017. It says that hormone therapy is quite safe and helpful in reducing symptoms of menopause such as hot flashes and vaginal dryness, particularly for women under the age of 60 and within 10 years of menopause. Hormone therapy is typically initiated to treat menopause symptoms early in the menopause transition when a woman is most symptomatic.

NAMS says the advantages outweigh the risks for women who are symptomatic. The organization notes that estrogen therapy has been shown to prevent bone loss and fracture.

While it’s true that menopausal symptoms do decrease within the first five years of menopause for most women, some women deal with persistent symptoms. These women may continue with hormone therapy. NAMS recommends women use the “appropriate dose for the appropriate duration,” to be evaluated by each woman and her health care professional.

The FDA advises health care professionals to prescribe postmenopausal hormone therapies at the lowest possible dose and for the shortest possible length of time to achieve treatment goals.

For women who aren’t confident that their health care professionals have expertise in dealing with menopausal issues, visit the website of the North American Menopause Society to help locate a North American Menopause Society Certified Menopause Practitioner.

Alternatives to Hormone Therapy

For heart protection. Lifestyle strategies for cardiovascular health include exercise, not smoking, maintaining a healthy weight and limiting salt and alcohol. A balanced diet rich in vegetables, fruits and fish, and low in saturated fat can also provide some heart-health benefits.

Your health care professional may prescribe medication to reduce cholesterol and blood pressure levels and reduce your risk of heart disease.

For reduced sex drive. Testosterone is a hormone that plays an important role in women’s bodies. Often thought of incorrectly as exclusively a male sex hormone, testosterone is secreted by the ovaries and adrenal gland and is natural to the female body. Surgical menopause (removal of the ovaries) may have a negative effect on sex drive, and testosterone therapy is sometimes prescribed to help.

Testosterone is not FDA approved for the treatment of low libido, however, and we don’t know what doses are appropriate for women. Too much testosterone may not help with sexual desire but may, instead, make you feel agitated, overly aggressive and/or depressed. Higher doses can cause masculinizing side effects that may not go away after stopping therapy, such as facial and body hair growth, acne, an enlarged clitoris, a lowered voice and muscle weight gain.

Testosterone may also be associated with adverse heart-related conditions, such as increased risk for atherosclerosis. There are currently no FDA-approved testosterone-alone preparations for women, although it is often prescribed “off-label” for women. There’s a specific prescription combination estrogen (esterified estrogens) and testosterone (oral methyltestosterone) pill called Syntest DS that may help combat testosterone deficiency. Do not use Syntest if you have liver disease; a recent history of heart attack, stroke or circulation problems; a hormone-related cancer such as breast or uterine cancer; abnormal vaginal bleeding; or if you are pregnant or breast-feeding. It also increases your risk of endometrial hyperplasia, which may lead to cancer of the uterus.

Since the safety of taking testosterone for extended periods has not been established, women should be very cautious when considering this type of hormone treatment. Discuss the risks and benefits with your health care professional.

Osteoporosis. Lifestyle changes shown to improve bone density in young women and prevent fractures in older women include dietary calcium and avoiding smoking and excessive alcohol consumption. Weight-bearing exercise is quite helpful, if approved by your health care provider.

Additionally, several prescription drugs are available to treat and/or prevent osteoporosis.

Herbal Remedies

Some women report that vitamin and herbal supplements are helpful in managing menopausal symptoms. For instance, phytoestrogens—naturally occurring compounds in certain plants, herbs and seeds—are similar in chemical structure to estrogen and produce estrogen-like effects.

Soy products (tofu, tempeh, soy milk, soy burgers and roasted soy nuts), certain herbs (red clover) and legumes (chickpeas, lentils and various kinds of beans) contain specific types of phytoestrogens called isoflavones. These are healthy foods that are excellent sources of protein and calcium and can be added to your diet.

Some studies show that the isoflavones (weak, plant-derived estrogens) in soy foods and dietary supplements can reduce mild hot flashes. But most studies show they are no more effective than a placebo. Talk to your health care professional before taking any form of isoflavones. Some oncologists have expressed concern about breast cancer survivors using soy products. If you have breast cancer (or have had it), talk with your oncologist before trying soy and soy isoflavones.

Black cohosh has been widely used in Europe for the treatment of hot flashes, and it has become more popular among U.S. women who want something to curb their hot flashes. The supplement’s safety record is good, but there is limited research supporting its effectiveness in treating menopausal symptoms. Talk to your doctor about black cohosh before taking any form of the supplement.

There is also no scientific evidence to support the effectiveness of evening primrose oil, ginseng, kava, licorice, sage and dong quai root. Discuss any herbal or vitamin supplements you are considering taking with your health care professional. Bear in mind that studies related to their effectiveness are sparse, and the FDA doesn’t oversee the production of supplements and does not require manufacturers to prove their products are safe. Also be aware that high doses of certain vitamins and herbal supplements can be dangerous. For example ephedra used in some weight-loss products has potentially serious side effects. Mixing herbal supplements with some prescription drugs can also be dangerous. So again, be sure to tell your health care professional everything you take.

Age of Natural Menopause Among Jordanian Women and Factors Related to

Introduction

Menopause is a natural chapter of the womanhood story. It is considered as a midlife breakthrough reality that is hallmarked by reproductive disability. The median age of natural menopause (ANM) varies according to an ethnic group, genetic, demographic, socioeconomic, dietary, reproductive, and behavior.1–3 The international range of ANM being 44.6–55 years,4 is quite variable worldwide. For instance, it has been reported that the ANM in Europe is 54, 51.4 in North America, and 48.6 in Latin America, and 51.1 in Asia.5 This milestone’s timing during women’s health trajectory is considered critical since it indicates aging is associated with adverse health and psychological effects. Thus, intensive research on women’s health wellness regarding early or late ANM aims to reduce the risks of chronic diseases that will reflect public health and global society.

It is recognized that women at ANM are more vulnerable to cardiovascular diseases,5–7 osteoporosis,8 urogenital inconsistency, estrogen-responsive malignancy,9,10 diabetes, vasomotor symptoms,11 cognitive problems,12 and possibly Alzheimer’s disease.13,14 Among those, the most critical causes of increased morbidity and mortality are higher risks of myocardial infarction and hypertension.6 Early menopause has been reported to be associated with a higher risk of cardiovascular disease all-cause mortality,7 and osteoporosis,8 while late menopause has been associated with an increased risk of breast cancer,9 endometrial,10 and ovarian cancer.15 Hence, identifying the link factors of menopausal age among postmenopausal women, especially those that are amendable, may help prevent morbidity and mortality.

Before ANM occurs, hormone estradiol becomes insufficient. The latter is primarily due to follicle aging leading to ovarian failure or secondary due to granulosa cell apoptosis,16–18 or epigenetic factors.19 Studies have shown that many other factors affect the ANM, such as the mother’s age at menopause, the age at menarche, reproductive life span, use of oral contraceptives, irregular menstrual cycle.20 Those factors may contribute alone or in combination to determine the timing of ANM. However, recent data have suggested that more than half of the underlying factors may be non-genetic sources.21 Data with respect to smoking, body mass index (BMI),22 the number of pregnancies proved to be linked to the timing of ANM.23 Those behavioral factors have been reported to accelerate the ANM,17 knowing that, globally, the ANM has been increased across populations.24

Cessation of menstruation before the age of 40 has been defined as premature menopause in clinical practice.25 In comparison, cessation of menstruation before the age of 45 years is defined as early menopause. However, the stage before menopause is referred to as the perimenopausal stage, characterized by irregular menses within the last 12 months or the absence of menstrual bleeding for more than 3 months but less than 12 months. Symptoms related to menopause transition are quite variable, and several symptoms variations are also reported among different nations. Menopausal transitional symptoms may affect the quality of life with markers of vasomotor symptoms, vaginal dryness, sleep problems, mood changes, and vaginal dryness.26 The study of Women’s Health Across the Nation (SWAN) has analyzed signs and symptoms of multi-ethnic, multi-race, multi-site study of 14,906 mid-aged women, which has revealed consistency in menopausal symptoms such as hot flushes, night sweats, psychological and psychosomatic symptoms.27 Also, recent SWAN revealed a broad window of variations in the age of onset of different menopausal stages within a population but less different among different populations. SWAN’s study also investigated specific variations in sexual hormonal profile and menopausal symptoms among different populations indicating that menopause is a trait that can be predicted, de-evolved, and controlled.28

To date, few studies were carried out on Jordanian women emphasizing on the severity of menopausal symptoms as an assessment of women’s health and needs.29–31 In this study, we investigated the actual ages of Jordanian women at different menopausal stages and the implications of environmental factors, specifically smoking and BMI, together with underlining diseases and socioeconomic factors. The study aimed to determine the factors that may play a role in the premature/early ANM among Jordanian women.

Materials and Methods

Study Approval and Design

A cross-sectional design protocol was submitted and approved by the Research Ethics Committee at the Jordan University Hospital (Approval #38/2015) in early 2016. This study was carried out at the Jordan University Hospital per the Declaration of Helsinki, whereby all subjects have read and signed an informed consent to enroll in the study.

Subjects

Subjects were selected based on random drop-off technique to the Obstetrics and Gynecology clinics at the Jordan University Hospital. Women 18 years of age and above were initially eligible to enroll. We included younger group of females as a control group for comparison purposes while studying hormone indicators, the vasomotor, psychosocial, and physical symptoms in Jordanian women during menopausal transition period and aging.

Four hundred and sixty-eight females were enrolled in the study. Initially, patients were stratified into seven groups according to their age. Each participant answered a questionnaire containing 30 questions with the help of health trained workers. The questions have information about menopause status, menstrual cycle, diseases, uterus, heart, breast conditions, sleep, mood, hot flushes, memory, and socioeconomic variables such as marital status, type of work, salary, and education. Hormone therapy was also included in the questionnaire as a treatment for instance regulating menstrual period or having ovarian cysts. Also, each subject’s weight and height were recorded, and body mass index (BMI) was calculated. Out of the 468 subjects, 59 data from women with hysterectomy or oophorectomy before the age of 55, Turner syndrome, systemic lupus erythematosus, and not Jordanians were excluded from the analysis.

Biochemical Tests

Blood samples were drawn from each participant to assess their estrogen (E2) and follicle-stimulating hormone (FSH). For the females in the premenopausal phase, the blood sample was withdrawn in the early days of the follicular phase. The E2 and FSH were measured on Elecsys 2010. The lower detection limit was 5 pg/mL and 0.1 mIU/mL for E2 and FSH, respectively.

Data Analysis

Parameters were scored from 1–4 according to the frequency of symptoms where 1 was “not present”, and 4 was “always”. Overall health was scored from 1–4, where 1, 2, 3, and 4 were referred to as excellent, good, average, and poor, respectively. BMI was classified from 1 to 6, where 1, 2, 3, 4, 5, 6 referred to underweight, standard, overweight, obese 1, obese 2, and obese 3.32

Depending on the skewness score, continuous data were expressed as either the means ± SD or median (interquartile range), whereas categorical data were reported as percentages. If skewness score is <2, the Student’s t-test was applied for testing between two groups n ≥8. Besides, in Student’s t-test the equal variance was assumed unless Levene’s test was significant. Similarly, ANOVA for means or the non-parametric Kruskal–Wallis test for medians was used to compare the quantitative variables among groups, when appropriate. For association analysis, data variables were either analyzed by Chi-square analysis using phi (or Cramer’s V) and or binary logistic regression. Multinomial logistic regression analysis was applied for a combination of variables to consider the independent relationships of significant covariates with premature/early menopause after adjusting for age and socioeconomic status at the time of the study. The estimated effect was reported by adjusted odds ratios (ORs) with their 95% confidence intervals (95% CIs). A p-value of <0.05 was considered to be statistically significant. All analyses were performed using SPSS 25 statistical package.

Results

Characteristics of the Study Population

The study group consisted of 409 Jordanian women with a mean age of 48.3 ± 14.9 years and range from 20–75 years (Table 1). The majority were overweight to obese (69.8%), married or have been married (74.2%), have a college degree (51.1%), housewives (61.3%), and have an income of less than 500 JD (equivalent to less than USD 700). In addition, almost half of the participants have chronic diseases such as hypertension, diabetes, dyslipidemia, and osteoporosis.

Table 1 Characteristics of the Study Population

Natural Menopause Ages in Jordanian Women

The mean ANM in our sample was 48.5±5.0, with 2.7% of the women experienced premature menopause (ANM <40) and 7.8% early menopause (ANM 40–44) (Table 2). Within the menopause women (n=242), the percentage of women who had premature menopause was 4.5%, 13.6% with early menopause, and 21.1% with late menopause (ANM >52) (Figure 1).

Table 2 Premenopause and Natural Menopause Status in Jordanian Women

Figure 1 The percentage distribution of menopause in Jordanian women, according to the cessation of menstruation age onset.

Perimenopause and Hormone Levels

To assess those women who were still having their period but in the perimenopause phase, the FSH level of >12.5 mIU/mL was the initial indicator. There were 12 women (2.93%) categorized as <40 (n=2), 40–45 (n=6), 46–49 (n=3), >50 (n=1) age groups, respectively. Besides, 50% of the women had E2 less than 12 pg/mL, and more than half of them have an irregular menstrual cycle and hot flushes.

As expected, the FSH level was higher in the perimenopause and menopausal age groups (p<0.001) than premenopausal women (Table 3). Besides, there was no difference in FSH levels between perimenopause and other menopausal groups (p=0.068). On the other hand, E2 levels were lower in the perimenopause and menopausal age groups (p<0.001) than premenopausal women, and there was no difference in E2 levels between perimenopause and other menopausal groups (p=0.086).

Table 3 FSH and E2 Levels in Premenopausal, Perimenopausal, Menopausal Age Groups of Jordanian Women

Vasomotor, Psychosocial, and Physical Symptoms

The mean scores of the frequency of vasomotor, psychosocial, and physical symptoms, and the mean score of overall health of the studied population are presented in Table 4. It is evident that overall health, BMI, arthritis pain, hot flushes and inconsistent urination were significantly higher in the early and regular menopause than in premenopause and perimenopause women. On the other hand, facial hair was significantly less in regular menopause age group.

Table 4 Mean Scores of the Frequency of Vasomotor, Psychosocial, and Physical Symptoms with the Mean Score of Overall Health

Variables Associated with Premature/Early Menopausal Age Groups

Several variables that may associate with premature and early menopause in comparison to normal or late menopause age were evaluated. Smoking was associated with premature/early menopause with an OR of 2.46 (95% CI: 1.08–5.59; p<0.05) (Table 5). Although hormone therapy showed an OR of 2.53, this association was not significant (p = 0.072). On the other hand, diseases in general such as hypertension, dyslipidemia, diabetes, heart conditions, and their combinations were significantly associated with normal or later menopausal age women (p<0.05) (Table 5). Besides, none of the variables, such as BMI, arthritis, osteoporosis, uterine fibrosis, ovarian cysts, having kids, and socioeconomic conditions such as work, marital status, working hours, salary, and education showed an association with either menopausal age.

Table 5 Selected Variables That May Associate with Premature/Early Menopause in Jordanian Women Comparison to Regular/Late Menopause Adjusted with Age Using Logistic Regression Analysis

Although smoking was associated with premature/early menopause and the ANM in smokers (46.7±6.5) was lower than women who were not smokers (48.8±4.6), this latter mean was not statistically significant (p=0.074). Also, no difference in menopause age between the smoking groups was observed.

Multinomial Analysis

Adjusting for age and socioeconomic factors, the multinomial analysis showed similar effects with slight variation in the OR, 95% CI, and p value (Table 6). Smoking was a significant variable for increased odds of women with premature/early menopause (OR 2.6, 95% CI: 1.06–6.38, p<0.05). On the other hand, women with occasional arthritis symptoms and diseases such as hypertension, diabetes, dyslipidemia, and their combination were associated with average or late menopause. On the contrary, hormone therapy, higher BMI or uterus conditions were not associated with premature/early menopause.

Table 6 Multinomial Logistic Regression of Variables Associated with Premature/Early Menopause* with Adjusted or Against Age and Socioeconomic Factorsϯ

Discussion

The current study aimed to understand and comprehend the menopause stages and underlying facts among Jordanian women using a unique wide window age groups ranging from 20 years to 75 years old. The study has explored the changes in the reproductive axis, menstrual cycle, health, environmental factors associated with 409 women’s quality of life.

Medical studies failed to predict the exact ANM since it is a gradual and multi-factorial phenomenon. Our findings herein indicated that smoking was the major risk factor for premature/early menopausal age among Jordanian women. A total of 10.8% of Jordanian women in our sample experienced premature and early menopause, and this percentage was associated with exposure to regular or previous smoking habits. This result was consistent with other previous studies that were not related to Arab women.33–36

Although the underlying relationship between smoking and earlier onset of menopause is not well defined, previous studies have hypothesized the irreversible toxic effect of smoking on ovarian function.37,38 Nicotine has been found to induce apoptosis of ovarian culture that may reduce ovarian reserve oocytes.37 Ruan and Mueck (2015) have demonstrated that smoking drastically affects both endogenous E2 and FSH levels and may cause a decrease or inactivation of the FSH hormone.39 These observations agree with the E2 and FSH hormone profile among premature/early menopause in our study. Although we did not account for the intensity, duration, cumulative dose, and timing of smoking with age, it has been shown that smoking and duration of smoking were a strong predictor of ANM.33

In the current study, the overall ANM of the tested participants was 48.5±5.0. This ANM value is within the range (47.5–49.4) of other studies.29–31 However, the later studies did not stress on premature/early menopause age, but more were interested in menopausal symptoms and their implications on Jordanian women’s health. In comparison with different populations occupying the neighboring geographical area, El Hajj et al (2020) showed the ANM in Lebanese women was 47.9 ± 4.5, which is significantly less (p<0.05) than ANM in Jordanian women presented in this study. In the former study, more than half of the studied population was smokers, contributing to the significantly lower ANM value.40 On the other hand, a study in Saudi Arabia disclosed that the ANM was 48.3 ± 3, which was not significantly different than Jordanians, and only 1.8% were smokers.41

A cross-sectional analysis that was conducted using data obtained from SWAN, Chan, et al (2020) showed that the ANM average of Afro-American, Chinese, Japanese, and Caucasian populations was 52 years and was significantly higher than the Hispanic population (50.8 years).28 These values are significantly higher than the ANM in our region/population. On the contrary, an earlier systemic review performed by Palacios et al (2010) have reported ANM for Asians, Latin Americans were similar to our populations but less than those of Europe and North America.5 Although meta-analysis has shown variations in ANM among populations may be due partly to the geographical region’s difference, lifestyle factors may contribute to almost its similarity.35 Our finding revealed that the ANM among Jordanian women was practically identical to women occupying the same geographical region that shares nearly the same lifestyle of living that may have a similar impact on epigenetic factors.19

The onset of menopause starts when women transition from the premenopausal or perimenopausal stage. This transitional period is characterized by relative changing levels of serum E2 and FSH.28,42 Our results were consistent with other studies where the transitional stage progresses with loss of ovarian follicles presented by reduced E2, causing an increase of FSH. During this period, measuring the hormonal profile of E2 and FSH is necessary to predict the progress of women’s menopause. The significance of tracking biomarkers may allow intervening before the onset of any health complications related to ANM.43,44

Menopausal symptoms and health complications have a more significant correlation with average or late-menopausal age.45 In the present study, chronic diseases were associated with women who had average to late menopause, and the latter was associated with an increase in BMI, arthritis, and overall health. The increase in BMI with age and chronic diseases-related complications is a major concern in Jordanian women, but it is beyond the scope of this article.46 However, health complications related to premature/early menopause are substantial to non-fatal cardiovascular diseases before the age of 60.33 In the present study, the frequency of heart diseases was 4.7% in the premature/early menopause group (2 out of 43) compared to 7.0% (14 out of 199) for women with regular-late menopause. Since the age of premature/early menopause women at the time of this study was only 53.7±8.7 years compared to 58.9±6.2 years for the regular-late menopause group, a concern must be taken. Therefore, more cardiovascular protocols and preventive measures should be implemented for women experiencing premature/early menopause.33

Our study has limitations that are worthy of being mentioned. This study was a cross-sectional design, and the ANM was self-reported by women retrospectively; therefore, it depends on the participants to recall their ANM. Studies have shown that remembering ANM has variations that increase with the duration since menopause.47 Besides, the study did not show the time of hormone therapy that might have been after the diagnosis of premature or early menopause women. Furthermore, in this study, the sample size was small and may be attributed to a higher percentage of women who had premature/early menopause in relation to total postmenopausal women.33 Although our sample size is limited, it’s primary strength was the biochemical testing to validate each participant’s hormonal status. Besides, the research team involved limited the errors associated with self-reporting or under-reporting.

Although multiple variables were addressed, only smoking showed a correlation with premature/early menopause. This positive correlation should increase smoking awareness in general and among young women and combat smoking through public policies. Furthermore, acknowledging the factors related to early menopause will permit rigorous research. Thus, it is essential to investigate the incorporation of determinant factors influencing menopause age of Jordanian women and the Arab region. Such information will increase the reproductive period and reduce the risk factors associated with cardiovascular morbidity and mortality diseases and lead to disease-less long-term survival.

Acknowledgments

The authors acknowledge the financial support from the Deanship of Research and Graduate Studies at the University of Petra (Grant Numbers 5-4-2015), Amman, Jordan, and Jordan University hospital to facilitate meeting the participants and collecting samples. A special grateful acknowledgment dedicated to Ms. Suzan Alwawi, University of Petra, for technical assistance and finally to all study participants.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

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16. World Health Organization. Research on the menopause in the 1990s: report of WHO scientific group, Geneva, Switzerland; 1996. Available from: https://apps.who.int/iris/handle/10665/41841. Accessed January12, 2021.

17. Harlow BL, Signorello LB. Factors associated with early menopause. Maturitas. 2000;35:3–9. doi:10.1016/S0378-5122(00)00092-X

18. Santoro N. The menopausal transition. Am J Med. 2005;118:8S–13S. doi:10.1016/j.amjmed.2005.09.008

19. Hefler LA, Grimm C, Heinze G, et al. Estrogen-metabolizing gene polymorphisms and age at natural menopause in Caucasian women. Hum Reprod. 2005;20:1422–1427. doi:10.1093/humrep/deh848

20. Shadyab AH, Macera CA, Shaffer RA, et al. Ages at menarche and menopause and reproductive lifespan as predictors of exceptional longevity in women: the Women’s Health Initiative. Menopause. 2017;24:35–44.

21. Mishra GD, Cooper R, Tom SE, Kuh D. Early life circumstances and their impact on menarche and menopause. Womens Health. 2009;5:175–190.

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36. Sun L, Tan L, Yang F, et al. Meta-analysis suggests that smoking is associated with an increased risk of early natural menopause. Menopause. 2012;19:126–132.

37. Cheng S, Qin X, Han Z, et al. Nicotine exposure impairs germ cell development in human fetal ovaries cultured in vitro. Aging (Albany NY). 2018;10:1556–1574.

38. Tziomalos K, Charsoulis F. Endocrine effects of tobacco smoking. Clin Endocrinol (Oxf). 2004;61:664–674.

39. Ruan X, Mueck AO. Impact of smoking on estrogenic efficacy. Climacteric. 2015;18:38–46.

40. El Hajj A, Wardy N, Haidar S, et al. Menopausal symptoms, physical activity level and quality of life of women living in the Mediterranean region. PLoS One. 2020;15:e0230515.

41. AlDughaither A, AlMutairy H, AlAteeq M. Menopausal symptoms and quality of life among Saudi women visiting primary care clinics in Riyadh, Saudi Arabia. Int J Womens Health. 2015;7:645–653.

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90,000 Attitudes towards hormone replacement therapy are changing.

2020.02.12

Studies have shown that about two thirds of postmenopausal women suffer from various discomfort and ailments. Systemic hormone therapy for menopause remains one of the most effective ways to relieve unpleasant menopausal symptoms such as hot flashes, palpitations, and night sweats. Menopausal hormone therapy also reduces genital discomfort such as vaginal dryness, itching, burning sensation, and pain during intercourse.PHT has also been shown to be beneficial for cardiovascular function, helping to prevent osteoporosis while keeping the risk of breast cancer, venous thromboembolism, and stroke low.

Unfortunately, due to false data from a 2002 Women’s Health Initiative study that erroneously indicated that HRT led to a sudden rise in breast cancer, millions of women around the world are still avoiding HRT, mistakenly believing that hormonal the treatment is unsafe.Fear and hormone replacement therapy can lead to the progression of osteoporosis, premature death from coronary heart disease.

Currently, medical experts agree that the risk of OGT is low in healthy women between the ages of 50 and 60. To further reduce this low risk, doctors do not recommend starting HRT 60 or 10 years after menopause, as many cancers get worse at this stage of life, even without any drug therapy.So cotton wool and non-wetting PHT preparations have their pros and cons. This must be understood and correctly measured when making a decision.

When should you avoid hormone replacement therapy?

Women with a history of or currently diagnosed with breast, ovarian, or endometrial cancer, as well as those with deep vein thrombosis or stroke, are usually not given hormone replacement therapy.Women on hormone therapy are not allowed to smoke, as this greatly increases the likelihood of side effects. Meanwhile, hormone replacement therapy is not required in menopausal women aged 45 and older who do not have adverse symptoms.

About 60% of women experience mild to moderate hot flashes and night sweats, 20% severe, and the remaining 20% ​​do not. Is it wise to endure such debilitating discomfort? Do not try or hesitate to contact your gynecologist for advice and help.

The benefits of hormone replacement therapy usually outweigh the risks if the woman is healthy and:

Has moderate to severe fever or other unpleasant symptoms of menopause;
Has low bone mineral density and no other treatment options for osteoporosis are available;
Menopause is premature and occurs before age 40.

5 things to know:

1.From the age of 40, women begin to experience hormonal changes in perimenopause

2.Menopause begins with your last menstrual period, and when you are 12 months without a period, you are considered to have entered menopause.

3.80% of menopausal women experience hot flashes and night sweats

4. Libido often begins to decline in the years before menopause and continues until menopause.

5. The risk of hormone replacement therapy is considered low.

6. There is always an opportunity to help yourself.

Based only on common sense and not taking into account the results of research, it can be seen that estrogen deficiency causes pathological conditions and clinical symptoms that are dangerous to health.There is nothing better than giving patients the same hormone therapy that the body lacks. Recommended to be taken after menopause, preferably between 50 and 60 years of age. In each case, an individual risk assessment is required. If high, hormone therapy is not indicated. In the past, hormone therapy was more commonly used for menopause. Currently, it is used only on an individual basis: if the normal rhythm of a woman’s life is disrupted, blood pressure rises, insomnia, electrolyte imbalance, depression and other similar symptoms occur.
Doctors always advise you to try other lifestyle changes first. Increase physical activity, change your diet, eat more legumes: soy, chickpeas, lentils, beans. You can use bee bread or pollen – they contain phytoestrogens. It is analogous to the female hormone estrogen in nature. Red clover improves the well-being of menopausal women because, like soy, they are high in isoflavones.

In addition, hormone therapy should be considered if there is no benefit.But, before doing this, it is necessary to assess the lining of the uterus: if it is absent or polyps, it is proposed to perform a mammogram of the mammary gland and check for pathological signs. If hormones are used, the breasts should be checked annually. It is recommended that this treatment begins with the lowest effective dose and continues for up to five years and up to seven years. Despite its many benefits, hormone replacement therapy is also associated with an increased risk of certain diseases, and it is important to see your doctor regularly to assess the benefits and risks of your therapy, and to have a preventive mammogram and pelvic exam.

The current fifties who are in menopause are very active, busy, have a high level of physical activity, but sometimes the physiology is delayed and there are phenomena that stop them. This encourages you to take more care of yourself – exercise, eat healthy foods, and remember to pamper yourself.

90,000 Which doctor should you contact with menopause, and why you need it

Even for modern women, the onset of menopause is often not a reason to see a doctor.Many people prefer to patiently endure an unpleasant period, guided by the fact that many generations before them coped with menopause without resorting to the help of specialists.

You should not be ashamed of menopause. This is a normal physiological process, which has not yet been avoided by any woman. And at the same time, menopause is not a reason to suffer alone, at the risk of facing unwanted symptoms.

In order to prevent the development of diseases associated with menopause, a specialist should monitor the state of the body during this period.He will assess the symptoms and recommend medications that can alleviate climacteric syndrome, and, if necessary, prescribe a course of hormone therapy.

Therapeutic help for menopause has existed for a long time, albeit in a general form. For example, in order to influence the lack of hormones, phytoestrogen preparations based on plants have been created. Such medications still exist today, but their significant drawback is the controversial beneficial effect on menopausal symptoms and the lack of evidence.

More efficient and effective means are synthetic hormones that are completely identical to natural estrogens and progesterone. If you have a prescription, you can buy them at every pharmacy, but it is important to understand that the benefits of the prescribed treatment should outweigh the risks.

Thus, the decision on the appointment of hormone therapy should be made by the doctor. He develops a treatment regimen, monitors the dosage, monitors the occurrence of side effects and decides on the appropriateness of taking a particular drug.

There is a simple explanation for this: an excess of hormones is no less dangerous than a lack of them.
So, for example, taking estrogen in high doses significantly increases the risk of developing the following pathologies:

  • hyperplasia of the mucous membrane of the uterus, and, as a result, uterine bleeding;
  • breast cancer;
  • gallstone disease;
  • hemorrhagic stroke;
  • emotional instability.

An incorrectly selected combination of hormones can increase the risks of diseases of the bone, cardiovascular, digestive, endocrine and other systems of the body.All of the above is a serious reason for refusing self-medication, but not taking hormonal drugs in principle. That is why a visit to the doctor is the first and most important step on the path to women’s health and well-being.

Test FRAUTEST (Frautest) for determination of menopause 2 pcs.

Short description

Set of 2 diagnostic test strips.
Rapid analysis is based on the determination of follicle-stimulating hormone (FSH) in the urine and helps to determine the onset of perimenopause.

If a woman is over 40, and menstruation has become irregular or menopause symptoms appear with regular menstruation, then the test will help to know about the approach of perimenopause (the first stage of menopause).
A long-term increase in serum FSH levels above 15 mIU / ml serves as a hormonal marker of perimenopause, and it is this increase that determines the test for menopause in urine. … – sensitivity – 25 mIU / ml.

-precision – more than 99%.
– To make a diagnosis, 2 tests should be carried out at intervals of a week.
– shelf life 2 years.

Directions for use:
To make a diagnosis, two tests should be carried out at intervals of a week. Testing should be done on morning urine as it contains the highest concentration of the hormone and therefore will give you the most reliable result.

If symptoms of climacteric syndrome appear, and the menstrual cycle is regular, then the first test should be carried out in the first week of your cycle (from 1 to 6 days of the cycle).The second test is repeated one week later. If your menstrual cycles become irregular within 3-5 months, then you can do the first test any day of the month.
The second test must be performed one week later.

Testing.
1. Immerse the test vertically in the test urine container up to the 10 second mark.
2. Place the test strip on a dry, horizontal surface.
3. Evaluate the result in 1-3 minutes, but no later than 5 minutes.

Evaluation of results.
1. Negative. Only one control line appears in the result area, or the test line is lighter than the control line. Normal FSH levels.
2. Positive. If two colored lines are observed and the test line is similar in color or darker than the control line. This means that the FSH concentration is increased, the darker the test line, the higher the concentration.

Positive results of 2-3 tests taken at weekly intervals indicate that you are in a state of perimenopause.In this case, you need to see a doctor.

If symptoms of climacteric syndrome are present, and the results of two tests are negative, then testing should be repeated every 2 months.

If there are no symptoms of climacteric syndrome and the results of two tests are negative, then the test should be repeated after 6-12 months.

If the first result is positive and the second is negative, then such episodic positive results are considered normal. FSH levels may rise for a short period during a normal cycle.Testing should be repeated after 2 months.

Oral contraceptives and hormone replacement therapy may interfere with test results.

3. Error.
Test completed incorrectly. This is extremely rare. Repeat the test with a new test strip, strictly adhering to the instructions in this manual.

class = “h4-mobile”>

Store in sealed packaging at temperatures from +2 to + 30 ° C in a dry place protected from direct sunlight and out of reach of children.

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Olga Beklemishcheva: Today we will talk about menopause in women. Climax in Russia does not like to discuss. Perhaps this reflects the shyness inherent in northern people, perhaps the remnants of patriarchal mores. But this leads to the fact that there is a sorely lack of reliable information on how to behave correctly during this period, how to prepare for it, how to ease the course of menopause, and how to avoid its complications.

Therefore, today our guest is Tatiana Viktorovna Chebotnikova, senior researcher of the Mmenopause group of the Institute of Endocrinology of the Russian Academy of Medical Sciences. By phone from America with us, as always, Professor Daniil Borisovich Golubev. And we will certainly discuss not only the prevention of climacteric disorders, but also the difference in European and American approaches to hormone replacement therapy.

Tatyana Viktorovna, first, let’s understand the terminology.Menopause, menopause, menopause – are they the same thing or are they slightly different things?

Tatyana Chebotnikova: Of course, these are terms that characterize the transition of a woman to an older age group, and all those endocrine changes that occur in the female body, and which a woman is forced to feel on herself. And not only internally, but also externally, it can change. Rather, the differences in terms are of interest to specialists. However, menopause is that age period when a woman’s menstruation ends and her reproductive function stops.Menopause is a broader concept, and includes the period from the last menstrual period to 65 years.

Olga Beklemishcheva: I see. And when is this last menstrual period on average?

Tatyana Chebotnikova: On average, in the Russian population, in the Moscow population, according to Moscow data, menopause occurs at about 51 years. It may come earlier. But the normal age for menopause in European women is 45 to 55, and that’s the norm.A little later – this is late menopause. And here you need to consult with specialists – is this the norm or is it a health problem. Or if earlier than 45 years old, then menopause is called early. If menopause occurs before the age of 45, it is premature menopause. And women, despite the early cessation of reproductive function, meet in the same way face to face with all those problems that are characteristic of older women.

Olga Beklemishcheva: Does it depend on something – on heredity or on the woman’s lifestyle – when will she have menopause?

Tatiana Chebotnikova: This is, of course, a collective reason.The most refined, so to speak, suspects are genetic characteristics. That is, if your mother has menopause at the age of 40, then there is a possibility that you will also have menopause a little earlier than other women. But this does not guarantee that you will repeat the path of your mother, since you still have inheritance, which is passed on from the father’s side.

And the second point to which you need to pay attention is iatrogenic intervention, that is, various endocrine diseases that are not compensated and untreated, which lead to an early onset of menopause.For example, such as poorly compensated or uncontrolled type 1 diabetes mellitus, thyroid diseases. But we will not dwell on this in detail now. And also there may be those problems that are important for a small number of our women – these are cancer and chemotherapy drugs.

Olga Beklemishcheva: And now I want to ask Professor Daniil Borisovich Golubev. Are there any peculiarities about the onset of menopause in America?

Daniil Golubev: According to medical statistics, menopause in American women occurs on average at the age of 50.It is considered premature if it starts before the age of 40, which may be due to smoking, high altitude living, or poor diet. It has been shown that women who smoke have their periods about three years earlier than non-smokers. In recent years, the number of smokers in the United States has significantly decreased, and in general, there are much fewer women smokers in America than in Europe, and, apparently, in Russia. However, the impact of smoking on the time of menopause is clearly visible, and one of the first questions a doctor asks a woman on her first visit concerns this addiction.

When assessing the timing of menopause, American doctors also attach great importance to the hereditary factor, since a woman’s menopause occurs at about the same time as her mother and grandmother.

Symptoms of menopause range from the most mild to very severe and are the same in all countries. The most severe consequences of menopause are associated with cardiovascular pathology, up to the occurrence of heart attacks and strokes. In 25 percent of postmenopausal women, acute manifestations of osteoporosis are recorded, and bone fractures are common.Women who abuse alcohol, smoke, and long-term corticosteroids are at greatest risk in this regard. Death and disability among postmenopausal women are often the result of osteoporosis and pathological fractures, although in the United States, surgical treatment of these lesions, in particular hip fractures, is very successfully and extensively carried out.

Olga Beklemishcheva: Thank you, Daniil Borisovich.

Tatyana Viktorovna, what are the signs of the onset of menopause?

Tatiana Chebotnikova: The first thing every woman should pay attention to is a violation of the usual interval between periods. As a rule, delays begin. That is, menstruation does not stop immediately: more regular menstruation is over – and that’s the point. No. As a rule, the interval between periods begins to lengthen over several years.And this may be the very first and surest sign of menopause.

Menopause syndrome does not develop in all women. That is, the characteristic, typical for us signs, here is what we know perfectly well with you – these are hot flashes, this feeling of sweating, a feeling of heat …

Olga Beklemishcheva: Irritability.

Tatiana Chebotnikova: Yes … they are experienced by about 60-70 percent of women of European upbringing, that is, of the traditional European worldview.

And an absolutely amazing thing. When researchers who used hormone replacement therapy conducted research in Japan, they found that Japanese women, in principle, do not know the word “hot flashes”. That is, a Japanese woman of traditional upbringing associated menopause with fatigue, back pain, but the women did not experience any hot flashes. However, the same women of Japanese descent who were raised in America feel almost the same amount… well, maybe a little less prevalence of hot flashes in women of the corresponding age of Japanese origin.

And an absolutely startling fact. For example, women of the African Yaruba tribe associate these hot flashes with the onset of menopause with the manifestation of malaria, and do not at all correlate it with the manifestations of menopause.

And, for example, women of the Central American Maya tribe, in principle, do not experience manifestations of menopause and climacteric syndrome, despite all those hormonal indicators characteristic of white women of European descent.

Olga Beklemishcheva: And what explains this is still not clear, right?

Tatiana Chebotnikova: This is due to the difference in attitudes towards menopause and the perception of menopause. Our traditional European perception of menopause … unfortunately, menopause is perceived as a period of extinction, loss of something, parting with something. And in Europe, the traditional concept of the onset of menopause was even associated with some kind of intellectual extinction.

But in fact, this is not at all true. Those women who are closer to nature, they experience menopause as a relief, as a withdrawal from the problems associated with the reproductive period associated with the birth of children, a period of freedom and openness of sensations of intimate relationships. Accordingly, the attitude towards the transition period will be completely different among different nationalities.

Olga Beklemishcheva: Interesting. What you said about some national and cultural peculiarities is, for sure, very true.Because I met many women who were enthusiastic about their maturity, and who looked great and felt and behaved very cheerfully, so they said that when you can just do a career, and personal growth, and many, many others. And there are women who really fold their wings, lower them. And I must say that they were aging much faster than those who retained such dynamism in their character.Perhaps this is what is called a cortically dependent situation.

Tatiana Chebotnikova: I think that those women who retain an interest in life, they not only retain their external attractiveness, but they retain, above all, their internal attractiveness. We all have examples before the eyes of such great actresses as Diana Ross, for example, Liza Minnelli, who remain attractive, lust for life and zest for life into adulthood. And they remain idols for many millions, not only of our compatriots, but for the whole world.

And our task is to help a woman in menopause feel a surge of new strength and maintain the usual quality of life, this is what a woman is used to, to help her continue to remain attractive, socially active, maintain an interest in life and joy in her eyes. This is something that is quite realistic to do at our current level of development of medicine. We know many things that will allow a woman to maintain the lifestyle to which she is adapted.

Olga Beklemishcheva: And, of course, we will discuss this closely.

But now I would like to ask you to briefly tell about the physiological basis of menopause. What happens inside the body? Why does a woman change so much?

Tatiana Chebotnikova: A woman is a completely unique creature. That is, this is the only female creature who goes through menopause. That is, not a single animal species experiences menopause, this is typical only for the human race, exclusively for the human race.

And what happens at this moment. There are dramatic endocrine changes taking place. The supply runs out … the follicular pool in the ovaries – and the woman loses the ability to become a mother. But she continues to live and maintain social activity. A startling endocrine change is taking place. The amount of female sex hormones in the body decreases, and a woman, adapted to the previous level of sex hormones, begins to feel a lack of them. And sometimes this lack is felt so sharply that it interferes with life, interferes with sleep, thoughts are concentrated on one thing.That is, these are constant hot flashes, this is a constant irritant in my head: “what if they look at me, what if it will be noticeable from the outside.”

But this state is not a reason to give up, fold your wings and drown in the stream of life. In no case. This is an excuse to contact a specialist who will help solve these problems.

Olga Beklemishcheva: That is, all organs and systems that are used to living under the control of female sex hormones in a woman must learn to do without them.It is logical that when gynecologists investigated ways to improve the state of the transition period, they turned to the idea of ​​introducing the missing hormones into the female body. And we will talk about how events developed further.

And now I want to ask Professor Golubev, are there any specific features of the course and treatment of menopause in the USA?

Daniil Golubev: As you know, all symptoms of menopause are associated with a decrease in the concentration of three hormones in a woman’s body – estrogen, progesterone and testosterone.Replacing the lack of hormones not only relieves and eliminates the unpleasant symptoms of menopause, but also significantly reduces the risk of osteoporosis.

Since the beginning of the 80s, hormone replacement therapy has taken a leading place in the treatment of severe manifestations and complications of menopause. Millions of women widely and for many years have used the appropriate hormonal preparations, which has a significant impact on the timing of their preservation of active life, efficiency and external attractiveness.

However, several years ago, the FDA and the American Medical Association issued a series of official regulations that sharply limited the use of hormonal drugs in connection with the data that the use of estrogens increases the risk of cervical cancer and, to some extent, breast cancer. glands.

Currently, estrogens in combination with progesterone for women who have not undergone hysteroctomy are used, but purely individually, with great caution and taking into account a hereditary predisposition to malignant neoplasms.The treatment is combined with constant special monitoring of the woman’s health using mammography and a laboratory Pap test. If estrogen is categorically contraindicated for treatment, the drug Clonidine is used.

All these circumstances led to an “explosion” of interest in natural substances contained in food, which can replace synthetic drugs and hormones for the prevention and treatment of complications of menopause, that is, to the so-called phytoestrogens.The most studied are two types of phytoestrogens – lignins and isoflavones. Lignins are found in grains, flaxseeds, fruits, vegetables; isoflavones – in soybeans and other legumes.

The evidence for the use of phytoestrogens in menopausal women was the observation that Asian women who consume a lot of food containing soy, rich in phytoestrogens, suffer less from postmenopausal complications. The promotion of phytoestrogens has contributed to the popularization of soy products.

For the prevention of osteoporosis, calcium supplements with vitamin D are used. For the treatment of osteoporosis, since 1995 in the USA, the drug Fosemax has been actively used, which inhibits the activity of osteoclasts that destroy bone tissue, and in recent years, also the drug Forteo, which activates osteoblasts – cells, synthesizing bone tissue.

An important role in the treatment and prevention of complications of menopause is played by the general health of women, control over blood pressure levels, prevention of obesity and diabetes, smoking cessation and alcohol intoxication, increased physical activity and comprehensive prevention of stress reactions.This latter is not at all easy to implement in our time, saturated with wars, threats of terror and influenza pandemics, as well as incessant natural disasters.

Olga Beklemishcheva: And now we come to the key question: hormone replacement therapy – for and against. As far as I know, after all, European and Russian endocrinologists and gynecologists have a slightly different view of the admissibility of hormone replacement therapy. What does it consist of? And what caused this difference?

Tatiana Chebotnikova: The position is as follows.American researchers use conjugated estrogens as a source of estrogens – the so-called estrogens, which are obtained from the urine of pregnant mares, equine estrogens. The European position is fundamentally different. European manufacturers, European doctors use exclusively analogs of natural estrogens, that is, not only analogs, but natural estrogens, which are completely identical to those produced in a woman’s ovaries. And chemically they are no different from each other.Of course, this position is more acceptable for me and for European researchers, since more than 20 estrogen metabolites that enter the body of a woman with the introduction of equine estrogens can give an unpredictable reaction, some of them, their metabolic pathways have not been studied. And what happens with natural estrogens, we have already studied quite well. Therefore, from a safety point of view, the conclusion is obvious: natural estrogens are absolutely justified.

Hormone replacement therapy has been widely used in Europe for many years.That is, female sex hormones were synthesized back in the 40s. And an American researcher suggested using them to treat osteoporosis. Then our views changed over time, different points of view came, we learned more about the possibilities of therapy. And they began to talk not about the treatment of osteoporosis, but about the prevention of osteoporosis with estrogens.

But the latest clinical guidelines from the European Society for Menopause and Andropause suggest that hormone replacement therapy is a treatment for osteoporosis, postmenopausal osteoporosis.That is, we returned to what we were leaving.

Olga Beklemishcheva: We made a circle. More precisely, the spiral is on a new level.

Tatiana Chebotnikova: Certainly. But drugs aren’t the only factor that can affect bone. Also in our country the same “Fosemax” is very widespread, as in America, which is successfully used, which belongs to a different class of drugs. But first of all, this is the treatment of climacteric syndrome, and already a new indication – the quality of life.

Olga Beklemishcheva: Quality of life is indeed a somewhat new approach. In principle, I heard about it 10 years ago, but somehow it began to be actively discussed quite recently, when people made the discovery that it is absolutely not necessary to suffer where it can be avoided. But you can still understand people who are afraid of hormone therapy, suspect that it can provoke some other diseases. Moreover, unfortunately, the results of American research have become widely known in the non-medical environment.

That is, what can you say to those people who are afraid of hormone therapy?

Tatiana Chebotnikova: We are not talking about hormone replacement therapy as a complete imitation of the functions of the ovaries, we are talking about the minimum dosage of female sex hormones, which allow you to achieve an effect and not create problems at the same time. The content of female sex hormones in the preparations is much lower than that which is created during the work of the ovaries during the reproductive cycle, in the reproductive period in women.

As for oncological diseases, that is what we need to know with you. If estrogens were the cause of the development of cancers of various localization, then the relationship would be clearly visible. The girl entered puberty, her sexual development began, her ovaries began to work – and the incidence curve for various oncological diseases went up, the hormonal dependence of risks should have increased.

Olga Beklemishcheva: But this is not so.

Tatiana Chebotnikova: But what do we see in reality? This is exactly the opposite picture. Menstruation ends, menopause sets in, 15-20 years pass – and that’s when we see an increase in the incidence of cancer. That is a paradox: there are no estrogens, and cancer is growing.

Olga Beklemishcheva: And that means that estrogens, in principle, are not to blame, right?

Tatiana Chebotnikova: Estrogens are not the reason for the development of oncological diseases.They can participate as the most demanded or highly demanded hormone, which is present in the blood of our women, and is also present in menopause, including …

Olga Beklemishcheva: Just like many other hormones, right?

Tatiana Chebotnikova: Of course, they take part at certain stages, but they are not the root cause of the development of the disease. Just like women who receive hormone replacement therapy, a small number may have malignant diseases, of course, so do those women who receive nothing, but also have malignant diseases.

Olga Beklemishcheva: And now Mark Krutov will introduce you to medical news from Evgeny Muslin.

What is more important for strengthening the heart and blood vessels and for preventing cardiac diseases – the duration or intensity of exercise? This question was posed by researchers led by Dr. Brian Duscha of Duke University Medical Center in North Carolina. To find the answer to this question, Dr. Duscha and his colleagues selected approximately 150 sedentary men and women with high blood cholesterol and divided them into subgroups.One subgroup continued to live as usual, another walked for a total of 20 kilometers per week, a third subgroup for a total of 30 kilometers, and a fourth subgroup jogged 20 kilometers a week. Such training continued for 9 months. The test showed that all active participants improved their physical form: they became more enduring, and their peak oxygen consumption increased. At the same time, 30 kilometers a week gave better results than 20 kilometers, but jogging did not add anything to them.“Thus,” says Dr. Duscha, “increasing the duration of exercise increases the benefits it brings, but increasing its intensity does little to nothing. To significantly reduce the risk of heart disease and maintain a constant weight, it is enough to walk at a brisk pace of 30 kilometers a week, but there is absolutely no need to torture yourself in stadiums and gyms>.

Early detection and better treatments for breast cancer today allow two-thirds of patients in France, Switzerland and the Scandinavian countries to survive more than 20 years after the initial diagnosis.Great Britain has now joined this list. “The life expectancy of patients with breast cancer has been steadily increasing over the past 15-20 years,” said London-based oncologist Professor Michael Coleman. Professor Tony Howell of the Christie Hospital in Manchester called the findings a “cancer triumph.” And new therapies, such as aromatic inhibitors that suppress estrogen synthesis, promise to improve patient survival even further.

Fish dishes at least once a week slow down negative age-related changes in the brain, while obesity in middle age doubles the risk of senile dementia.These are the conclusions reached by American and Swedish researchers. A six-year observation by Martha Clare Morris and her staff at the Chicago Medical Center showed that omega-3 fatty acids in fish improve brain function and reduce the risk of strokes. “Fish dishes,” they write in the journal “Neurological Archives”, slow down the aging of the brain by 10-13 percent, which is equivalent to its rejuvenation by 3-4 years. In another study published in the same journal, Swedish doctors at the Karolinska Institute in Stockholm write that factors such as obesity, hypertension and high cholesterol in middle age double the risk of dementia in old age.The presence of all three factors increases the risk sixfold. Researchers confirmed such conclusions by processing the case histories of 1.5 thousand people, which were monitored for more than 30 years, starting from 1972.

Olga Beklemishcheva: And we return to our topic. Let me remind our listeners that the difference between the American and European-Russian approaches to hormone replacement therapy lies in the fact that European and Russian doctors use other types of hormones for hormone replacement therapy, obtained synthetically from plant materials.

In addition, a study that alerted endocrinologists and gynecologists about hormone replacement therapy, conducted in America, was about women of high age. The average age, I was told, was 67.5 years old. That is, this is far from menopause. And hormone replacement therapy is related, first of all, as Tatyana Viktorovna said, to women from 45 to 55 years old.

And now Tatyana Viktorovna and I will discuss the indications for her and the correct approach to hormone replacement therapy.But from myself I can say that the women who resort to it, of course, look much better.

So, Tatyana Viktorovna, you have a lot of patients at the Center who are treating severe climacteric syndrome. How do you find therapy for them? What tests do they need? How should such patients be monitored?

Tatiana Chebotnikova: Of course, the first thing that we discuss with the patient is what problems she is worried about.According to the apt expression of the famous Russian doctor Botkin, who said that “we are all completely different”, there is a very figurative expression: “Ivanov has ivanite, and Petrov has petritis”. All women who come to us have different problems, although all these problems can be caused by a deficiency of female sex hormones.

So, first, we must decide what is the priority for this woman, what is the priority for the woman who is sitting in front of us. And the second part of our communication is to recommend the necessary minimum of research in order to make sure that she has no contraindications to this type of therapy.

Olga Beklemishcheva: And what types of research are these?

Tatiana Chebotnikova: First of all, this is an ultrasound examination of the pelvic organs. That is, it is standard, and we must exclude this or that gynecological pathology, which may be the limit for the appointment of hormone replacement therapy.

Olga Beklemishcheva: Is this, first of all, fibroids?

Tatyana Chebotnikova: Rather, these are not fibroids, but rather a tumor or oncological diseases that may already exist in this patient and which she may not be aware of.We must be sure that the woman is healthy, that hormone replacement therapy here will bring exclusively the benefits and effects that we expect from female sex hormones.

The second study is mammography. That is, we also need to make sure that there are no diseases, which are contraindications, of the mammary gland of a woman who turned to us for hormone replacement therapy.

Olga Beklemishcheva: These are just nodules of breast cancer or maybe fibroadenomas too…

Tatiana Chebotnikova: Rather, the nodal forms are fibroadenomas, that is, those tumors that have the ability to grow. And female sexual hubbubs here can potentiate this growth.

Olga Beklemishcheva: I draw the attention of our listeners to the fact that, in fact, according to the criteria of the World Health Organization, after 50 years it is desirable for any woman, it is highly desirable to undergo a mammography examination once a year in order to conduct primary diagnostics some kind of cancerous changes.And if you pass this diagnosis when prescribing hormone replacement therapy, this is only a plus. Because all of this can be discovered at any time.

Tatiana Chebotnikova: Certainly. If there is a desire and you are engaged in self-palpation, that is, this is the method that should, of course, be used by every woman at home, and compare the results with mammography, then if there is some kind of education, then with mammography the size of the education that we will see, it will be less than a centimeter.The growth that you can find in the breast on your own is more than 2 centimeters. That is, the conclusion is obvious: self-palpation does not exclude mammography. Once a year or once every two years in the absence of hormone replacement therapy for an absolutely normal breast, it is absolutely necessary. This is the most powerful factor that allows us to preserve our health and increase life expectancy – timely mammography and detection of formation in the mammary gland.

Olga Beklemishcheva: And if a person does not live in a city with a population of over one million, with limited access to a mammograph, some alternative methods can allow early diagnosis of breast cancer?

Tatiana Chebotnikova: Mammography will probably be the “gold standard” here.And yet, we are already a sufficiently developed country to have special X-ray equipment for mammography in any, even a small district town. This is not a unique study, it has become a part of our everyday life. And you can be sure that you can always get a referral for this research and can always do it.

Olga Beklemishcheva: Look and you will find, dear women. After all, you need to take care of yourself.

So, here’s a person who underwent these primary examinations – ultrasound, mammography …

Tatiana Chebotnikova: That’s not all. And we also need a biochemical blood test – these are the functions of the liver, how adequately the liver works, that is, are there any severe liver dysfunctions, for example, acute hepatitis. Also, a coagulogram – that is, it is an indicator of the blood coagulation system. Since female sex hormones during the initiation of admission can affect the clotting system, we must be sure that everything is in order here, that the woman can begin calmly, freely and confidently hormone replacement therapy.And as a result, we will have only positive effects.

Therefore, after conducting these studies, we can in the future already discuss what to do next and which drugs from the huge arsenal that we have on the market, which, fortunately, can now be used to treat menopausal disorders, our doctors have it. …

Olga Beklemishcheva: That is, in fact, the range of choice of these drugs is very wide. And what does the choice depend on? Why is one woman shown this and the other another? What groups of women can be identified and correlated with drug groups?

Tatyana Chebotnikova: First, I would like to say that there are generally three groups of women in menopause.The first group of women is those women who are indicated for substitution therapy, yes, we are sure of this. The second group is where there is an absolute reading. For example, this is premature menopause, this is an early menopause, these are all those changes that occur in women younger than menopause on average.

Olga Beklemishcheva: And in this case, hormone replacement therapy must be performed?

Tatiana Chebotnikova: Certainly.Otherwise, the risks of diseases associated with aging will be extremely high in these women. That is, the early onset of menopause without hormone replacement therapy will increase, for example, the risk of developing cardiovascular diseases by 1.05 percent. That is, this may be the point that will force our lady to turn to the doctor with a premature shutdown of the ovarian function in order to discuss – what should I do next, how should I be with myself?

Olga Beklemishcheva: Because, once again I draw the attention of our listeners, the heart and blood vessels are also those organs that are used to working under the control of female sex hormones during our life.And when there are few of them, naturally, the risk of cardiovascular disorders increases until they get used to doing without them.

Tatiana Chebotnikova: The second point to be paid attention to is that a younger woman with less experience of menopause will receive a higher dosage of hormonal drugs, that is, maybe 2 milligrams. If a woman has a sufficiently long experience of using hormone replacement therapy, she has the right, and the doctor is obliged to offer her a decrease in the dosage of hormone replacement therapy, for example, from 2 milligrams we go to 1 milligram of estrogen, and this is a completely adequate dosage that allows you to solve the same Problems.That is, the older the woman, the lower the dosage of estrogen preparations in the packaging that she carries with her.

Olga Beklemishcheva: That is, in fact, gynecologists-endocrinologists follow nature, only they somewhat stretch this period of getting used to reducing the dose of hormones inside the body.

Tatiana Chebotnikova: Certainly. We adapt a woman to the transition period, and do not allow abrupt changes to rigidly change any positions in a woman’s life.That is, we do not change the woman’s usual way of life and allow her to remain herself in this situation.

Olga Beklemishcheva: And our listener on the line is Elena from St. Petersburg. Hello, Elena.

Listener: Good afternoon. I was born in 1936. In 1964 my thyroid gland was removed. And in 1971, the uterus and appendages were removed. Now I am almost 70 years old. My only torment is the hot flashes, the hot flashes are simply unbearable.And when it’s cold, I usually do not notice them, well, a little, especially the sweating of the face. And I must tell you that if it were not for this, then I feel great. And I run lightly, and the pressure is 180 to 120, but I do not feel it, and I am not discouraged about it. True, I don’t get treatment and I don’t go to the doctor. Scold me. And tell me what to do.

Olga Beklemishcheva: Thank you, Elena. I do not think that our task is to scold you. Everyone decides for himself …

Tatyana Viktorovna, in your opinion, with such a history, what can cause increased sweating and hot flashes?

Tatiana Chebotnikova: There can be two factors, of course.Firstly, it is the deficiency of female sex hormones itself. But here it would be necessary to ask Elena herself when the hot flashes occurred – either immediately after the operation, or a little later.

Olga Beklemishcheva: Immediately after the operation.

Tatiana Chebotnikova: Then this is due to a deficiency of sex hormones. And I must tell her the following that she is not alone. Nearly 17 percent of women will experience severe climacteric syndrome for many years.That is, it is not a fact that it will pass several years after the cessation of menstruation. 17 percent of women will experience all the “delights” of menopause for many years of their lives.

Olga Beklemishcheva: My God, what an injustice!

Tatiana Chebotnikova: Yes, women here also feel themselves not left out by nature. The fact is that if hormone replacement therapy is not prescribed in a timely manner, then at the age of 70, I certainly will not take risks and recommend hormone replacement therapy.Here selective serotonin reuptake inhibitors can play a role – this is what our colleague from America was talking about. This is the same Clonidine. It can help solve all our problems.

But Elena told us that her thyroid gland was removed. And here is the question of the adequacy of compensation for hypothyroidism that developed after the operation itself. If the dose is too large, the patient may experience exactly the same complexes, exactly the same manifestations of an excessive amount of thyroid hormones taken in pills, as in menopause.

Olga Beklemischeva: That is, in fact, her hot flashes can be both due to the fact that her gland has been removed, and because she is postmenopausal?

Tatiana Chebotnikova: Due to the fact that she can take excessive amounts of hormones as replacement therapy. And not because the gland is removed, but because it can take an excess amount of hormones as replacement therapy.But this can be solved very easily – a simple hormonal study of the thyroid-stimulating hormone of the pituitary gland is done, with which Elena is probably familiar. And it will not be superfluous for a woman in the transition period, after 50 years, to sometimes carry out such a study, at least once.

Olga Beklemishcheva: Well, Elena, we sympathize with you from the bottom of our hearts, and we advise you to have a good conversation with your endocrinologist, who, of course, knows you better.

And we return to our topic.You said that there are three groups of women. Some are those for whom hormone replacement therapy is indicated. Others are those who are highly indicated – with an early onset of menopause. And the third, obviously, are those for whom it is contraindicated.

Tatiana Chebotnikova: There is a group of women, of course, to whom she is absolutely shown. Those who have the pros and cons. That is, we must each time weigh the existing indications or existing nuances that can limit us in choosing hormone replacement therapy as a treatment method.

And the third group of women, for whom it is absolutely contraindicated. That is, these are, for example, those patients who have had heart attacks, for example, in a history, or those patients who have had thromboembolism or hormone-dependent cancers. That is, these are the patients who should avoid the appointment of hormone replacement therapy.

Proceeding from the fact that we basically divide all women into these three groups, in the future we can look at it more simply. The patient who sits in front of us has the right to say what basic positions are worried about her, what worries her in her state of health, and what she would like, first of all, what points she would like to draw the attention of the doctor to.

Olga Beklemishcheva: And what is the main complaint of your patients?

Tatyana Chebotnikova: There are two main complaints – menopause …

Olga Beklemishcheva: Which ones?

Tatiana Chebotnikova: These are tides, first of all.

Olga Beklemishcheva: This is the most painful thing in this case.

Tatiana Chebotnikova: This is something that does not leave the patient for a second, and she absolutely needs the help of a doctor.

And the second reason is the unwillingness to change with age. That is, this is the usual quality of life and the desire to keep oneself young and charming.

Olga Beklemishcheva: And this is possible.

And our next listener is Lydia Alexandrovna from Moscow. Hello, Lydia Alexandrovna.

Listener: Good morning. I have a question regarding my granddaughter. She has not yet climax, she is only 18 years old. But she still has no menstruation. It is very dangerous?

Olga Beklemishcheva: Thank you.

Tatiana Chebotnikova: I think, Lydia Alexandrovna, your granddaughter … 18 years old is already the case when a girl should have independent menstruation, a regular menstrual cycle, of course.You need to take your granddaughter by the hand and bring her to the gynecologist-endocrinologist. For example, in the Endocrinological Research Center, where there is a powerful reproduction department. And this, of course, is the basis for a serious examination of your girl.

Olga Beklemishcheva: So, Lydia Alexandrovna, don’t waste your time.

And returning to the main complaints. Here is the reluctance to change the usual way of life – I understand very well. Painful experiences about the climax itself.And what will this hormone replacement therapy, correctly selected, of course, give us?

Tatyana Chebotnikova: Of course, if a woman agrees to take drugs, the intake is long enough, and you need to immediately orient the woman …

Olga Beklemishcheva: How long is it?

Tatiana Chebotnikova: As a rule, this is several years. Moreover, visits should be repeated annually to the doctor in order to make sure that everything is proceeding normally, the situation is controlled, everything is under control, and the doctor and the woman herself can be calm until the next visit.

Olga Beklemishcheva: And what is this control?

Tatiana Chebotnikova: This is a very good question. Every year we have to do a smear for oncocytology, which I forgot to mention initially, an ultrasound examination of the pelvic organs, mammography and a biochemical blood test. This is all that is needed to make sure everything is going well, and we can be calm about a woman receiving hormone replacement therapy.

Time costs and feelings of a woman who feels safe, attractive, charming, they are completely incommensurable.

Olga Beklemishcheva: But what you listed is included, relatively speaking, in the state guarantee program? That is, you can get it in a regular antenatal clinic?

Tatiana Chebotnikova: Of course, you can get it in the antenatal clinic. However, antenatal clinic doctors are more cautious about prescribing hormone replacement therapy.That is, they are not used to working with this method of treatment. Certainly not all. But if you do not find the understanding of the doctor in the antenatal clinic, there are always dispensary-level specialists or city-level specialists. You can contact our Endocrinological Research Center, for example, the School “Menopause”, where we work with patients, conducting training programs in order to obtain the most accessible information.

Olga Beklemishcheva: That is, dear women, in principle, all that is required of us is a little more than we are used to, to value our own health and our own attractiveness and to spare no time, in general.As Tatyana Viktorovna says, it doesn’t take so much time.

But you said that 17 percent of women will still experience these hot flashes. Is it against the background of hormone therapy?

Tatiana Chebotnikova: Of course, hormone replacement therapy is the best way to treat menopausal disorders, primarily hot flashes. And 17 percent of women … if we do not give hormone replacement therapy, they can only experience similar disorders in this case.

Olga Beklemishcheva: That is, we can say that hormone replacement therapy, correctly selected, guarantees the cessation of these hot flashes?

Tatiana Chebotnikova: If a woman continues to experience disorders, then this is a reason to contact an endocrinologist to exclude endocrine diseases. That is, it can be a combination of the climacteric period, and climacteric disorders, and, for example, thyroid diseases.Not everything is so simple with us. Everything is ambiguous.

Olga Beklemishcheva: I see. Well, a woman is a mystery in many ways, and probably in medical ones too.

Are there any necessary additional elements in order to carry out the prevention of further disorders during the climacteric period? Well, I mean osteoporosis, cardiovascular disorders and so on.

Tatiana Chebotnikova: The optimal option in order to solve problems with the skeletal system is sufficient physical activity, a correct lifestyle (I will not dwell on it, since we know perfectly well what is included in this concept), and adequate intake of calcium supplements.That is, we must receive it either with dairy products or take calcium supplements. The best option is in combination with vitamin D3. That is, since the main building material for bones is precisely calcium, if we take an insufficient amount of it with food, the result will be the mobilization of calcium from the bones, which we absolutely need for daily life, that is, every hour, every moment, every second of our existence. And, naturally, bones will suffer from this.

Olga Beklemishcheva: That is, hormone replacement therapy is combined, say, with the prevention of osteoporosis in the form of calcium preparations?

Tatiana Chebotnikova: This is a great combination. And this must be done, because not every woman is a lover, for example, of dairy products.

Olga Beklemishcheva: But how is hormone replacement therapy combined with other diseases? I mean, first of all, of course, diabetes.

Tatiana Chebotnikova: Diabetes is a disease that can limit the choice of a drug for hormone replacement therapy. But we have at least two types of diabetes: type 1 diabetes – with an absolute lack of insulin; diabetes of the second type, which is associated with the insensitivity of peripheral tissues to insulin – and, accordingly, completely different mechanisms of the development of these diseases. In both cases, it is possible and necessary to use substitution therapy for the treatment of climacteric disorders, if necessary.Perhaps the choice of drugs will be more stringent, but we will already analyze this in the following options.

Olga Beklemishcheva: And there is also a pager question related to overweight women. Is it possible to choose a drug that will not carry the risk of weight gain?

Tatiana Chebotnikova: Preparations of female sex hormones, they do not lead to weight gain. The studies that have been carried out, and a lot of studies are devoted to the increase in body weight in women, and it turns out that weight gain does not begin at all at 50 years old and with the onset of menopause, but begins precisely at the age of 30.That is, when a woman reaches a certain social position, she becomes physically less active, she spends more time at sedentary work, or it is connected with her family, if she is a housewife. That is, she has less time left for physical exercises. And that’s when the weight gain begins. Well, what self-respecting boss would go by public transport or walk if he has a car? Or, for example, walk up the stairs when there is an elevator for this.In no case. And all these little details that are associated with social status, they lead to the fact that physical activity is reduced. Due to our workload, physical activity decreases. But the diet remains the same, the number of calories consumed does not decrease. And as a result, the weight gradually increases, there is a slow increase in weight. Our task, having noticed an increase in weight, in time to restructure our diet, our diet in order to remain slim and charming.

If a woman experiences weight gain during menopause, the mechanism is the same – a discrepancy between the amount of calories consumed and the physical activity that a woman experiences every day.

Olga Beklemishcheva: Dear women, our program is coming to an end. And I draw your attention to the main points, first of all, to the fact that you can be shown hormone replacement therapy in menopause, you do not need to be afraid of it, you just need to find a good doctor and do good tests.

All the best! Try not to get sick.

90,000 How your age affects your appetite

  • Alex Johnston
  • Head. Department of Nutrition, University of Aberdeen

Photo Credit, Getty Images

We need food every day, but our attitudes towards it change with age, and these changes can have a profound effect on our health.

Do you eat to live or live to eat? Our relationship with food is quite confusing, influenced by the price of food, their availability, and even pressure from others.

But all people understand what appetite is. There is desire – we all experience it.

Hunger (the way our body makes us want to eat when it needs nourishment) is just one of the factors affecting appetite, far from the only one.

After all, we often eat when we are not hungry at all, and sometimes we can refuse food, despite the fact that we are very hungry.

A recent study has shown the abundance of factors that influence our desire to eat: smells, sounds, advertisements … In the modern world there are so many temptations associated with food that they become one of the main reasons for overeating.

Our appetite is not something fixed once and for all, over the course of life, as we age, it changes.

As Shakespeare would say in this case, appetite has seven actions (meaning the famous monologue of Jacques from the play “As You Like It”, which begins with the words “The world is a theater; / In it women, men, all are actors; / Each has its own entrance and exit, / And the person is the same role / Different plays in the play, where / There are seven actions “- Approx. Translator ).

Understanding these seven phases can help develop new ways to prevent the health consequences of both overeating and malnutrition.

The first decade (0-10 years)

In early childhood, our bodies go through stages of rapid growth, and the eating habits formed here can spread into adulthood – for example, by making a fat child a fat adult.

Increased fastidiousness or dislike for any particular food makes each feeding of the child a real challenge for his parents, but the strategy of repeating over and over again in a positive atmosphere acquaintance with tastes and foods, maybe unusual, but important – for example , with various vegetables.

Photo Credit, Getty Images

Photo Caption,

Childhood dislike of a particular food can lead to nutritional problems in adulthood

In addition, children should be monitored while eating, especially regarding portion size. Forcing a child to eat every last bite is a risk that as he gets older, your son or daughter may lose the ability to listen to his own appetite and the signals that the body gives through the feeling of hunger.As a result, already in adolescence, a child can get fat.

Governments of some countries are already calling for children to be protected from fast food advertising – not only television, but also on Internet applications, social networks and video blogs.

Second decade (10-20 years)

In adolescence, hormones affect appetite, which signals the onset of puberty. Future habits and, by and large, the choice of lifestyle depend on how the relationship with food develops in this critical period.

This means that the decisions that young men and women make about their own diet at this age are inextricably linked to the health of those representatives of the next generation, whose parents they will become.

Unfortunately, without proper advice and guidance, teens easily develop unhealthy eating habits.

Because of their reproductive biological characteristics, young women are more likely than young men to suffer from malnutrition or malnutrition.

Girls at this age are at particular risk in the event of pregnancy, since their bodies are still growing on their own, and it is difficult for him at the same time to take care of the fetus.

Third decade (20-30 years)

Changes in life such as starting university, marriage or life with a partner, motherhood, can trigger weight gain.

Having accumulated fat, the body then with great difficulty refuses it. It sends us strong signals in the form of hunger and increased appetite when we consume less than necessary, but other signals – which should prevent overeating – are usually much weaker.

There are many physiological and psychological factors that greatly interfere with our desire to eat less and keep from overeating for a long time.

Photo by Getty Images

Caption,

The stressful situations we regularly experience between the ages of 20 and 30 are also pushing us to gain weight

A number of new studies are now focusing on how to develop feelings satiety, the feeling that you have already eaten enough.

For those who are trying to get rid of excess weight, such a technique would be very useful, because one of the main barriers in this situation is the feeling of hunger (the body continues to tell you that you need to eat more, although in fact it is too much).

Different foods send different signals to the brain. It is very easy to eat a serving of ice cream because fat does not send us a signal to stop eating.

On the other hand, foods rich in protein, water or fiber keep us feeling fuller longer.

It may be necessary to work in partnership with the food industry to find a way to put the right sensations in different meals and snacks, leading to healthy choices.

The fourth decade (30-40 years)

The working life of an adult brings new problems – and this is not only a constantly rumbling stomach, but also stress, which has a direct impact on appetite and food preferences in 80% of the population. At the same time, stress as much as increases appetite and leads to its loss.

It is interesting that scientists still do not understand very well what exactly becomes the reason for the irrepressible desire to consume this or that specific product (most often, high-calorie). Some researchers even doubt the existence of such a phenomenon.

Scientists emphasize that our “eating behavior” under stress can also be influenced by our personality traits, such as perfectionism and conscientiousness.

Redesigning our offices so that they do not have vending machines with fast food and all kinds of chocolate bars is not an easy task.

Employers must understand that for the health and effectiveness of their employees, they must promote healthy eating – not to mention reduce stressful situations.

Fifth decade (40-50 years)

The word “diet” comes from the Greek δίαιτα, which means “way of life”.

We are people of habit, we often just do not want to change our usual way of life, even if we know that it will be useful.

We want to eat what we want, not change anything in our lives and still expect to keep our mind and body healthy.

Photo author, Getty Images

Photo caption,

In middle age, stress pushes us towards high-calorie foods

There is a lot of scientific evidence that our diet is one of the main factors affecting health (or rather, ill health) and the death rate of people.

The World Health Organization (WHO) lists these factors: smoking, unhealthy diet, physical inactivity and alcoholism.

It is between the ages of 40 and 50 that a person should change their lifestyle as their health dictates, but symptoms of illness (such as high blood pressure or cholesterol levels) are often very difficult to notice.

So many of us are just missing out on time.

Sixth decade (50-60 years)

After 50, we begin to gradually lose muscle mass – about 0.5-1% per year.

This is called sarcopenia, and factors such as decreased physical activity, intake of too little protein, and menopause in women accelerate muscle loss.

A healthy and varied diet, combined with physical activity, is essential to reduce the effects of aging.

And here we have to say bluntly: for old people who need tasty, inexpensive and protein-rich food, little is done. There are very few products on the market that would meet the requirements of an elderly body, its need for protein.

Seventh decade (60-70 )

People have begun to live longer, and one of the main problems associated with this is how to maintain a proper quality of life in old age.Otherwise, we risk becoming a society of the very old and very decrepit.

Photo author, Getty Images

Photo caption,

In old age, the importance of proper nutrition for maintaining health increases even more

Proper nutrition is very important, since old age also brings with it poor appetite, lack of hunger. This leads to unintentional weight loss and physical weakness. Decreased appetite can also be the result of an illness such as Alzheimer’s.

Food is largely a social experience, and the loss of a partner or the whole family, leading to the fact that a person begins to eat breakfast, lunch and dinner alone, affects his appetite, reduces the degree of pleasure from food.

Health problems inherent in old age – difficulty swallowing, aching teeth, gradual loss of taste and smell, etc. – also reduce the urge to eat.

Remember that throughout our lives, food is not just fuel for us, but also a social and cultural experience.We are all food experts – we eat every day.

So we better use every meal as an opportunity to enjoy – both from the food itself and from what a healthy diet gives us.

Alex Johnston heads the Department of Nutrition at the Rovett Institute at the University of Aberdeen. This article was written for The Conversation and is published here under a Creative Commons license.

How to keep fit during menopause?

There are many “horror stories” about menopause on the Internet.After reading the forums, we realized that some impressionable people from a lack of objective information sometimes panic. In addition, many women do not understand when “it” has already begun and whether it is “it”. For clarification, we went to the doctors.

Do not panic

Doctors say that there is nothing terrible for a woman during menopause. This is a normal stage in life, not a natural disaster. In addition, now there are many ways to prevent or reduce the manifestations and negative effects of menopause.

“This is an extinction of the reproductive function of the body,” says Valery Orlov , obstetrician-gynecologist at polyclinic No. 7 . – Nature itself decides for you that you have raised children, you do not need new ones, you have to live for yourself and pamper your grandchildren.

The doctor explained that menopause is the last menstrual period in a woman’s life. It is defined retrospectively, in other words, “retroactively”: if the last menstruation was a year ago, then it was menopause.The average age for this is 45 – 53 years. Before that – early, and after – late menopause.

Menopause does not come suddenly, it is preceded by premenopause – a period when the level of estrogen and progesterone begins to decline. Menstruation cycles become irregular, their nature and duration change. The term “postmenopause” refers to the period that lasts throughout a woman’s life after menopause. At this time, hormonal changes take place in the body.Gradually, estrogen levels stabilize at low levels, and unpleasant menopausal symptoms disappear in many cases.

No need to steam

According to statistics, up to 80% of women face manifestations of climacteric syndrome of varying intensity and duration.

– Only 3% of women enter menopause without symptoms, says Valery Orlov. – That is, the menstruation ends and nothing negative in the psycho-emotional state happens – there is only joy because there is no need to worry in anticipation of their beginning.

According to the doctor, menopause is manifested by hot flashes, increased sweating, decreased sex drive, weight gain, dry vaginal mucosa, osteoporosis, as well as nervous disorders, anxiety, sleep disturbances: heredity, body irradiation, disharmony in family relationships, physical inactivity. ”

As Valery Anatolyevich explained, with hot flashes up to 10 times a day, a mild form of menopause is noted, and more than 20 times a severe one.In hot flashes, it is best not to consume hot drinks, especially at night. It is recommended to give up spicy and very hot food, alcohol, tobacco. Shows a contrast shower in the morning and evening, walks before bedtime. “You can only wash in the bathhouse. Do not take a steam bath, ”the doctor draws attention.

Weight gain in menopause is the body’s defensive reaction: “Fat itself produces estrogens, so food is processed into fat. Meals should be fractional, low-calorie. ”

The main thing is regularity

Head of the medical prophylaxis office of polyclinic № 7 Ksenia Ivanova draws attention to the fact that it is important to maintain physical activity during menopause.In this case, it is not so much the intensity of the exercise that matters as the regularity. Exercise should be at least 30 minutes a day.

What is recommended? Walking, swimming, skiing, swimming, yoga. The most accessible thing is morning exercises. You need to form a set of exercises taking into account your physical capabilities and existing diseases. For example, in case of osteochondrosis, exercises for stretching and strengthening the muscles of the back are shown, and in case of heart problems – walking and light jogging.But in any case, you need to consult a doctor.

– Be sure to be in the fresh air regularly. At the same time, it is important to remember that women during menopause are not recommended to stay in the sun for a long time, – says Ksenia Aleksandrovna.

How to be treated

Any medication for menopause should be prescribed by a doctor, taking into account the woman’s condition and her concomitant pathology. In no case should you start hormone replacement therapy yourself.

– Symptomatic therapy is selected individually. Phytotherapy is possible – taking herbal estrogen-containing preparations, says Valery Orlov. – Hormone therapy is prescribed for severe menopause. With emotional lability, sedatives such as bromine, valerian, glycine help. In osteoporosis, the intake of drugs is complex, aimed at restoring mineral metabolism with the addition of calcium supplements. In conclusion, we can say that the cessation of menstruation does not mean that old age has come.You can grow old much earlier, if you do not monitor your appearance and lead an inappropriate lifestyle.

Inna Anokhina, newspaper “Voice of Cherepovets”

drug search, prices and availability of drugs in pharmacies in Ilyichevsk and Ukraine

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