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MENOPAUSE FACTS: PATIENT INFORMATION A Summary of Information Obtained at the North American Menopause Society Meetings--- by DR. SUZANNE MONTEMURO

Menopause refers to that period in a woman's life when the ovaries gradually stop producing the hormones Estrogen and Progesterone. This process takes many years and is unique for each woman.

The years which precede MENOPAUSE (the final menstruation) are often referred to as the TRANSITION. The TRANSITION can start anywhere from the mid 30's to early 40's. It is often a time of increased PMS, irregular menstrual bleeding, fluctuating moods, and sometimes migraines, night sweats and hot flushes. The cause of these symptoms are the widely fluctuating amounts of Estrogen and Progesterone that the failing ovaries produce. At times these hormone levels (which can be measured in a blood test) are too low and at other times they are much too high. Women can often feel "not quite right", as the internal melieu of their bodies changes dramatically from month to month. Menstruation continues, although sometimes irregularly throughout the Transition. MENOPAUSE follows the TRANSITION. At this point natural menstruation stops. This usually happens at about age 50. Menstruation usually does not stop suddenly but becomes erratic, often missing for months at a time only to return for shorter and shorter periods. The symptoms which many women notice at this time are hot flushes, night sweats, insomnia, vaginal dryness, memory changes, muscular and joint aches and some lack of interest in sex. These symptoms vary in each individual woman. They may last from a few months to many years. In some women MENOPAUSE occurs suddenly because their ovaries (which produce Estrogen and Progesterone) are surgically removed for medical reasons. These women experience sudden, severe menopause symptoms. Menopausal symptoms are most severe the first year after menopause and gradually abate over time. Some women, however, continue to have hot flushes etc. many years after menopause. The POST-MENOPAUSAL YEARS follow. In the early 1900's the average life expectancy for women was approximately 5O to 6O years. Many people were considered'old'by the time they were in their late 40's and early 50's. This meant that many women experienced the POST-MENOPAUSAL YEARS for a relatively short time. Today, in Western Society, a woman can expect to live an average of 80+ years. She can expect to have 30-40 POST MENOPAUSAL YEARS. Research and new information about this period is being assessed with the view to finding ways to make the quality of women's lives better than it has been in the past. The North American Menopause Society is a multi-disciplinary body that promotes both research and education in this rapidly expanding field. What advice do I have for women entering this challenging passage. Preparing for MENOPAUSE long before it occurs is of great importance. A diet that has adequate calcium (1 000-1 500mg per day) and vitamin D(400-800 l.U. per day) will enable women to build strong bones during the reproductive years when estrogen is still available to promote bone growth. A diet which Includes plenty of vegetables, fiber, and fruits, while limiting saturated (animal) fats also helps prevent heart disease and cancer (especially colon, breast and uterus cancers). Smoking should be stopped because it causes osteoporosis, cancer and heart disease. A regular program of weight-bearing exercise builds bone and prevents heart disease. It also is good psychologically. TRANSITION symptoms of irritability, mood swing and PMS can be alleviated using vitamins and herbs (B6 @ 100 mg per day, Evening Primrose Oil @ 3-6 caps per day or Priminal @ 2-4 caps per day). Excessive bleeding and hot flushes can be extremely bothersome. Herbs like Dong Quai (2-12 tabs per day) can control mild Transition symptoms. Progesterone hormones like Provera and Prometrium or the new Mature-women's oral contraceptives(Marvelon, Ortho-cept, Cyclen, Minestrin etc.) controls these symptoms when they are severe. Remember that the body's internal melieu is continuing to change, so none of these remedies need be used for very long. They serve only to help women overcome some specific symptoms while the body continues its progress towards MENOPAUSE.

Once MENOPAUSE occurs some women experience an increase in hot flushes, depression, and vaginal dryness. If these symptoms are mild one could use herbs like Dong Quai(? dose) and Ginseng (2-6 caps per day) or Vitamin E (400-800 IU.per day). If symptoms are severe and interfering with sleep and normal daily activities then Hormone Replacement should be tried. I recommend a short trial of Estrogen for about three weeks to see whether it helps, If it relieves symptoms and increases a person's sense of well-being then it should be continued. Try and find the lowest dose of estrogen that relieves the menopausal symptoms. How long to use Estrogen is a question everyone asks. Each person must be individually assessed. If Estrogen relieves the acute symptoms of MENOPAUSE, then it can be used to gently ease a woman through this period .... perhaps for one to two years and then gradually reducing the dose. Some women prefer to remain on Estrogen and this is a choice they are free to make. Using Estrogen for 5-7 years is both safe and effective. Long Term Studies have been carried out on the use of POST-MENOPAUSAL estrogen. Most studies carried out on Premarin .625 or.3 have shown it to be safe up to 20 years. Other studies however, show a slight increase in Breast Cancer after 7-1 0 years of estrogen therapy especially in women over the age of 60. It is not clear if this increase is related to the dose or type of estrogen that women use. More investigation is needed in this area of long term safety. It makes sense, however, to keep the dose low. Women need to weigh the risks and benefits of long term therapy individually. Progesterone (Provera or Prometrium) must be added to Estrogen Therapy in women who have a uterus. This hormone can be taken on a cyclic basis (10-12 days per month) which will result in monthly shedding of the uterus lining (a withdrawal bleed). Sometimes progesterone is taken intermittently (i.e. every 2-3 months). This will result in a withdrawal bleed on those months when the progesterone is taken. Other women take a very small amount of progesterone on a continuous basis along with Estrogen. When taken in this way withdrawal bleeding is very light and gradually stops altogether. Individual preference helps choose between these various methods. Regular Medical Checkups are an essential part of POST-MENOPAUSAL preventative health. Breast Self Examination as well as Mammograms are important. Pelvic exams should continue and abnormal vaginal bleeding must be investigated. Long term use of Hormone Replacement is a new prospect for the future. If a woman is at high risk, or suffers from Osteoporosis or Heart Disease she may be wise to consider this option. The major cause of death after MENOPAUSE is Heart Disease. Estrogen deficiency has now been shown to play a role in the development of POST-MENOPAUSAL Heart Disease and Estrogen replacement has been shown to prevent this. Cardiologists are now considering Estrogen as a Heart Disease Medication for women. Osteoporosis refers to the gradual loss of calcium from bone after MENOPAUSE. This results in easily broken bones especially the wrist, back and hip. Women who have an early MENOPAUSE are at particular risk, as are those who smoke, have a diet inadequate in Calcium, drink excessive coffee/alcohol and rarely exercise. A family History of Osteoporosis is significant. Thyroid Disease and Cortisone Therapy increase the risk of brittle bones. Estrogen both prevents Osteoporosis in early MENOPAUSE and treats Osteoporosis in later years. Estrogen can increase the strength of weak bones. It is important to consider this option if a woman's Osteoporosis risk is high or if she already has Osteoporosis. One can determine the strength or weakness of bones by doing a Bone Density Study. Women going through 'rthe Change" today are taking a much different approach than their Mother's did. They are talking about MENOPAUSE like never before. They are sharing their experiences with each other and gaining strength and enlightenment from doing so. They realize that with every " Change" in their lives comes first, a sense of "loss" which is later replaced by a sense of "re-birth" as a new stage in life begins. The POST-MENOPAUSAL YEARS are likely to be the very best years for many women today. With the experience and wisdom of their years and good health and more personal freedom, mature women stand to make significant contributions to their own lives and to those around them.