| When a hot flash occurs: A very sudden, explosive phenomenon occurs that takes place over about 30 seconds to 5 minutes. First there is an increased skin perfusion,leaving the skin red and flushed. This is followed by increased skin temperature, followed by changes in circulating norepinephrine and other hormone levels and an increase in heart rate. A woman may break out in a sudden cold sweat. At night, a woman may be awoken by the sudden outbreak of a drenching sweat without associated flushing symptoms. Osteoporosis Contrary to appearances, bones are very active. Bone tissue is in a constant state of flux, being laid down by “osteoblasts”, and continually being absorbed by”osteoclasts”. About 4% of the surface of all living bone has osteoblastic activity occurring, so that at least some new bone is formed constantly. These two processes of absorption and deposition are in balance; they are equal to each other so that the total mass of bone remains constant. Estrogen stimulates osteoblast activity, and thus keeps the balance in favor of constant bone mass. When estrogen is absent, less bone matrix is laid down, and the bones become weak. Genetics play a very strong role in who will develop osteoporosis; the lifetime average risk in women is 25%; if her mother or sister has osteoporosis, the risk increases to 50%. Calcium, vitamin D, vitamin C, and weight-bearing exercise all have some effect on maintaining bone mass, but none of these, individually or in combination, have the same effect as estrogen or the newer drugs designed to prevent and treat osteoporosis. Treatment Menopause, per se, does not require treatment, but symptoms and the sequelae of decreased estrogen may. Since the publication of the Women’s Health Initiative in 2001, the way that menopause has been managed has changed, and individuals must determine the nature and extent of treatment that is necessary. In many cases, no treatment is needed. Where indicated, many of the symptoms and sequelae of menopause can be relieved with combined hormone replacement therapy, bioidentical hormone replacement, selective serotonin reuptake inhibitors, other medications, dietary and behavioral adjustments, and alternative therapies including herbal supplements, homeopathic remedies, acupuncture and acupressure, naturopathic approaches, etc., with new therapies being developed all the time. |
Menopause is most often considered the cessation of menstrual bleeding, but that is only one aspect of the climacteric process. The mean age of menopause in the United States is around 51 years, most often sometime between 45 and 55 years. If menstruation ceases before age 40, a woman is felt to be in “premature ovarian failure”. Menstruation after age 55 is considered abnormal, and should be evaluated. Essentially, women are born with all the eggs they will ever have. At menopause, the follicles that contain those eggs become depleted and estrogen production decreases. However, the other cells that make up the matrix of the ovaries, the “stroma”, continue to function and produce chemicals that are destined to become male-like hormones. Therefore, the ratio of male-like hormones to female-like hormones changes and several things occur as a result. Many systems are affected by changes in the absolute and relative amounts of hormone produced. Physiologic changes
o Vaginal bleeding o Pain with intercourse
o Urinary incontinence o Urinary frequency
o 1/3 of American women will seek help with hot flashes o 20% of women with hot flashes will have more than one a day o Rarely, women will have hot flashes that persist > 5 years
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| Menopause |
| Brenda L. Kehoe, M.D. |
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