Menopause - The Culmination Of A Women's Climacteric

Menopause is the culmination of a woman's climacteric. The climacteric is a period of several years, usually beginning in the forties, during which ovulation and menstruation become irregular as the ovaries produce less estrogen. Menopause is reached when menstruation completely stops, usually by age 55 but sometimes by age 40. Commonly called the change of life, menopause involves physical and psychological changes that vary in their extent and in the effects they have on women. Although many symptoms have been blamed on menopause, only a few are direct consequences of declining estrogen, including hot flashes, vaginal changes, weakening of muscles controlling urination, and loss of bone density (osteoporosis).

Hot flashes are reported by as many as 75% of women in the year surrounding the actual menopause. The flashes or flushes are feelings of warmth and sometimes cause profuse perspiration. They last for a few minutes to an hour.

Vaginal changes include lack of lubrication and thinning of the vaginal walls, which may produce pain and bleeding during intercourse. Weakening of the urethral muscles may cause women to leak urine under the stress of sneezing, coughing, or laughing.

Lowered estrogen causes loss of bone density in about 25% of white, Asian, and Hispanic women. African-American women are at low risk for this effect, while smokers and thin women are at higher risk. Bone density loss increases the risk of fractures and the deformed vertebrae of dowager's hump.

An obvious consequence of menopause is infertility. However, during the climacteric but before final cessation of ovulation, women are still fertile and may have an increased likelihood of conceiving a child if they stop using contraceptive practices. A simple blood test can determine when a woman has become infertile.

Menopause is normal; it is neither a physical nor a psychological disorder. The meaning that menopause has for a woman may lead to worries and even depression, however. For some women, especially in the United States, menopause means declining femininity and sexual attractiveness. For others, loss of fertility signals uselessness and old age. These and other psychological reactions may combine with hormonal changes to produce additional signs associated with menopause, such as headache, nervousness and anxiety, weight gain, and memory problems.

Some women lose interest in sexual activity due to a combination of vaginal changes and concerns about femininity and attractiveness. Some women believe that sexual activity ought to cease after menopause, but that idea is not supported by medical research.

Many women welcome menopause as liberation from dealing with menstruation and contraception, and they may become more interested in sexual activity. In many Asian and African cultures, in which older women are respected sources of advice and wisdom, menopause is more likely to be welcomed than it is in cultures that eulogize youth and ignore the aged.

Treatments are readily available if the physical signs of menopause are distressing. Hormone replacement therapy, which supplies the missing estrogen by pill, vaginal cream, or patch, is the most effective treatment. It is also the treatment of choice for osteoporosis. There has been considerable controversy over the advisability of estrogen replacement for symptoms of menopause, since estrogen is associated with increased risk of cancer of the breast or endometrium (lining of the uterus). Taking progestin for part of a monthly cycle appears to prevent endometrial cancer, but it reestablishes menstruation. Women with none of the risk factors for breast cancer can probably take estrogen safely, especially if they take it for less than five years. Most physicians believe that estrogen reduces the risk of heart disease more than enough to offset any increased risk of breast cancer.

Other ways to manage signs of menopause are satisfactory for many women. Osteoporosis may be offset by exercise and calcium supplements. Exercise and a low-fat diet help to control the cholesterol elevation that is associated with higher risks of heart disease after menopause. Kegel exercises (repeated contraction of the muscles that stop the flow of urine) maintain and improve bladder control.

Many women find practical remedies effective. A drink of ice water may end a hot flash, or removing a sweater may make it less troublesome. Thirty minutes of exercise may relieve insomnia, and pain during intercourse may be eliminated by spending more time in foreplay for arousal before attempting penetration. Using a water-soluble lubricating jelly in the vagina may make intercourse more enjoyable for both partners.

Husbands and other family members play a significant role in a woman's feelings of usefulness and desirability. The church may also play a beneficial role by providing opportunities for service that draw on her accumulated wisdom and experience. In addition, church leaders should reinforce Christian teachings of respect for the aging process, opposing the contrary cultural stereotypes that produce negative reactions to menopause.