Menopause is the body's process of ending menstrual periods.   The average age of a woman at her last menstrual period is 51.  However, early menopause can occur before the age of 40.

With approaching menopause, a woman's ovaries produce less estrogen.   Estrogen is made in the ovaries during the entire menstrual cycle.  This hormone prompts the lining of the uterus (or endometrium) to thicken each month in preparation to receive and nourish an egg from one of the ovaries.  As menopause gets closer, there may be changes in the menstrual cycle.  Lower levels of estrogen may cause irregular periods or a change in menstrual flow.  Menses may be lighter or heavier.  Bleeding may be longer or shorter than usual.

Abnormal bleeding can be a sign of a uterine problem.  So although periods may tend to be irregular around the time of menopause, it is important to be aware of abnormal bleeding.  Call your doctor if you:

• Bleed following intercourse
• Bleed more often than every 3 weeks
• Bleed longer than normal
• Bleed more heavily than normal
• Have a change in your monthly cycle

Menopause is a natural part of the aging process, but its changes usually occur slowly, over time.  The decrease in estrogen may cause symptoms for some women.  There are treatments available to address these symptoms.

Hot flashes are the most frequent complaint of women.  A hot flash is a sudden feeling of heat that spreads over part or all of the upper body.  Skin may blush or break out in a sweat.   Occurring any time of the day or night, hot flashes may disrupt sleep at night.  For some women there will be no hot flashes while other will have them for a few months and some even for a few years.

Changes in the vaginal area may occur due to loss of estrogen.   The lining may become thinner, less flexible and drier making intercourse painful.   Some women have vaginal burning and itching.  A few women have problems with inflammation or irritation of the urethra causing the need for more frequent urination.   Painful urination, however, can be a sign of urinary tract infections.

Accelerated bone loss is another effect of menopause.  This major health problem can cause up to 20 per cent of women to suffer hip fractures that will result in death from complications.  See Osteoporosis.

Some women experience menopause with no emotional changes while some struggle with increased nervousness, irritability, physical exhaustion and mild depression.  Talk with someone if emotional changes become a problem.

Menopause should not affect a woman's ability to have sexual relations.  Hormonal changes may cause vaginal dryness, but this can be treated with lubricating jellies or estrogen creams.  Regular intercourse actually helps keep the vagina more elastic and lubricated.

Birth control during menopause is still essential for women desiring to limit their family.  This should be discussed with your physician.

Routine visits to your doctor for breast, pelvic and rectal exams are recommended for all women including those who are menopausal and postmenopausal.   A PAP test to screen for cancer of the cervix should be done, and a yearly mammogram is recommended for women over 50.

HRT - Hormone Replacement Therapy

Your doctor may recommend HRT the goals of which are to alleviate symptoms and prevent osteoporosis.  Hormone treatment works better to prevent osteoporosis if begun at the inception of menopause.  Estrogen usually will not rid you of all symptoms, but it will lessen the physical and sometimes emotional problems.

Along with estrogen, your doctor will often prescribe another hormone called progestin to reduce the risks of taking estrogen.   When progestin is prescribed, some women will have bleeding once a month.  Ask your doctor what to expect.  Women who do not take progestin should be monitored carefully.  Your doctor may perform an endometrial biopsy.

Estrogen may be given in pill form or through a skin patch.

Hormone use has benefits and risks.  Estrogen alone may be linked to endometrial cancer.  The risk may be lessened by taking progestin with the estrogen or by taking lower doses of estrogen.   Not all women can take estrogen.  If you have had breast cancer, endometrial cancer or liver disease estrogen is usually not recommended.  Be sure to discuss estrogen usage and its risks for you personally with your physician.

Some women experience side effects of the hormones.  These can include:

• pelvic cramping
• mood changes (depression or irritability)
• swelling
• fluid retention
• breast tenderness
• vaginal bleeding

A balanced diet and exercise will help keep you fit and healthy.  Most doctors recommend a total of 1500 mg/day of calcium for women.   Calcium supplements may be necessary to maintain those levels plus a little sunlight with the Vitamin D it provides help with calcium absorption.  Alcohol and tobacco can decrease calcium absorption.  Weight bearing exercise slows bone loss, keeps weight down, helps control appetite and improves overall health.