Early Menopause Signs And Symptoms UK – Each woman responds to the ageing process in her own way. Most women have coping skills that adequately equip them to deal with the gradual changes associated with ageing. Factors that may provoke a lowered self-esteem are the loss of youth, a sense of emptiness as children leave home and the need to redefine one’s self-concept and roles as parenting becomes less important. Women who place a high value on their physical attractiveness may experience a painful psychological response to the physical changes of menopause.
As a woman progresses through the perimenopausal period, changes in her appearance and the loss of childbearing ability may combine to make her feel vulnerable to community stereotyping of the ‘older woman’ as less attractive and unproductive. Although this is far from the truth, with women living at least one-third of their lives after menopause in productive careers and activities, it nevertheless is the perception of women as well as society.
Menopause is the permanent cessation of menses. The climacteric, or perimenopausal, period denotes the time during which reproductive function gradually ceases. For most women, the perimenopausal period lasts several years. It begins with a decline in the production of the hormone oestrogen, includes the permanent cessation of menstruation due to loss of ovarian function, and extends for 1 year after the final menstrual period, at which time a woman is said to be postmenopausal. On average, women live one-third of their lives after menopause.
Menopause is a normal physiological process. It is not a disease or a disorder. It is included here because it does increase the risk of physical disorders, as well as affecting various aspects of women’s health. Many women welcome the freedom from monthly menstrual periods and have relatively minor physical effects from the reduction in oestrogen. However, the hormonal changes that occur can be accompanied by side effects. There is wide variation in how individual women experience these side effects. In Australia, most women cease menstruating at between 48 and 55 years of age, with the average being about 50 or 51 years. Early menopause is when a woman stops menstruating before 45 years of age. In 50% of cases of early menopause there are no known causes. However, early menopause is associated with surgical removal of the ovaries, chemotherapy and radiotherapy. After menopause certain health risks increase, including heart disease, osteoporosis, macular degeneration, cognitive changes and breast cancer.
The physiology of menopause
The menopausal period marks the natural biological end of reproductive ability. Surgical menopause occurs when the ovaries are removed in premenopausal women, dramatically reducing the production of oestrogen and progestins. Chemical menopause often occurs during cancer chemotherapy, when cytotoxic medications arrest ovarian function. As ovarian function decreases, the production of oestradiol (E2) decreases, and is ultimately replaced by oestrone as the main ovarian oestrogen. Oestrone is produced in small amounts and has only about one-tenth the biological activity of oestradiol. With decreased ovarian function, the second ovarian hormone, progesterone, is also markedly reduced.
As oestrogen decreases, various tissues are affected, and breast tissue, body hair, skin elasticity and subcutaneous fat decrease. The ovaries and uterus become smaller and the cervix and vagina also decrease in size and become pale in colour. These changes may result in problems with vaginal dryness, dyspareunia, urinary stress incontinence, urinary tract infections (UTIs) and vaginitis. Hot flushes, palpitations, dizziness and headaches are often caused by vasomotor instability. Other problems resulting from vasomotor instability include insomnia, frequent awakening and perspiration (night sweats). The woman may experience irritability, anxiety and depression as a result of these events.
Long-term oestrogen deprivation results in an imbalance in bone remodelling and osteoporosis, leading to fractures and kyphosis. The risk of cardiovascular diseases increases in response to an increase in atherosclerosis (from an increase in the LDL-toHDL cholesterol ratio). Symptoms of the perimenopausal period are listed in the following box. These symptoms vary widely. Some women experience few or no symptoms, others experience moderate symptoms and some women experience severe symptoms.
Care of the woman experiencing menopausal symptoms focuses on relieving symptoms and minimising postmenopausal health risks. Diagnosis As oestrogen secretion diminishes, levels of FSH and LH rise and remain elevated. A woman who has not menstruated for 1 full year or who has an increased FSH blood level is considered menopausal. Medications Hormone replacement therapy may be prescribed to alleviate severe symptoms of menopause, but only for a limited amount of time and only after a woman has been provided with information about known risks. HRT may include oestrogen alone for women who have had a hysterectomy, or a combination of oestrogen and progestin for women who still have their uterus. The addition of progestin stimulates monthly shedding of the interuterine lining, decreasing the risk of uterine cancer.
HRT relieves hot flushes and night sweats, and decreases problems of vaginal dryness and urogenital tissue atrophy, which can lead to painful intercourse and urinary incontinence. Long-term HRT may increase the risk of breast cancer, ovarian cancer, stroke and venous thrombosis (Mayo Foundation for Medical Education and Research, 2015). However, women who have had a menstrual cycles become unpredictable. menstrual flow varies widely in amount and duration and eventually ceases.
1. Vaginal, vulval and urethral tissues begin to atrophy.
2. Vaginal pH rises, predisposing the woman to bacterial infections.
3. Vaginal lubrication decreases and vaginal rugae decrease in number. This may result in dyspareunia, injury and fungal infections.
4. Vasomotor instability due to a decrease in oestrogen may result in hot flushes and night sweats. A hot flush starts in the chest and moves upwards towards the face, and may last from seconds to several minutes.
5. Psychological symptoms may include moodiness, nervousness, insomnia, headaches, irritability, anxiety, inability to concentrate and depression.
Manifestasioons The perimenopausal period hysterectomy and take oestrogen alone do not have an increased risk of breast cancer. Selective oestrogen receptor modulators (SERMs), such as raloxifene (Evista) and tamoxifen, bind to oestrogen receptors and exert site-specific effects in different target tissues. Tamoxifen and toremifene (a derivative of tamoxifen) have a beneficial effect on bone mineral density, and serum lipids and decrease the risk of invasive breast cancer in women at high risk. They also provide an alternative to HRT for preventing osteoporosis. Alternative and complementary therapies Non-traditional or alternative therapies have become popular as a result of the controversy surrounding the use of HRT.
The following complementary therapies are examples of those used by menopausal women to reduce associated discomfort:
d. herbs such as Cimcifuga racemosa (black cohosh), Vitex agnus castii (chasteberry), Rehmannia, ginseng, the Chinese tonics he shou wu and dong quai, golden seal, flaxseed and evening primrose
e. supplements such as vitamin E and soy protein (soy is high in plant oestrogens)
f. meditation and yoga.
However, there is little reliable research available on the effect of soy, primrose oil, black cohosh or other herbs on decreasing hot flushes or sleep disturbances. However, exercise such as yoga or walking will assist women to maintain a healthy lifestyle and may combat some of the side effects of menopause.