A research demonstrated that for non small-cell lung carcinoma, there was an important chance of dying if the females taking these semisynthetic endocrines developed carcinoma.

There were sixty-seven lung carcinoma fatals in the females taking Prempro and thirty-nine among those in the placebo category, according to Chlebowski. The females consuming the synthetic endocrines had an average survival rank of 9.4 calendar months while the selection rate of the females who took the placebo and got the disorder was 16.1 calendar months.

This late analysis concerning Prempro and lung carcinoma fatals was taken from information stemming from the Woman`s Medical Initiative research in which Chlebowski was chief writer. This research took part 16,608 postmenopausal female ages fifty through seventy-nine and indiscriminately assigned these females either a placebo or Prempro. In 2002, researchers ceased this research short of its completion as they noted a substantial multiplied incidence of breast carcinoma and cardiovascular disorder among the females who took the semisynthetic endocrines.

According to Chlebowski, fifteen percent of postmenopausal females still take semisynthetic endocrines.

An endocrine is separated as semisynthetic if it doesn’t have the identical system as is felt in the human body. When a semisynthetic endocrine is taken into the body, the body metabolises it otherwise than it would a natural endocrine. This difference may account for the a lot of grave fallouts females who take semisynthetic endocrines encounter.

Fortuitously, natural endocrines do exist and have been applied by holistic doctors for a lot of years. Natural endocrines have an identical construction as those discovered in the human body and are applied to effectively cure climacterical period attributes. Natural endocrines are available in creams, capsules, patches, and additional system delivery processes. Prior to ordering natural endocrines, the holistic practitioner will exam a woman’s current endocrine level through blood, urine, and saliva examination.

As you near climacterical period, you could have attributes as a consequence of the shifts your body is making. Many females wonder if such shifts are the right, and a lot of are confused on how to cure their attributes. You could feel better by discovering as much as potential about climacterical period and talking with your health care professional about your health and attributes. If you want to treat your attributes, your health care professional can tell you more about your alternatives and assist you make the best therapy alternatives. Climacterical period is a pattern part of life, exactly like pubescence. It is the time of your last time period, but attributes can start some years prior to your last time period and last for calendar months, or even years, thenceforth. Once around age forty, you may detect that your time period is dissimilar — how long it endures, how much you hemorrhage, or how frequently it occurs may not be the same. Or, without warning, you may discover yourself feeling very warm during the day or midmost of the nighttime. Altering rates of oestrogen and progesterone, which are 2 female endocrines made in your ovaries, may lead to these attributes.

A lot of females and their physicians call this time of shift “perimenopause.” Perimenopause frequently commences some years prior to your last catamenial time period. It lasts for one year afterwards your last period of time. A complete year without a time period is required prior to you are able to say you’ve been “through climacterical period.” Postmenopause follows climacterical period and endures the rest of your life.

Some 42 million American women will be aged between 45 and 64 years by 2010, and this figure will rise to 47 million in 2050. Menopause is a natural phase of female development, which is uncomplicated in most women. However, it is estimated that at least 7 million women in the USA alone will present to primary care or gynecology for help with the more distressing symptoms of menopausal transition over the intervening 40-year period.

The ten-article collection has been compiled by, and contributed to, by Dr Jeanne Leventhal Alexander, Director, Northern California Kaiser Permanente Psychiatry Women’s Health Program, and Founder of the Alexander Foundation for Women’s Health, a not for profit organization, http://www.afwh.org. The focus of the clinical review collection is to address the likely etiology and treatment of midlife patients who have new complaints or complain of an exacerbation of preexisting complaints in the context of their menopausal transition. The reviews highlight somatic symptoms of depression, the depression continuum and its impact on morbidity and functioning, treatment issues related to remission of depression, cognitive decline or impairment secondary to mood disorder, sleep problems in women and their impact on well-being and functioning, and attention and working memory problems in the vulnerable woman patient.

The audience for this collection spans a wide range of specialties, hence the nomenclature or disorders is carefully defined in each article/section; and summary tables of clinical points are included in selected reviews to help those unfamiliar with the material or those who are familiar but need rapid access to the information. Selected reviews also have case examples to clinically illustrate the material for those who do not practice that specialty.

Dr Leventhal Alexander commented; “The aim of this clinical review series is to examine the evidence for the diagnosis and treatment of the woman who presents with distressing symptoms that she attributes to menopause, whose actual etiology may be a psychiatric disorder, a pre- or co-existing problem such as sleep, mood, stress, or cognitive problems, or a dynamic interaction among one, or more of these, and a symptomatic menopause. Integrated multi-specialty treatment is necessary for the successful treatment of these women who have a combination of these factors, resulting in a distressing and symptomatic menopausal transition.”

Dr Leventhal Alexander continued; “To achieve this integrated multi-specialty treatment approach, the editors of this series have divided it into ten separate reviews, each exploring a different aspect of the comorbid symptomatic menopausal woman’s distressing complaints, their pathophysiology, diagnosis and treatment. We hope that through these articles, readers will come to appreciate the dynamic interactions of genetics (genomic polymorphisms), environment, psychiatric illness and medical comorbidity, and how they interact to affect the health of these patients in the context of a symptomatic menopausal transition.”

The editors of this series are, Dr Jeanne Leventhal Alexander, who has been a psychiatrist at the Northern California Kaiser Permanente Medical Group since 1985, and has served as Director of the Northern California Kaiser Permanente Psychiatry Women’s Health Program since 1995; Dr. Lorraine Dennerstein, Director and Professor , Office of Gender and Health, Department of Psychiatry, University of Melbourne, Australia; Dr. Nancy Fugate Woods who is currently the Dean of the School of Nursing, University of Washington, Seattle, Washington, USA; and Dr. Henry Burger, is a Professor, Prince Henry’s Institute of Medical Research, Monash Medical Center, Clayton, Victoria, Australia.

Expert Review of Neurotherapeutics is a monthly Medline-listed title published by Future Drugs Ltd (http://www.future-drugs.com). The Expert Review series provides healthcare practitioners and research professionals with a unique source of objective, cutting-edge information on the exciting emerging trends in healthcare.

Note: The full series of articles is available for evaluation from http://www.future-drugs.com/r/meno

About Future Science Group

Future Science Group, based in London has developed an innovative publishing portfolio to reflect post-genomic medicine. The sequencing of the human genome was a colossal milestone in the evolution of healthcare, with repercussions for all those involved in the healthcare chain. Through its imprints, Future Medicine, Future Drugs and Future Biology, the Future Science Group provides healthcare practitioners and research professionals with a unique source of objective, cutting-edge information on exciting trends emerging in the light of these advances. Our flagship title Pharmacogenomics has evolved to become a leading source of commentary and analysis from international opinion leaders. Momentum toward an individualized approach to medicine is increasing as the value of linking diagnostic and therapeutic approaches becomes ever clearer. For more information please access http://www.future-drugs.com, http://www.futuremedicine.com and http://www.future-biology.com.

The trend is of particular note because growing numbers of women are turning to alternative therapies to relieve such symptoms as hot flashes, headaches, mood swings and sleep disruptions because of concerns about health risks associated with hormone therapy, which is still considered the most effective way of treating such difficulties. The researchers recommend that physicians learn more about these products so that they can help their patients choose safe, effective methods of treating their symptoms.

“We’re not promoting the use of these alternative therapies,” said lead author Jun Ma, MD, PhD, research associate at the Stanford Prevention Research Center. “We’re just saying that the demand for these therapies is growing and that physicians should be prepared to talk to their patients about it.”

The study appears in the May/June issue of The Journal of the North American Menopause Society. The study was funded by GlaxoSmithKline Consumer Healthcare, which had no role in the study design, data collection or preparation of the manuscript for publication. The pharmaceutical company manufactures the herbal product RemiFemin Menopause.

The study was based on a 2004 online survey of a random sample of 781 U.S. women between the ages of 40 and 60. Because the sample size was small, Ma cautioned that the findings may not accurately represent all women, but said the data provide useful insights into women’s attitudes toward menopause treatments and how much physician guidance they have received in deciding which therapies to use.

Among the women surveyed, nine out of 10 reported having experienced at least one menopausal symptom at some point. When it came to treating their symptoms, 37 percent reported using hormone therapy while slightly less than that – 31 percent – used herbal products. Soy supplements were used by 13 percent.

What interested Ma and her colleagues was that three-quarters of the women who had formerly taken hormone therapy said they stopped primarily because of concern about potential risks. “A majority of the women who had discontinued their hormone therapy were not on any therapy – not because of lack of need or desire to continue, but because they didn’t know which therapy would best suit their clinical needs,” Ma said.

The concerns about hormone therapy stem largely from the federally funded Women’s Health Initiative, a long-term study that turned the conventional wisdom about hormone therapy on its head. For many years, observational studies indicated that in addition to relieving menopausal symptoms, hormone therapy helped protect women against heart disease. However, the WHI found that neither estrogen nor the combination of estrogen and progestin helped prevent heart disease. Instead, although both forms of hormone therapy offered some benefits in easing menopausal symptoms, they both posed substantial health risks.

Despite these risks, hormone therapy is still considered the most effective approach for treating menopausal symptoms. Women are advised to use the lowest possible dose of hormones and to limit the duration of the treatment in order to minimize the risks.

But the new study shows that many women are instead turning to herbal and soy products to ease their menopausal symptoms. The most commonly used herbal products reported by survey participants were ginkgo biloba, ginseng, St. John’s wort, black cohosh or a combination product.

“The reduced use of menopausal hormone therapy, while an appropriate response to the WHI findings, has left both patients and their physicians in a difficult position,” said Randall S. Stafford, MD, PhD, associate professor of medicine and senior author of the study. “While other pharmaceuticals and alternative therapies are available, many physicians are not fully prepared to discuss these options, particularly given the limited data available about the effectiveness of these options.”

Among the women who used herbal therapies, 55 percent chose the products because of concerns about hormone therapy while 45 percent said they wanted to use a natural remedy. But Ma said many women mistakenly equate the term “natural” with “safe,” and falsely believe that herbal products won’t interact with other medications. “That misperception really needs to be corrected,” she said.

In fact, herbal products may have side effects. For instance, some studies have shown that St. John’s wort interacts with selective serotonin-reuptake inhibitors, which are the most commonly prescribed class of antidepressants, and it is recommended that the two not be combined.

Additionally, Ma said there is little in the way of high-quality data on the efficacy of many of the alternative therapies, adding that most of the data are limited to short-term use of the products.

The women in the study regarded physicians as their most-trusted source of information about alternative therapies, yet many said they didn’t get enough guidance in choosing a remedy for their menopausal symptoms. Nearly 75 percent of the women said that they – not their doctors – initiated discussions about possible treatments for their symptoms. And when it came to alternative therapies, 20 percent of the women weren’t confident in their doctors’ ability to discuss the treatments knowledgeably.

“Hormone therapy is unique in that patient preference is important in deciding what therapy to use,” Ma said. “A balanced dialogue is essential because it’s a treatment decision that a physician should make with a patient, not for a patient.”

Ma suggested that physicians know enough about alternative menopause therapies to put them in four categories: those that have data suggesting some effectiveness, those that have data demonstrating concerns about side effects, those with neutral data and those lacking any data.

“It’s OK to tell patients that little is known about a product, despite any anecdotal stories they may have heard. Anecdotal stories should not be taken as a substitute for rigorous clinical evidence,” Ma said.

NIH researchers in July 2002 ended the Women’s Health Initiative study of combination HRT three years earlier than scheduled because they determined that the treatment might increase the risk for heart disease, invasive breast cancer and other health problems (Daily Women’s Health Policy Report, 3/5). The results of the study, which also found HRT increased the risk of ovarian cancer and strokes, caused millions of women to end their use of the drugs.

Pines said that he and colleagues reviewed numerous related studies of women who took HRT and found no increase in the risk of heart disease among women between ages 50 and 59. Pines also said the WHI study was flawed because the study group was relatively old and had other conditions that increased the risk of health problems. According to the research team, some types of HRT can slightly increase breast cancer risk, but the risk is minimal in comparison to other risks such as smoking or having a first child after age 30.

Pines said, “The message is that each woman should discuss her general health, and risk factors such as family history … with her doctor, but, generally, healthy women entering menopause should not have fears.” However, Valerie Beral, an epidemiologist at the University of Oxford, said the IMS review was not valid because it only looked at a fraction of the evidence, adding that regulatory bodies worldwide recommend HRT only for short-term use. IMS’ review only “quote[s] a small number of the very large studies that have been done,” Beral said, adding, “The review does not agree with regulatory bodies in the United Kingdom, U.S. or Europe who have reviewed the totality of the evidence” (Reuters, 5/20).

IMS President David Sturdee said that common “misperceptions” surrounding HRT have resulted in many women having difficulty coping with menopausal symptoms and that women should take the drugs “for as long as they need to be on it.” He added, “HRT is the most effective treatment for menopausal symptoms, but press reports over the last few years have made it difficult for many women to consider its use” (BBC News, 5/20).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

More than four out of five women (84%) believe that menopausal symptoms require treatment and should not simply be accepted, according to a survey of over 4200 European women aged 45 to 60 years. However the research – Organon’s 3rd European Menopause Survey – also shows that less than half of women have a positive opinion about hormone replacement therapy (HRT) today and many are unaware of its established benefits.

The survey also reaffirms that the menopause has far-ranging and considerable consequences on women’s lives and indicates that women may be suffering menopausal symptoms but are too concerned about the risk of breast cancer to seek treatment. Women are also unaware of differences between menopausal therapies in relation to the breast.

“These findings provide a fascinating snapshot of women’s views and experiences today. Overall, they highlight the extent of the loss of confidence in HRT, yet clearly demonstrate that the need for treatments to relieve menopausal symptoms is as great as ever,” said Dr Nick Panay, consultant gynecologist, Queen Charlotte’s Hospital, London, UK. “Clearly more must be done to explain both the benefits of therapies and the true risks in order to rebuild women’s confidence in the appropriate use of HRT.”

The European Menopause Survey interviewed more than 4200 women in detail to provide current insights into their views, experiences and needs during and after the menopause. It reaffirms that menopausal symptoms continue to impact the lives of many women. In all, 94 % of women report menopausal symptoms in the last five years, and 64 % report one or more severe menopausal symptoms. Hot flushes were the most common symptom reported by 74 % of women, and have the most impact on women’s lives.

Although most women were aware of HRT, the majority of women have a negative feeling about it. Awareness of their benefits is low. One in five (21%) were unable to name any benefits. By contrast when asked about the main risk factors, 61 % of women say risk of developing breast cancer and 22 % cancer in general.

Half of the women who were on treatment stopped HRT. However, of those who stopped their treatment 42% restarted largely in response to the return of menopausal symptoms. At the same time, 19% of women are currently using natural, herbal or homeopathic treatments including plant estrogens of which clinical effectiveness has never been proven in meta-analysis.

Finally, the findings indicate that one in eight women may be suffering from menopausal symptoms but not using HRT most commonly because of fears about the risk of breast cancer. The proportion of the population suffering without treatment is greatest in Belgium (19%) and France (17%) and lowest in the Netherlands and Spain (both 7%).

Karen Winterhalter, spokeswoman for Women’s Health Concern added: “In recent years, we have seen the impact of menopausal symptoms on women’s lives trivialized and an orchestrated campaign of misinformation about HRT. This research shows the consequences: women are too concerned to take HRT when they need it with subsequent suffering due to menopausal side effects. It is time to end the confusion and turn our attention back to women and their needs so that we can help them manage menopausal problems appropriately.”

About treatment

Women are unaware that menopausal therapies differ in relation to their effects at the breast. Livial, Organon’s menopausal therapy, is in a number of countries licensed for use in postmenopausal women for the relief of troublesome menopausal symptoms and in some of these countries also for prevention of bone loss. Livial continues to be the subject of an ambitious clinical trial program to identify the full extent of its benefits and risks.

About the European Menopause Survey

In total 4,201 women from seven countries – UK, The Netherlands, France, Belgium, Germany Spain and Switzerland – took part in the research undertaken by TNS NIPO on behalf of Organon. Women were aged between 45 and 60 years of age and were menopausal or postmenopausal. The interviews lasted 15 minutes and were conducted by female interviewers. All interviews were carried out between December 2004 and January 2005.

Organon – with shared head offices in Roseland, NJ, USA and Oss, The Netherlands – creates, manufactures and markets prescription medicines that improve the health and quality of human life. Through a combination of independent growth and business partnerships, Organon strives to remain or become one of the leading pharmaceutical companies in each of its core therapeutic fields: reproductive medicine, psychiatry and anesthesia. Organon products are sold in over 100 countries, of which more than 60 have an Organon subsidiary. Organon is the human health care business unit of Akzo Nobel.

ChiliPad™, a revolutionary mattress pad with both heating and cooling functions, reduces the severity of hot flashes by allowing consumers to adjust the entire surface of their bed to the desired temperature. ChiliPad cools and warms a bed from 48 to 118 degrees F.

“Often if a room is too cold for one person it is too warm for the other,” said Todd Youngblood, president and co-founder, ChiliTechnology, LLC. “Some couples resort to opening windows or turning on the AC all night to stay cool. Instead of cooling the whole house to get a comfortable night’s sleep, you can just cool the bed. This is especially helpful for women experiencing hot flashes and night sweats or anyone who just needs to cool their body down to get a good night’s sleep.”

According to the National Sleep Foundation, about 61 percent of menopausal women suffer from some kind of sleep disorder. Sleep is an essential part of a healthy lifestyle, allowing the mind to rest and reorganize before the next day’s events; menopausal women who are having trouble sleeping feel the effects in every part of their lives.

“When having hot flashes, it’s hard to fool Mother Nature,” said Karen Giblin, president, Red Hot Mamas. “Hot flashes and night sweats affect 75-85% of women. Women feel intense heat, get flushed, perspire, and they may get uncomfortably wet during the night. This may cause them to awaken and the next day they may feel fatigued and moody. Good news gals, we now have a product that can fool Mother Nature. The new product is the ChiliPad which gives some of us a new lease on menopausal life. So, as the temperatures soars in your bed at night, and you are tossing and turning feeling that greenhouse effect when those hot flashes and night sweats strike, all you have to now do is to turn on your ChiliPad. Your bed will stay cool and you will be more comfortable during the night.”

The ChiliPad can be used 12 months out of the year to keep the bed cool in the summer and warm in the winter. Anyone suffering from menopause, injury or illness where cooling the body down or warming it up helps, benefits from a ChiliPad.

Source
ChiliTechnology, LLC

The culprit is likely not age, as is commonly believed, but the change in hormone balance that occurs during the menopause transition, according to researchers at Rush University Medical Center.

“Of all the factors we analyzed that could possibly account for the increase in visceral fat during this period in a woman’s lifetime, levels of active testosterone proved to be the one most closely linked with abdominal fat,” said Imke Janssen, PhD, assistant professor of preventive medicine and the study’s lead investigator.

The study, which has been published early online in the medical journal Obesity, included 359 women in menopausal transition, ages 42 to 60, about half black and half white. Fat in the abdominal cavity was measured with CT scans, a more precise measurement than waist size. Blood tests were used to assess levels of testosterone and estradiol (the main form of estrogen). Medical histories covered other health factors possibly linked with an increase in visceral fat.

Statistical analyses showed that the level of “bioavailable” testosterone, or testosterone that is active in the body, was the strongest predictor of visceral fat.

A woman’s age did not correlate significantly with the amount of visceral fat. Nor did race or other cardiovascular risk factors.

The level of estradiol also bore little relationship to the amount of visceral fat.

Visceral fat, surrounding internal organs around the waistline, is metabolically different from subcutaneous fat, which is fat located beneath the skin. Research has shown that visceral fat is a source of inflammation that contributes to premature atherosclerosis and risk of acute coronary syndrome.

The study’s findings extend earlier research conducted by Janssen on testosterone’s link with what is called the metabolic syndrome during the menopausal transition, published in the Archives of Internal Medicine in 2008. That study, examining women six years before and six years after their final menstrual period, found that the rise in metabolic syndrome – a collection of risk factors for heart disease – corresponded with the rise in testosterone activity.

“For many years, it was thought that estrogen protected premenopausal women against cardiovascular disease and that the increased cardiovascular risk after menopause was related only to the loss of estrogen’s protective effect,” said Janssen. “But our studies suggest that in women, it is the change in the hormonal balance – specifically, the increase in active testosterone – that is predominantly responsible for visceral fat, and for the increased risk of cardiovascular disease.”

Other researchers at Rush involved in the study were Lynda Powell, PhD, Dr. Rasa Kazlauskaite and Dr. Sheila Dugan.

The study was funded by the National Institutes of Health and the Charles J. and Margaret Roberts Trust.

Source
Rush University Medical Center

According to Medilexicon’s medical dictionary, the menopause is the “Permanent cessation of the menses due to ovarian failure; termination of the menstrual life.” (menses = shedding of blood during a woman’s menstrual period). The peri-menopause is the 3 to 5 year period before the menopause when a woman’s estrogen levels begin to drop. Let’s recap the meaning of these two words:

* Menopause – when periods (menstruation) stop forever.
* Peri-menopause – the years before the menopause when estrogen levels start to drop

A study revealed that some British women are in denial when it comes to the menopause.
What are the symptoms of menopause and peri-menopause?
Experts say that technically the menopause is confirmed when a woman has not had a menstrual period for one year. However, the symptoms and signs of menopause generally appear well before the one-year anniversary of the final period. They may include:

* Irregular periods – this is usually the first symptom; menstrual pattern changes. Some women may experience a period every two to three weeks, while others will not have one for months at a time.

* Lower fertility – during the peri-menopausal stage of a woman’s life her estrogen levels will drop significantly, lowering her chances of becoming pregnant.

* Vaginal dryness – this may be accompanied by itching and/or discomfort. It tends to happen during the peri-menopause. Some women may experience dyspareunia (pain during sex). The term vaginal atrophy refers to an inflammation of the vagina as a result of the thinning and shrinking of the tissues, as well as decreased lubrication, caused by a lack of estrogen. About 30% of women experience vaginal atrophy symptoms during the early post-menopausal period, while 47% do so during the later post-menopausal period. There are cases of women who experience vaginal atrophy more than a decade after their final period. The majority of post-menopausal women are uncomfortable talking about vaginal dryness and pain and are reluctant to seek medical help, a study found.

* Hot flashes (UK term: hot flushes)  – this is a sudden feeling of heat in the upper body. It may start in the face, neck or chest, and then spreads upwards or downwards (depending on where it started). The skin on the face, neck or chest may redden and become patchy, and the woman may start to sweat. The heart rate may suddenly increase (tachycardia), or it may become irregular or stronger than usual (palpitations). Hot flashes generally occur during the first year after a woman’s final period.

* Night sweats – if the hot flashes happen in bed they are called night sweats. Most women say their hot flashes do not last more than a few minutes.

* Disturbed sleep – sleeping problems are generally caused by night sweats, but not always. Sleep disturbance may be caused by insomnia or anxiety. Difficulty falling asleep and staying asleep increase as women go through menopause, this study revealed.

* Urinary problems – women tend to be more susceptible to lower urinary tract infections, such as cystitis. Having to urinate may also occur more frequently.

* Moodiness – this often goes hand-in-hand with sleep disturbance. Experts say that most mood disturbances are triggered by poor sleep.

* Problems focusing and learning – Some women may also have short-term memory problems, as well as finding it hard to concentrate on something for long. A very large study found that women may not be able to learn as well shortly before menopause compared to other stages in life.

* More fat building up in the abdomen.

* Hair loss (thinning hair).

* Loss of breast size

If left untreated, these symptoms will usually taper off gradually over a period of two to five years. However, some women may experience symptoms for much longer. Most women who experience vaginal dryness, itching or discomfort may find symptoms either persist or get worse with time if left untreated.
What causes the menopause and peri-menopause?
The hormones estrogen and progesterone regulate menstruation – more specifically, estrogen regulates menstruation while progesterone is more involved with preparing the body for pregnancy. When the ovaries start producing less of these two hormones the peri-menopause will start. In fact, by the time a woman is in her late 30s the ovaries start producing less progesterone and estrogen. By the time she is n her 40s the post-ovulation spike in progesterone becomes less emphasized. A woman’s fertility starts to decline a long time before she may notice any menopausal or peri-menopausal symptoms.

As time passes and the ovaries produce less and less estrogen and progesterone the ovaries eventually shut down completely and the woman no longer has any more menstrual periods. The vast majority of women experience a gradual change in menstrual activity, while some go on normally until they suddenly stop.

Some women may experience premature menopause – their ovaries fail earlier than they are supposed to (before the age of 45). Ovarian failure can occur at any age – but very rarely – and often the doctor and patient will never find out why. Some women who experience ovarian failure may still have periods and some degree of fertility for a while. Premature menopause may be caused by:

* Enzyme deficiencies

* Down’s syndrome

* Turner’s syndrome

* Addison’s disease

* Hypothyroidism

* Removal of the ovaries (bilateral oophorectomy surgery)

* Radiotherapy to the pelvic area

* Chemotherapy

* Hysterectomy surgery (the uterus – womb – is surgically removed)

* Some infections – such as mumps or TB (tuberculosis), malaria and varicella. However, in all cases risk of ovarian failure is extremely small.

* Genetic factors – scientists have been able to identify genetic factors that influence the age at which natural menopause occurs in women, as explained in this article.

* Being a twin – twins are more likely to have a premature menopause than other women, a study found.

How is menopause diagnosed?
A GP (general practitioner, primary care physician) should be able to diagnose menopause or peri-menopause if he knows the age of the patient, has information about her menstrual patterns, and receives feedback from her on her symptoms.

Apart from a blood test which can measure levels of FSH (follicle-stimulating hormone), there is no definitive test to diagnose menopause or peri-menopause. FSH blood levels rise when a woman is in the menopause. However, as FSH levels tend to fluctuate a lot during the menopause and peri-menopause, a FSH blood test may provide a little data, but may not be that helpful for a diagnosis. Under certain circumstance a doctor may order a blood test to determine the level of estradiol (estrogen). As hypothyroidism (underactive thyroid) can cause menopause-like symptoms, the doctor may order a blood test to determine the woman’s level of thyroid-stimulating hormone.
What is the treatment for menopause or peri-menopause?
According to the National Health Service, UK, only about 10% of women seek medical advice during the menopause. Many women require no treatment. However, if symptoms are affecting the woman’s daily life she should see her doctor. The kind of treatment the patient should have depends on her symptoms, her medical history, as well as her own preferences. Available treatments include:

* HRT (hormone replacement therapy) or HT (hormone therapy) – this is very effective for many of the symptoms that occur during the menopause, including vaginal dryness, vaginal itching, vaginal discomfort, urinary problems, bone-density loss, hot flashes and night sweats. HRT tops up the woman’s levels of estrogen. However, as with many treatments, HRT has its risks and benefits:

Benefits of HRT

o Effectively treats many troublesome menopausal symptoms.
o Helps prevent osteoporosis.
o Lowers colorectal cancer risk (cancer of the colon or rectum)

Risks of HRT

o Raises breast cancer risk
o Raises ovary cancer risk
o Raises uterine cancer risk (cancer of the womb)
o Raises coronary heart disease risk
o Raises stroke risk
o HRT was found to slightly accelerate loss of brain tissue in areas important for thinking and memory among women aged 65 and over, according to a study.

Dr. Robert Reid, Professor Ob/Gyn, Chair of the Division of Reproductive Endocrinology and Infertility, Queen’s University stated that “Not all women need HT, but many with troublesome symptoms were needlessly scared away from that option due to misunderstandings about the actual risks associated with it.”

Older women who take hormone therapy to relieve menopausal symptoms may get the added benefit of reduced body fat if they are physically active, a study revealed.

* Low-dose antidepressants – SSRIs (selective serotonin reuptake inhibitors) have been shown to decrease menopausal hot flashes. Drugs include venlafaxine (Effexor), fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalopram (Celexa) and sertraline (Zoloft).

* Omega 3s – Researchers from the Universite Laval’s Faculty of Medicine found that Omega-3s ease psychological distress and depressive symptoms often suffered by menopausal and peri-menopausal women.

* Gabapentin (Neurontin) – this medication is effective in treating hot flashes. It is commonly used for treating seizures (epilepsy).

* Clonidine (Catapres) – can be taken either orally as a pill or placed on the skin as a patch. It is effective in treating hot flashes. The drug is commonly used for treating high blood pressure (hypertension). However, unpleasant side-effects are common.

* Osteoporosis treatments – please see the article “What is osteoporosis?” which has a section on treatments.

* Vaginal estrogen – may be applied locally using a tablet, ring or cream. This medication effectively treats vaginal dryness, discomfort during intercourse, as well as some urinary problems. A small amount of estrogen is released and absorbed by the vaginal tissue.

* Soybeans – soy aglycons of isoflavone (SAI), a group of soybean constituent chemicals, have been shown to promote health in a rat model of the menopause, according to a study by scientists at National Chiayi University, Taiwan.

* Exercise – a study found that slow exercise is better for post-menopausal women than fast exercise.

Complications
After the menopause it is common for the following chronic conditions to appear. Chronic, in medical English, means long-term, continuous (as opposed to “acute”).

* Cardiovascular disease – a drop in estrogen levels often goes hand-in-hand with an increased risk of cardiovascular disease. Heart disease is not exclusively a male problem, it is the main cause of death among both men and women. In order to reduce the risk of developing cardiovascular disease a woman should quit smoking, try to keep her blood pressure within normal levels, do plenty of regular exercise, sleep at least 7 hours each night, and eat a well-balanced healthy diet.

* Osteoporosis – a woman may lose bone density rapidly during the first few years after menopause. The lower a person’s bone density gets the higher their risk is of developing osteoporosis. For more information on osteoporosis, go to “What is osteoporosis?”. The absolute risk of a second clinical fracture is highest in the five years after any first clinical fracture for post-menopausal women, a study found.

* Urinary incontinence – the menopause causes the tissues of the vagina and urethra to lose their elasticity, which can result in frequent, sudden, strong urges to urinate, followed by urge incontinence (involuntary loss of urine). Stress incontinence may also become a problem – urinating involuntarily after coughing, sneezing, laughing, lifting something, or suddenly jerking the body as may happen when we temporarily lose our balance.

* Low libido – this is probably linked to disturbed sleep, depression symptoms, and night sweats, a study found.

* Overweight/obesity – during the menopausal transition women are much more susceptible to weight gain. Experts say women may need to consume about 200 to 400 fewer calories each day just to prevent weight gain – or burn of that number of calories each day with extra exercise. The chances of becoming obese rise significantly after the menopause, according to this article.

* Breast cancer – women are at a higher risk of breast cancer after the menopause. However, as this article explains, regular exercise after menopause significantly reduces breast cancer risk.

Self help
Unless your symptoms are severe, you may find that some changes in your lifestyle and diet are all you need to deal with the symptoms.

* Hot flashes and night sweats

o Do plenty of exercise.
o Avoid wearing tight clothing.
o Make sure the bedroom is not hot.
o Try to reduce your levels of stress.
o Remember the following commonly trigger symptoms for susceptible people: spicy food, caffeine, smoking, and alcohol.

* Sleep disturbance

o Exercise regularly. However, do not exercise too late during the day. Exercising too late may keep you awake longer.
o Go to bed and get up at the same time each day – even during weekends.
o Cut out all drinks and foods that contain caffeine.
o Learn how to do deep breathing, guided imagery, and progressive muscle relaxation.

* Moodiness

o Make sure you do not get tired – get plenty of rest.
o Do regular exercise. If you can, do strenuous exercise – check with your doctor whether this is OK for you.
o Practice yoga. Make sure you have a well qualified trainer.

* Vaginal discomfort and dryness

o Get some OTC (over the counter) water-based vaginal lubricants or moisturizers.
o Stay sexually active.

* Urinary incontinence

Practice pelvic floor muscle exercises – Kegel exercises. If you practice three or four times a day you will most probably notice a difference after a few weeks. This review of studies explains that women suffering from urinary incontinence can benefit from pelvic floor muscle training.

* Overweight/obesity and osteoporosis prevention

Eat a well balanced diet that includes plenty of vegetables, fruits, wholgrains, good quality fats, fiber, and unrefined carbohydrates. Try to consume 1,200 to 1,500 milligrams of calcium and 800 IUs of vitamin D per day. Do plenty of exercise. Make sure you sleep at least 7 hours each night.

The study provides new information on the health benefits of any type of physical activity, not just exercise, said the presenting author Poli Mara Spritzer, MD, PhD, a professor at the Federal University of Rio Grande do Sul in Porto Alegre, Brazil, and chief of the Gynecological Endocrinology Unit at the university’s Hospital de Clinicas de Porto Alegre.

After menopause, a woman’s percentage of body fat tends to increase and redistribute to the abdomen, Spritzer said. Excess belly fat is a risk factor for diabetes and heart disease. Postmenopausal women who exercise have a lower percentage of body fat than sedentary women, past research shows. However, Spritzer said less is known about the influence on body fat composition of physical activity in women receiving hormone replacement therapy, or HRT. Some data suggest that estrogen treatment may add to the effect of exercise in reducing fat.

Spritzer and her colleagues studied 34 healthy women who had an average age of 51 years, had experienced menopause for less than 3 years and sought HRT to relieve hot flashes, night sweats and vaginal dryness. They evaluated the women’s cholesterol levels, body mass index (BMI), waist circumference (a measure of abdominal fat) and percentage of body fat before and after 4 months of HRT. The women received estrogen plus progesterone therapy in either non-oral (nasal and vaginal) or low-dose oral preparations. For 6 consecutive days before starting HRT and 6 days at the end of HRT, women wore a pedometer to estimate their level of physical activity. The device measured the steps they took, including walking, working, and doing house chores and leisure activities. They were instructed to not change their usual activities. Most of the women did not play sports or do any structured physical exercise, according to Spritzer.

Results showed that 24 of the women were physically active – defined as taking 6,000 steps or more per day – and 10 were inactive (less than 6,000 steps a day). For a woman who has a step, or stride, length of 2 feet (60 cm), 6,000 steps would be around 2.25 miles (3.6 km), Spritzer estimated. For active women, the higher the number of steps they took, the lower was their waist measurement and the better their level of “good” (high-density-lipoprotein, or HDL) cholesterol, the authors reported. The inactive women did not have any changes in body fat or cholesterol. However, when all 34 women were considered in the analysis, body fat still declined significantly after HRT.

“Data from our study suggest that active women could benefit from hormone therapy beyond the relief of menopausal symptoms – by preserving a good body fat percentage and distribution,” Spritzer said. “Further studies with a larger number of subjects are needed in order to answer whether a specific physical activity is better than others.”

The Brazilian National Council for Science and Technology and the Brazilian National Institute of Hormones and Women’s Health funded this study.

Source:
Aaron Lohr
The Endocrine Society