Menopause (the change of life) is when women stop menstruating (having periods) and their ovaries gradually stop working. The time leading up to menopause is called perimenopause. Perimenopause is a transition period in a woman's life and signals the beginning of the loss of fertility (ability to become pregnant) because of the body's natural aging process. Perimenopause and menopause are not diseases. They are healthy and natural parts of a woman's life.
Sometimes menopause does not happen naturally but is a result of medical treatments for health problems. Cancer treatments, including chemotherapy, pelvic radiation, and surgery, can cause early menopause. Removal of both ovaries (bilateral oophorectomy ) for any reason starts menopause. Having a hysterectomy alone (removal of only the uterus, not the ovaries) does not cause menopause but will stop a woman's menstrual periods. Medical studies have shown that having a hysterectomy may speed the start of natural menopause by 1 to 2 years. Menopause usually happens between the ages of 40 and 55 years. Earlier natural menopause is more common in women who smoke, women who have had a hysterectomy without ovary removal, and women whose mothers and sisters have had earlier menopause. Most women experience hot flashes, which can last for 1 to 30 minutes but are usually 2 or 3 minutes long. Some women may have hot flashes for several years, and other women only have them for a short time. The February 19, 2003, issue of JAMA includes an article about perimenopause and menopause.
Irregular menstrual periods
Hot flashes
Night sweats
Vaginal dryness
Difficulty sleeping
Mood swings
Abnormal vaginal bleeding—See your doctor if this occurs because there are other causes besides perimenopause
Heart disease—Control high blood pressure and diabetes, maintain a healthy weight, exercise regularly, and eat a low-fat diet rich in fruits and vegetables
Osteoporosis (brittle bones)—Take calcium supplements and exercise regularly
Pain during sexual intercourse due to thinning and dryness of the vaginal walls
Sleep disturbances
Hormone replacement therapy (HRT) has been often prescribed to control menopausal symptoms such as hot flashes. Recent medical studies have shown that HRT does not prevent heart disease in postmenopausal women and may increase the risk of breast cancer. You should discuss your individual benefits and risks of HRT with your doctor.
Regular exercise may reduce the intensity of hot flashes
Eating food rich in soy proteins (isoflavones); legumes (beans and peanuts) may also help hot flashes
Vaginal lubricants may ease dryness and pain associated with sexual intercourse
Wearing clothing in layers and avoiding what triggers hot flashes (exposure to a hot environment, hot drinks, spicy food, alcohol, and stress)
Alternative treatments, such as phytoestrogens (plant-based substances) and black cohosh (an herb), should be discussed with your doctor because they may interfere with some medications
American College of Obstetricians and Gynecologists 800/762-2264 www.acog.org
National Women's Health Information Center 800/994-9662 www.4woman.gov
North American Menopause Society 800/774-5342 www.menopause.org
To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA's Web site at www.jama.com. They are available in English and Spanish. A Patient Page on women and heart disease was published in the December 25, 2002, issue, and one on hormone replacement therapy was published in the August 28, 2002, issue.
The JAMA Patient Page is a public service of JAMA . The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.
Sources: American College of Obstetricians and Gynecologists, National Women's Health Information Center, North American Menopause Society
Topic: WOMEN'S HEALTH
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