Menopause

Alternative names:

change of life; climacteric

Treatment:

Natural menopause usually requires no treatment. Surgical menopause that occurs prior to natural menopause may require estrogen replacement therapy (ERT). Not all postmenopausal women need to be treated with ERT. Each woman should discuss her individual risks and benefits with her health care provider.

Many physicians recommend estrogen replacement therapy to:

• Reduce the undesirable symptoms of menopause.
• Help decrease vaginal drying.
• Prevent osteoporosis after menopause.

Some side effects of estrogen replacement therapy include:

• Vaginal bleeding.
• Breast tenderness.
• Nausea.
• Vomiting.
• Abdominal bloating.
• Uterine cramps.

To reduce the risks of estrogen replacement therapy and still gain the benefits of the treatment, physicians may recommend:

• Adding progesterone to the estrogen.
• Adding testosterone to the estrogen.
• Using the lowest possible dose of estrogen.
• Having frequent and regular physical exams, including a pelvic examination and Pap smear to detect problems as early as possible.

Numerous studies have been done on the effects of ERT and the results are conflicting. ERT does reduce the severity of hot flashes and vaginal dryness, and helps to prevent osteoporosis. These facts are strongly supported by previous studies and agreed upon by physicians. Some long-term studies have suggested that ERT helps to prevent heart disease, although recent studies have been contradictory. Promising new research studies have suggested that ERT may help prevent Alzheimer's disease, although the results are too preliminary to regard seriously. Some studies show an associated increase in uterine and breast cancers, while others don't. Some show an increase in sex drive; others show a decrease. Rather than helping depression during menopause, estrogen may actually make it worse. Incidence of liver tumors and gallbladder disease may also increase, while the risk of colon cancer may decrease. Studies showed that endometrial cancer was associated with ERT, but when progesterone was added to the therapy (hormone replacement therapy, or HRT), that association disappeared. The addition of testosterone may decrease the amount of nausea experienced with ERT, but may also decrease the positive cardiovascular effect that estrogen alone might have. Until more is known about ERT, women should weigh the benefits and the possible risks against the symptoms being experienced. Thorough discussion with a physician is recommended.

Expectations (prognosis):

Although menopause is a difficult period for some, most women will experience menopause without long-term problems. Many women report an increase in energy, more self-confidence, and a better attitude.

Complications:

Decreased estrogen levels are associated with an increased risk of developing osteoporosis and an increased risk of cardiovascular disease.

Calling your health care provider:

Call for an appointment with your health-care provider if you are a woman older than age 40 who is experiencing the symptoms of menopause and would like treatment for them. Specific symptoms may include:

• Irregular menstrual periods.
• Hot flashes.
• Vaginal dryness.

Call if you are postmenopausal and are experiencing any bleeding.

Also, call if you are experiencing the symptoms of menopause and you are under the age of 40.