Every woman is going to go through menopause at some point in her life. Menopause is not an illness; it’s a natural biological process and a stage in every woman’s life.
While menopause is not a medical condition, the drop in hormone production that happens during menopause can cause unpleasant or even painful changes in the body. Some common menopause symptoms include hot flashes, vaginal dryness, insomnia, a frequent need to urinate, depression, and mood swings. Osteoporosis is also very closely linked to the onset of menopause.
Treating Menopause Symptoms: Then & Now
For many years, hormone therapy (HT)—which provides the body with extra supply of the hormones estrogen and progestin—was regularly used to treat menopause symptoms. But in 2002, the Women’s Health Initiative published the results of a large clinical trial that discovered HT carried some serious health risks, including an increased risk for heart disease, stroke, and blood clots. In early 2010, new analyses from the Women’s Health Initiative confirmed that HT nearly doubles the risk of a woman developing heart disease within the first two years of the treatment.
Nowadays, HT is recommended almost exclusively for younger postmenopausal women, particularly those who have had early-onset menopause. The North American Menopause Society (NAMS) and the Endocrine Society both issued new guidelines about HT in 2010, stating that the benefits of HT outweigh the risks only for women who initiate HT close to the onset of menopause, and that the benefit-to-risk ratio decreases significantly with age. In other words, a 45 year old will benefit from the therapy much more than a 65 year old will. And the benefits that 45-year-old initially experiences will start to decline as she ages.
New Development in Hormone Therapy
For those considering HT, there are some recent developments to be aware of. Lower doses are becoming more common, and the method of delivery does matter. “Research suggests that women who use transdermal preparations of hormones may be at lower risk for blood clots than those who use oral medication,” says Dr. Margery Gass, executive director for NAMS. These preparations could come in cream, gel, spray or patch. “However, there are no head-to-head trials of oral versus transdermal preparations to know definitively the difference in risk.”
A dangerous trend to be wary of is the marketing and use of bioidentical compounded hormones. These are compounds of estrogen, progesterone, and testosterone (identical to the hormones made by your body) that are mixed and administered by local pharmacists. “These products are often promoted as being healthier and safer than the FDA-approved pharmaceutical products,” says Dr. Gass. “There’s really no evidence to support that claim.”
There are, in fact, FDA-approved preparations of “bioidentical” hormones already on the market. “The FDA-approved patches and creams have been tested and come with a product information page that lists the risks and benefits,’” says Dr. Gass. “However, the products women buy in the compounding pharmacies are often missing that written warning.”
New Menopause Treatment Options
And while HT is still a viable treatment option for many women, alternatives have started to become more and more commonly prescribed. One example of an emerging alternative treatment is using guided imagery and hypnotic relaxation therapy to ease hot flashes. A study performed at Baylor University in the summer of 2010 found that by imagining a cool place, a woman will feel cool rather than the heat of a hot flash.
Predicting the Start of Menopause
Scientists may have uncovered a test to accurately predict the age that a woman will eventually reach menopause. It’s a simple blood test that measures the concentration of anti-Mullerian Hormone (AMH) in the blood. AMH is produced by cells in the ovaries and controls the development of ovarian follicles, which contain a woman’s eggs. “The test has the potential to be beneficial for women who have had early menopause in their family,” says Dr. Gass. “Those women are often caught off-guard when someone tells them at age 36 that they’re menopausal. This test could help these women decide if they need to think about having children earlier.” Dr Gass warns that larger and long-term studies are needed to confirm the accuracy of the test.
New Information on Early Menopause
While menopause happens to all women, for some it happens too early. Menopause is generally considered to be early when it occurs in women younger than 45. While not in-and-of-itself a health concern, early-onset menopause has, over the years, been linked to a number of other health problems. Here are two significant findings related to early-onset menopause of the past year:
Early Menopause & Alzheimer’s
Early in 2010, The Journal of Alzheimer’s Disease published a study that looked at women with Down Syndrome and found that there is a strong relationship between the age of menopause onset and the age at which dementia is diagnosed. Scientists involved in the study—which was performed at Erasmus Medical Center in Rotterdam, Netherlands—stated that the results could be translated to the general population. In other words, early-onset menopause may be a predictor of early-onset Alzheimer’s. It is also possible, of course, that the relationship is the reverse: problems in the brain lead to an earlier menopause.
Early Menopause & Heart Disease
In June of 2010, the results of a 10-year study on more than 2,500 women were analyzed and published. Presented at the Endocrine Society’s 92nd annual meeting in San Diego, CA, the study showed that women who experienced early menopause were almost twice as likely as the general population to have a heart attack, stroke, or other cardiovascular disease later in life. The scientists involved stated that the study was only observational; it was not meant to determine what the connections between menopause and heart disease risk are. Other recent studies, however, do suggest that it is heart disease risk that determines menopausal age, and not the reverse.
The Rise of Male Menopause
In the past year, more researchers—and media outlets—have focused their attention on male menopause, a condition in men that mimics the symptoms of menopause.
Contrary to popular belief, menopause is not only a problem for women. Well, not exactly. Men experience a change in gonadal hormones as they grow older. This involves a drop in the levels of testosterone in their body. The key difference between female menopause and male “menopause”: Female menopause is characterized by a precipitous drop in hormone production, while the male verions involves a gradual decrease in hormone production. And because testosterone, estrogen, and progesterone all play different roles in the body, a change in the production of any one of those three will lead to its own set of symptoms in the body.
It’s also important not to confuse a normal, gradual decrease in testosterone with an abnormal and significant decline in the production of sex hormones in the body—or what’s called “late-onset hypogonadism.” In hypogonadism, which experts estimate affects more than five million men, testosterone production drops, causing symptoms like fatigue, mood swings, lowered libido, hair loss, and weight gain. Unlike male “menopause” (or female menopause for that matter), hypogonadism is a medical condition. Although doctors are seeing more cases of hypogonadism in men than they used to, there is still suspicion that many men are uncomfortable talking openly to their doctor about symptoms of the condition.
When it comes to normal (non-pathological) male “menopause,” it’s hard to say whether symptoms (which imitate female menopause symptoms) are caused by lowered testosterone production or simply by the normal experiences of the midlife transition—the passing of parents, children growing up and leaving, questioning the value of your career, etc. Regardless as to the cause, it is important to be aware of the emotional changes you may experience as you reach your 40s and 50s, and to talk openly about them with your doctor or health care professional. Only you and your doctor can decide what’s right for you.