As women approach middle age their bodies change. The monthly hormonal signals of the feminine hormones begin to wane at first causing disruption and ultimately cessation of the monthly cycle of ovulation and menstruation. For most women this occurs in their late forties to early fifties but for some it can occur in their thirties or even early sixties.
The early disruption is called the “perimenopause’ which lasts until there have been no menstrual cycles for a year at which point a women is considered to be in menopause.
The perimenopause can be associated with light periods or heavy periods or skipping of periods for a month or more. In the normal monthly cycle there is a building of tissues in the uterus preparing it for receiving a fertilized egg early in the month. If the body receives no signal that an egg has been fertilized than this tissue is allowed to breakdown and is removed each month in the menses or period.
If the hormone signal becomes disrupted in the perimenopause period then sometimes the breakdown period does not occur at the end of the month. When this occurs the blood rich layers in the uterus can become abnormally thick and fragile which can lead to menorrhagia. Menorrhagia is excessive menstrual flow beyond a normal amount which is can be defined as heavy flow for more than four or five days or needing to change pads every hour. This condition can be caused by other conditions other than early menopause in younger women and older women as well.
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Often this can be treated successfully by low dose hormone therapy to prevent overgrowth in the uterus. If hormonal therapy does not work than minimally invasive surgical outpatient procedures can be done to remove the excess tissue in the wall of uterus and stop its bleeding. Whereas in the past before these newer procedures were developed it was not unusual for women to undergo a hysterectomy for abnormal bleeding today this is extremely rare. Sometimes benign (non-cancerous) growths are found in the uterus which can be removed without removing the uterus but not always.
It’s very important for women who are experiencing heavy periods to discuss it with their doctor. Severe anemia (low iron in the blood) can result in serious complications. Although the cause may be the coming of menopause other serious conditions such as pregnancy, cancer, disorders of the blood clotting, or the endocrine glands may be the cause. Similarly a missed period even in a sexually active 50 year old may be a pregnancy or other process. Therefore women are undergoing changes in the menstrual cycle should always discuss it with their doctor and not just assume it is just menopause.
There are other signs and symptoms of menopause including “hot flashes’ which are sensations of heat in the upper body, night sweats, mood changes, vaginal dryness, thinning of scalp hair and thickening of facial hair.
Hormonal therapy can sometimes be of use in treating these symptoms but for some women there may be considerable risk. Generally speaking the goal in using hormonal therapy is to use the least dose if possible for the shortest period of time. The doctor will need to take a complete history including family history because a strong family history of breast cancer may increase the risk for breast cancer from taking hormonal replacement.
It is very important for women to exercise at least 30 minutes every day and take at least 1000 to 1200 mg of Calcium in the diet every day. The changes in hormonal balance that occur with menopause affect the strength of bone. Bone is normally under a constant state of re-construction. With menopause the ability of the bone to get calcium and incorporate it into the architecture is diminished while the breakdown process is unaffected. Therefore over time the bone can become gradually weakened. This process may be totally without symptoms until a fracture occurs.
Family history can play a significant role in determining an individuals risk for osteoporosis which is the condition associated with bone loss due to hormonal changes of life. It is important for women to measure their height because a gradual loss of height and curving of the thoracic spine can be sign of osteoporosis.
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