Paula Dearholt-Winckler and Colleen Swanson

The theme for Health Views this month is menopause. Host Colleen Swanson will be talking to Paula Dearhol-Winkler, a Woman's Health Nurse Practitioner, about this passage of life. Menopause is the permanent cessation of reproductive fertility occurring some time before the end of the natural lifespan. The term was originally coined to describe this reproductive change in human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruation or "menses". The word "menopause" literally means the "end of monthly cycles" from the Greek words pausis (cessation) and the word root men from mensis meaning (month). In humans, menopause is the time in a woman’s life when her reproductive cycles end. It is part of a biological process that for most women is first noticed in their mid-forties. During this transition, the ovaries start producing lower levels of natural sex hormones—estrogen and progesterone. Estrogen promotes the normal development of a woman’s breasts and uterus, controls the cycle of ovulation (when an ovary releases an egg into a fallopian tube), and affects many aspects of a woman’s physical and emotional health. Progesterone controls menstruation and prepares the lining of the uterus to receive the fertilized egg.

During the menopause transition years, as the body responds to the rapidly fluctuating and dropping levels of natural hormones, a number of effects may appear. Not every woman experiences bothersome levels of these effects; the range of effects and the degree to which they appear is very variable from person to person. Effects that are due to low estrogen levels (for example vaginal atrophy and skin drying) will continue after the menopause transition years are over; however, many effects that are caused by the extreme fluctuations in hormone levels (for example hot flashes and mood changes) usually disappear or improve significantly once the perimenopause transition time has been completed. All the various possible perimenopause effects are caused by an overall drop, as well as dramatic but erratic fluctuations, in the absolute levels and relative levels of estrogens and progesterone. Some of the effects, such as formication (crawling, itching, or tingling skin sensations), may be associated directly with hormone withdrawal. Both users and non-users of hormone replacement therapy identify lack of energy as the most frequent and distressing effect. Other effects can include vasomotor symptoms such as hot flashes and palpitations, psychological effects such as depression, anxiety, irritability, mood swings, memory problems and lack of concentration, and atrophic effects such as vaginal dryness and urgency of urination. The average woman also has increasingly erratic menstrual periods, due to skipped ovulations. Typically, the timing of the flow becomes unpredictable. In addition the duration of the flow may be considerably shorter or longer than normal, and the flow itself may be significantly heavier or lighter than was previously the case, including sometimes long episodes of spotting. Early in the process it is not uncommon to have some 2-week cycles. Further into the process it is common to skip periods for months at a time, and these skipped periods may be followed by a heavier period. The number of skipped periods in a row often increases as the time of last period approaches. At the point when a woman of menopausal age has had no periods or spotting for 12 months she is considered to be one year into post-menopause.

Many women arrive at their menopause years without knowing anything about what they might expect, or when or how the process might happen, and how long it might take. Very often a woman has not been informed in any way about this stage of life; at least in the US, it may often be the case that she has received no information from her physician, or from her older female family members, or from her social group. In the US, there appears to be a lingering taboo which hangs over this subject. As a result, a woman who happens to undergo a strong perimenopause with a large number of different effects, may become confused and anxious, fearing that something abnormal is happening to her. There is a strong need for more information and more education on this subject.

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