Menopause: Maintaining a Healthy Lifestyle

What is menopause?

Menopause is defined as the complete cessation of ovarian function due to ovarian aging, failure, or removal.

What causes menopause?

Menopause is a part of the normal aging process in women. A woman is born with a finite number of eggs, which are stored in the ovaries. The ovaries also produce the hormones estrogen and progesterone, which regulate menstruation and the time of maturing an egg.

Menopause occurs when the ovaries are totally depleted of eggs, and no amount of stimulation from the regulating hormones can force them to work. Thus, the ovaries stop working and therefore stop producing hormones. If the ovaries are surgically removed, or injured by drugs or radiation, menopause can occur earlier in life.

What are the symptoms of menopause?

Several significant menopause symptoms are common to a large number of women. All women will have hot flashes, sudden feelings of warmth that spread over the upper body, often accompanied by blushing and some sweating. The severity of this symptom varies from mild in most women to severe in others.

Other common symptoms include:

• Insomnia (inability to sleep)
• Mood swings
• Emotional lability (emotional shifts)
• Fatigue
• Malaise
• Depression
• Irritability
• Joint and muscle aches and pains
• Changes in libido (sex drive)

Not all women get all of these symptoms. In fact, less than 2 percent of women get symptoms severe enough to debilitate them completely.

Does menopause cause long-term health problems?

Unfortunately, the loss of estrogen after menopause has been linked to a number of health problems that become more common as women age. Many of these health problems do not produce symptoms. After menopause, women are more likely to suffer from:

• Osteoporosis (brittle-bone disease)
• Heart disease
• Poor skin elasticity (increased wrinkling)
• Some deterioration in vision, such as from cataracts (clouding of the lens of the eye) and macular degeneration
• Some weight gain

Whether or not all of these problems are helped by estrogen therapy is still unclear.

How can I prevent menopause symptoms and protect my long-term health?

The common, quick answer is hormone or estrogen therapy (called HT or ET). However, it’s important to note that HT is not the primary preventive treatment for the health problems listed above. It is an adjunct (added) therapy that is prescribed with recommendations for maintaining a healthy lifestyle. You can help ensure your long-term health by:

• Eating a nutritious, well balanced diet
  • Restrict your calories to maintain a healthy weight.
  • Restrict fat intake to no more than 30 percent of your total calories, especially for cholesterol and saturated fat.
  • Eat a diet rich in fiber and lots of green vegetables.
  • Consume at least 1000 to 1500 milligrams of calcium a day. (One glass of milk contains about 300 mg of calcium.)
  • Limit your consumption of caffeine, sugar, salt, and alcohol.
• Quitting smoking
• Exercising every day
• Exercises that require your muscles to work against gravity (weight-bearing exercising), such as walking or jogging, are better than non-weight bearing exercises, such as swimming.
• Walk 45 minutes a day.

What is HT/ET?

"HT" stands for hormone therapy. "ET" stands for estrogen therapy. They are the easiest, most proven, most studied, and most extensively used drug treatments for treating menopause symptoms. Both therapies involve taking hormones as medicines. The principle is to replace the hormones that are no longer produced by the ovaries.

If a woman has her uterus, she must take:

• Estrogen, which treats menopausal symptoms
• Progesterone, which protects the lining of the uterus

Estrogen can be taken as a pill, skin patch, vaginal cream, topical gel or spray. Progesterone is taken as a pill or as a vaginal gel. The most widely used and studied estrogen is Premarin^®, which also comes in a fixed combination with Provera^® (progesterone) called Prempro^® (pill form).

Why is it necessary to take progesterone?

Taking progesterone is crucial because the unshed lining can be pre-cancerous. Taking the two hormones reduces the risk of uterine/endometrial cancer by more than 90 percent. If the uterus has been removed, only estrogen is required.

A woman who has a uterus and who takes progesterone might continue to have menstrual-like bleeding at the end of taking the progesterone.

What are the benefits of hormone therapy?

Hormone therapy is indicated to:

• Improve bothersome symptoms, including:
  • Hot flashes, sweats
  • Irritability and emotional lability
  • Fatigue and insomnia
• Improve sexual interest by improving vaginal health
• Slow down osteoporosis (might also help make bone)
• Slow down skin and muscle deterioration

Large-scale studies have revealed some decrease in the frequency of colon cancer and diabetes in HT users.

What are the side effects of hormone therapy?

• Continuing and occasionally irregular menstrual flow (with progesterone)
• Weight gain
• Bloating
• Breast pain (mastalgia)
• Breast cancer (risk increases only slightly with long-term use)

What are the long-term risks of hormone therapy?

In contrast to previous studies in large populations, called epidemiologic studies, where HT was shown to be protective for heart disease, a large, interventional study using HT in older women (>70 years of age), women showed an increased incidence of developing heart disease after five to eight years of use.

What is the real risk of breast cancer?

• Your risk for breast cancer increases only slightly after five to 10 years of hormone use (1.2 to 1.4 fold)
• The usual lifetime risk for non-hormone users is one in nine women.
• The lifetime risk for hormone users is approximately one in eight women.
• Cancer associated with hormone use is usually the least troublesome type and is often detected very early.
• The number of women dying from breast cancer over the past 25 years has not increased in spite of higher hormone use. (The number of women dying from breast cancer after taking hormones is the same as the number of women dying from breast cancer who have not taken hormones.)

Are there alternative treatments for menopause symptoms and the long-term health risks associated with menopause?

Remember your ABCs:

Avoid smoking, caffeine, alcohol, excess salt, and sugar

Balanced diet — Herbalists recommend grains, cold-pressed oils, leafy vegetables, and nuts for relief of hot flashes

Calcium and minerals

D vitamin (1000 IU of vitamin D daily), also vitamin C, B5, and E

Exercise — Weight-bearing daily, 45 to 55 minutes

Fat restrictions

Give local vaginal lubrication — Try olive oil or vitamin E oil

Herbal medicines — Beware; some may increase liver toxicity

• Cranberry juice to reduce urinary tract infection
• Valerian or Black Cohosh for hot flashes and irritability (may increase liver problems)
• Passion flower for hot flashes and irritability
• Clonidine (Catapres transdermal patch or pill) for help with hot flashes
• Plant estrogen (phytoestrogens) — Available from diet only
• Soybean, soyflour, tofu
• Oats and wheat
• Nuts

Is hormone therapy right for me?

How to decide

© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved.

Can't find the health information you’re looking for?

Ask a Health Educator, Live!

Know someone who could use this information?...send them this link.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/23/2008...index#5442