During the fertile period of a woman's life, her ovaries produce eggs, estrogen, and progesterone. Between the ages of 45 and 55, the amount of estrogen and progesterone produced will decrease, marking the approach of the menopause. The ovaries will no longer produce eggs and the fertile period in a woman's life will finally end.
Because estrogen is used in so many parts of the female body, there will be many noticeable changes. Some of these, such as hair growing in new places, are just nuisances and completely normal. What also changes are the risks of serious health complications. Aging and menopause make us more susceptible to health issues such as heart disease, osteoporosis, urinary incontinence, abdominal obesity and numerous others.
Without estrogen to protect the heart, the risk of heart problems and disease will increase. The risk of heart attack, stroke, and coronary disease will rise, and if you are in early menopause, your risk is even higher.
In the brain, estrogen maintains the body's temperature. With less estrogen, your temperature can fluctuate rapidly in the form of hot flashes. Hot flashes can, in turn, cause heart palpitations. Normal increases in heart rate during the palpitations are about 8 to 16 beats per minute, and increases that cause hearts to be up to 200 times per minute have also been known to occur.
Serious palpitations go hand in hand with dizziness, being short of breath, and an uncomfortable feeling in the chest. Your doctor will want to know if you experience any of those symptoms. The less serious palpitations can often be addressed by making some changes in your diet or daily routines and activities. For example:
- Quit or at least drastically cut back on smoking.
- Stay away from stimulants like coffee or caffeinated drinks.
- Avoid alcohol.
- Develop a habit of eating more fruits, vegetables, and unprocessed grains.
- Focus your endeavors on losing weight or at least avoid gaining weight in menopause.
- Take up yoga or other relaxing practices such as meditation, tai chi, or at least stretching.
- Add some aerobic activity to your daily schedule, such as swimming or walking.
Hormone replacement therapy (HRT) can help to relieve some symptoms related to menopause. Some forms, such as tablets, can additionally increase the risk of developing blood clots, and they can in turn, lead to:
- Deep vein thrombosis
- Pulmonary embolism
- Coronary artery disease.
While we're young, we build the bones that are meant to last a lifetime. Our bones have both osteoblasts, which promote bone growth, and osteoclasts, which absorb bone material. During our youth, we do lose bone, but our bones are also known to have a well-developed regenerating capability. However, when we get older, even before the age of 40, we start to lose bone faster than we make it, and this occurrence is even more typical for women. Estrogen is one of the hormones that helps the osteoblasts to produce new bone cells, however, as estrogen decreases, women are left without fueling material for bone regeneration and the growth of the bones drastically decreases. Menopause and particularly post menopause is thus the time when osteoclasts significantly weaken female bones.
The view of a normal bone under a microscope would show a honeycomb pattern with holes and spaces. Osteoporosis is a condition in which bones have larger holes than in a normal bone, causing bones to be brittle and more susceptible to breaks or fractures, which are the most dangerous consequence of osteoporosis. Fractures frequently happen to the spine, hip, and wrist. As already mentioned, when fractures occur at an older age, the body can't heal as well or as quickly as when it was younger because of it's decreased capacity of regeneration. Some studies claim that approximately four out of 10 of all postmenopausal women will eventually experience fractures. During the first five years after your periods stop, a woman can lose up to five percent of her bone mass annually. This quick drop does decrease, but the loss of bone mass still continues.
The threat of osteoporosis sounds scary, but there are things women can do to reduce their risk of lowered bone density and fractures. It's best to start when young. Steps all women can take include:
- Getting enough calcium, either through supplements or diet, which will strengthen her bones.
- Supplementing with vitamin D, which plays a key role in the process of calcium absorption.
- All women should eat a well-balanced diet with plenty of fruits and vegetables.
- All women should exercise because regular physical activity helps strengthen and support bones.
- Don't smoke or at least cut back on smoking.
- Don't drink too much alcohol.
However, if you develop osteoporosis anyway, you can still treat it with medication and changes in your way of life:
- Doctors often prescribe Bisphosphonates. They include Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva), Zoledronic acid (Reclast). However, be cautious. Women who have reduced kidney function cannot take bisphosphonates.
- Denosumab (Prolia, Xgeva) might be prescribed to women who can't take bisphosphonates.
- Occasionally, a solution can offer low doses of hormones, such as estrogen and other hormone-like medications such as raloxifene (Evista).
- Doctors prescribe Teriparatide (Forteo) and Abaloparatide (Tymlos) to women who are postmenopausal and have very low bone density, or whose osteoporosis was caused by a steroid medication.
As estrogen decreases, the elasticity in the vaginal tissues and the lining of the urethra will decline too. It's common for sneezing or coughing to cause a sudden release of urine in women with this condition. There are some things women can do to guard against incontinence:
- Lose weight (if you are overweight) and you will reduce the pressure this burden has on your bladder.
- Drink less caffeine and alcohol. Simply replace it with water, unsweetened teas or healthy smoothies.
- Perform Kegel exercises as part of a daily routine to strengthen your pelvic floor muscles.
- Retrain your bladder to hold more urine by adhering to a schedule of urinating at specific times of the day.
Other available treatments include:
- Doctors can prescribe anticholinergics to calm an overactive bladder or to increase the amount of urine your bladder can hold.
- Topical estrogen products can help tone the vaginal and urethra area which will help you deal with incontinence.
- There are medical devices that can be inserted in the urethra.
- There are also medical techniques that stimulate the pelvic nerves and thus improve problems related to incontinence.
- Finally, surgery is available, in which your bladder is lifted or repaired.
Abdominal weight gain
Menopausal women frequently gain weight. This increase is often in the abdominal area and is dangerous because it increases the chances of developing heart problems. Women should pay attention to their diet, they should exercise more, and reduce caloric intake. These are simple but smart and preventative steps to take in order to avoid weight gain and the increased risk of heart disease, as well as other health risks.
Some women will experience an excessive growth of hair in new or unwanted areas, such as the face, chest, and back. This is often genetic because some women are more inclined to it than others, but excessive hair growth can be also attributed to excess male hormones or androgens. There are several options available to treat hirsutism:
- Home and self-treatments such as waxing, shaving, bleaching, and depilatory creams, and plucking. All of these techniques are inexpensive and easily available to all. However, in some women, they can irritate the skin and sometimes cause scarring.
- Physical treatments primarily target and destroy the root of the hair. These treatments include intense pulsed light (IPL), electrolysis, and laser. These treatments are, compared to those mentioned above, more expensive and can cause scarring, changes in skin tone, and redness. Their main benefit is that they are more permanent.
- Medical treatments include a cream to slow the growth of hair. This cream is based on anti-androgens and can include Cyproterone (Androcur), spironolactone (Aldactone), and oral contraceptives. Postmenopausal women can also use finasteride (Proscar, Propecia) as a treatment.
Many women, even up to eight in 10, develop uterine fibroids at some point in their lives, whether before or the during menopause. Some women develop single fibroid, while others multiple fibroids. They can remain as tiny as a seed or can grow so huge they fill the uterus. Many women experience no symptoms at all and the fibroids are detected by a doctor during a routine check. However, those that have symptoms most commonly report the following:
- Heavy menstrual bleeding
- Pelvic pressure or pain
- Frequent urination
- Backache or leg pain.
Estrogen is the hormone responsible for the growth of fibroids. The good news is that as estrogen production decreases during menopause, so does the risk of developing uterine fibroids. However, some women who are on hormone replacement therapy, which contains both estrogen and progesterone, can have problems with uterine fibroids. If doctors detect fibroids in women who take hormone replacement therapy, they will have to stop the HRT treatment.
Fibroid treatments include:
- A "watch and wait" approach for women who have no symptoms or only mildly annoying symptoms.
- Medications such as a Gn-RH that blocks the production of estrogen and progesterone. These medications are not recommended for menopausal women because they do cause bone loss, which is naturally one of the main side effects of menopause and definitely does not need additional medical stimulation.
- Surgery can also solve fibroid-related problems and can include myolysis, uterine artery embolization (UAE), and endometrial ablation.
- Hysterectomy or the removal of the uterus is the last resort for women with severe symptoms.