Menopause

What is menopause?

Menopause is another name for menopause. Menopause is the period around the last menstrual bleeding, which is also called menopause – ie the time when the menopause. Menopause comes in 45-55 years of age in most women. Menopause begins a few years before the last menstrual period. When approaching menopause, there may be warning signs in the form of bleeding disorders and symptoms such as hot flashes. Some women have no genes at all associated with menopause – the bleeding just keep up, either gradually or suddenly. Most, however, symptoms in some extent, and some are so annoyed that they need treatment.

Women who have had the uterus removed before menopause, menopause is generating the same extent as other women.

bleeding disorders

It is usually with irregular bleeding  associated with menopause. For some it begins as early as 40 years old. Some women may have heavy menstrual bleeding, while in others are rare and irregular. In the last years before menopause, many alternating bleeding, which in turn can be month break, periods of irregular and frequent menstrual periods and other periods of a more normal menstrual cycle. It is typical of menopause, the bleeding is unpredictable and variable. In general, decreases bleeding in volume and becomes more rare toward menopause.

Hot flushes and sweating

When there is less of the hormone estrogen in the body associated with menopause, you become more sensitive to temperature fluctuations. A small temperature rise is enough that the body will try to get rid of the heat. This is why hot flashes, which is something most women experience a greater or lesser extent during menopause. Some may have only a hot flush or two, others have 100 per day and continues to have, even after they are filled 70th

Hot flashes can start with a warning, where you feel it is coming. Then appears a very intense feeling hot, especially on the face and upper body. Some sweat while violently. The flush can last a few minutes and be accompanied to anxiety and palpitations. They are frequently at night. If you have many nocturnal hot flashes, it affects the quality of sleep and one’s abilities during the day.

Many find that coffee, alcohol, spicy food, stress and high temperatures may cause hot flashes.

Before menopause may have hot flashes just before or during menstruation. After menopause is the hot flush most pronounced for the first few years so as to decrease gradually. Every fifth woman still has symptoms five years after menopause, and in individual genes can last for 10 years or more.

Mucosal Changes

When the estrogen lost after menopause are the mucous membranes of the abdomen thinner and more vulnerable. In the urinary bladder and urethra can change mean that, more likely to get cystitis . Thin, dry and sensitive mucous membranes  in the vagina can cause problems associated with sex.

The mucous membranes elsewhere in the body can also be changed. It is, for example. not uncommon to experience dry eyes  after menopause, and it can cause problems if you wear contact lenses.

bone loss

There is a slow loss of bone tissue from the mid-30s in both men and women. Bone tissue is sensitive to estrogens, and during menopause increases the loss of bone tissue, thus losing 10-15% of the existing bone mass in the first 10 years after menopause. Women already have more fragile bones than men, and when they lose bone mass at menopause increases the risk of fractures.

cardiovascular disease

Before menopause, women have lower risk of cardiovascular disease – for example. blood clots and high blood pressure – than men. It is believed that this is because estrogen has a protective effect on blood vessels and prevents atherosclerosis. After menopause increases women’s risk for cardiovascular disease, and age 65 is as high as men’s.

What causes menopause?

Normally producing ovaries of the female hormones – estrogen and progesterone. Estrogen builds lining of the uterus up and strengthens the mucous membranes of the vagina and urinary tract. Progesterone stabilizes the lining of the uterus so that your periods are regular. Estrogen also prevents the loss of bone tissue and prevents  atherosclerosis . The genes in menopause can largely be explained by estrogen deficiency, but fluctuating production of progesterone also contributes, especially for bleeding disorders.

Smokers and thin women are more at risk for atherosclerosis, genes from mucous membranes and bone loss. The same applies to women who have ovaries removed by surgery, or if the ovaries are destroyed by chemotherapy. They get a sudden drop in hormones that can lead to genes is stronger and lasts longer than in other women. Inheritance also seems to have an impact on when you go into menopause and how much distress you get.

Obese women are at greater risk for hot flashes.

How is it diagnosed?

If a woman over 45 years, hot flushes and bleeding disorders can be assumed that it is menopause and it is not necessary to investigate further. If the woman is under 45, your doctor may. take a sample of hormone levels. In the sample can be, inter alia, measuring the amount of FSH (follicle stimulating hormone), the overall sex hormone that stimulates the ovaries. FSH is elevated in menopause and can remain so for several years before menstruation stops. Moreover swings considerably during menopause, so you can not use it to say something about when menstruation stops.

If the woman has a bleeding problem, the doctor will perform a gynecological examination.

What treatment is there?

The purpose of treatment is to reduce the genes, i.e. hot flashes and / or mucosal changes.

There are some simple precautions you can take – for example. using layer-by-layer clothing, keep the bedroom cool and avoid provocative factors. There are a number of preparations that claimed to be good against menopausal symptoms. Generally, there is no evidence for the effect, so you have to feel your way, and see what you think works best.

The most effective treatment of menopausal symptoms is hormone replacement therapy with estrogen.

Against discomfort in the lower abdomen

Genes in the vagina and urinary tract can be treated with locally acting estrogen. It is available as cream or suppository that can lead into the vagina 2-3 times a week. There is also an estrogen ring that can be put in the vagina, without being able to feel that it’s there. It should be changed every 3 months. You can do it yourself or get help from the doctor.

Anyone can tolerate topical therapy and can be life-long. It takes up almost no hormone in the body, so this treatment has no effect on hot flashes or bone, nor have some side effects. You do not get bleeding when using topical treatment.

If you will not use hormones, you can buy over the counter preparations. These often contain hyaluronic acid and is used several times a week. During intercourse should use a good lubricant.

Against Hot Flashes

Estrogen supplementation is the most effective treatment of hot flashes. It is available as tablets, patch and gel for spreading on the skin. Treatment with the gel or patch with the least side effects and are therefore preferred more and more. Usually start with a small dose, sees the effect depends for 2-3 months and then increase the dosage if necessary. It used the same type of estrogen that woman generates in the ovaries.

If you have not got uterus removed, you also have the progestin (synthetic progesterone) to protect the uterine lining and prevent bleeding problems. It can be given as tablets or other dressings, or as the IUS, which is widely used particularly in combination with estrogen as a patch or gel.

In most cases, start with a treatment that lasts 1-2 years. You can then pause to see if there are still genes. During hormone recommend one annual check to the doctor when we are discussing how long the treatment should last for new elements that militate for or against treatment, or whether there have been new knowledge about hormones.

By systemic hormone therapy may be an increased risk of breast cancer, blood clots, cardiovascular disease, biliary diseases and growth of fibroids in the uterus. The risk is not the same for all women. It depends on the woman’s age, if she is otherwise healthy or not, her lifestyle, the type of hormones and dose. Therefore, it is important to discuss the pros and cons with her doctor before starting on HRT. In otherwise healthy women in their 50s Research indicates that the net effect of taking estrogen is beneficial.

There have been written and said about the advantages, disadvantages and side effects of hormone therapy. Use of hormones associated with menopause has been halved since the early 90s, and many doctors find it difficult and time consuming to get acquainted with all the details.

The dose you today recommend by hot flashes, is only half or a quarter of the one previously used. Most believe that there is no significant risk by taking hormones for a few years by bothersome hot flushes. Others think you should avoid any hormonal therapy. No matter what you choose, you have to feel comfortable with his choice.

Women who have had blood clots, breast cancer or pelvic cancer should be seen by a specialist before starting hormone therapy.

How is long-term prospects?

Without treatment, hot flushes usually disappear or diminish after a few years, but some are bothered for many years after the last menstrual bleeding. Problems with dry and sensitive mucous membranes of the abdomen is not better with time. The effect of hormone therapy is good and dampening genes quickly. The normal development after menopause is the occurrence of osteoporosis , cardiovascular disease and urinary tract infection increases significantly. These natural consequences of aging may to some extent be prevented by hormone treatment, as long as you are using this medicine. Hormone therapy is not recommended for the prevention of these conditions, but only for the symptomatic treatment.