Endocrinology Dr. Schneider Dr Einhorn | La Jolla | San Diego

Conditions of the Ovaries

Menopause

Menopause is a natural part of a woman's life cycle. After menopause, a women's monthly periods end and she no longer can get pregnant naturally. Menopause can be challenging both emotionally and physically, and we are here to help you manage this transition. In the US, the average age of menopause is around 50, although there is a great range.

The changes of menopause begin when the production of female hormones in your ovaries decreases.

Two hormones made in the ovaries - estrogen and progesterone - help to regulate a woman's monthly period and to prepare the body for a pregnancy.
As you approach mid-life, estrogen begins to drop to low levels. The reproductive organs gradually shut down, just as they gradually became active during puberty. Most women notice that their periods become lighter, farther apart and then, eventually, they end.
The menopausal transition may take from one to 10 years, and during that time hormone levels are likely to fluctuate widely. Some months you may have a period; other months you may not. During this time, you may still be able to get pregnant.
Menopause typically happens gradually, over time.

In some cases, the onset of menopause may occur suddenly for reasons such as the removal of both ovaries, radiation or chemotherapy, gland disorders, or a sudden, severe illness.

Symptoms of Menopause

Symptoms of menopause begin when estrogen levels start changing. A woman's body can go through several kinds of changes at the same time.

Early in menopause, estrogen levels can rise sharply and then drop, which means you may skip periods or even have more frequent and heavier flow than usual during some months. Your period is likely to become increasingly irregular, and then eventually stop altogether.

The first menopause symptoms most women notice are hot flashes and mood swings. Some report mental confusion and sometimes a sense of sadness or depression. You also may have problems during sex, either because of vaginal dryness or lack of desire. Eventually, as your estrogen stays consistently at a low level, symptoms of menopause including the hot flashes, changing moods, and mental fogginess usually disappear.

Menopause can affect your body organs and systems in many different ways:

Blood Vessels - Quick body temperature changes, or hot flashes, and waking during the night
Psyche - Moods that change frequently or a tendency toward sadness, anger, or, in extreme cases, depression or anxiety
Genitals - Problems with dryness, itching, pain during sexual intercourse, or irritation of the tissues in and around the vagina
Urinary system - Problems with sudden or frequent urinating
Bones - Increased risk for osteoporosis, and bone fractures
Heart - Acceleration of risk factors associated with heart attacks and other heart problems

Menopause Treatment Options

Treatment for the symptoms of menopause can be approached in two phases:

Early in menopause, you and your doctor should discuss your first signs of menopause and whether to treat them as they occur. You should be evaluated for your risk of getting breast cancer or heart disease, as well as osteoporosis, which is severe bone loss that puts you at increased risk for broken bones. If you are not at high risk for breast cancer, you may wish to consider taking estrogen for a limited time. By using the lowest effective dose, you may be able to manage several menopause symptoms at once. If, after weighing the pros and cons of estrogen, you decide it's not for you, other treatments are available.
Later in menopause you should focus on effectively preventing diseases such as osteoporosis and heart disease. Your earlier menopause symptoms will probably disappear.
You and your doctor should form a partnership and share information that will help you make the best decisions about your health. There are many things to keep in mind, because menopause and the years that follow it usually cover the second half of a woman's life.

Talk to Dr. Schneider about all treatment choices to decide what is right for you.

Please also see the below table - Treating Your Menopausal Symptoms: The Quick Pros and Cons.

Hormone Treatment Options

Many women want to address the hormone imbalance and keep estrogen levels by taking estrogen, because it is often the most effective way to relieve many of the troubling symptoms of menopause. Because estrogen increases the risk of uterine cancer, if taken alone, women who still have a uterus should take a combination of estrogen with a form of progesterone, called progestin, which helps to protect the uterus. Progestin can be taken every 3 or even every 6 months for a certain period of time, without loosing its protective effects.

If a woman no longer has a uterus, she can take estrogen alone.

If you have a family history of breast cancer or have survived breast cancer, or if you have had cancer of the uterus, liver disease, a history of blood clots, heart disease or any unusual bleeding from the vagina you should not take hormones without discussing with your doctor, or Dr. Schneider, first.

Estrogen can help to reduce hot flashes, vaginal dryness, and possibly skin changes. It is also an effective way to protect your bones from rapid weakening as you age.

Treating the symptoms of early menopause without using hormones:

The following are some other ways to treat your symptoms of the hormone imbalance that occurs during menopause without choosing hormones:

Selective-Serotonin Reuptake Inhibitor (SSRI) drugs and Serotonin Norephinephrine Reuptake Inhibitor (SNRI) drugs are useful both in treating depression and in treating hot flashes.
Gabapentin may be used to treat hot flashes, particularly for those occurring at night and disturbing sleep.
Medroxyprogesterone acetate and megestrol acetate, progesterone-type drugs, may be used to treat hot flashes.
Clonidine is a blood-pressure-lowering drug that is also used to reduce the frequency and severity of hot flashes.
Individual counseling or support groups can also help you to handle sad, depressed, or confusing feelings you may be having as your body changes.
Vaginal moisturizers such as Vagisil or Replens, can help women with thinning vaginal tissue or dryness. Lubricants, such as K-Y Jelly or Astroglide, can help with lubrication difficulties that may be present during intercourse.
Low-dose vaginal estrogen is generally a safe way to take estrogen to solve vaginal thinning and dryness problems while only minimally increasing the levels of estrogen in the blood.

Menopause Lifestyle

Women have many choices in the ways they can treat symptoms of menopause. All women, however, should aim for a healthy lifestyle. Eat a healthy diet, including 1,500 mg of calcium daily, lower the amount of fat in your diet, and maintain the right balance of calories to support an active lifestyle. If you are overweight, losing weight is encouraged.

Quit or try to cut down on smoking.
Drink alcohol moderately, if at all.
Exercise for 30 minutes at least three times a week.
Avoid stressful situations.
Have a yearly mammogram and breast examination by a health professional.
Preventing disease will be a major concern after you go through menopause. Your risk of bone loss and bone fractures (both of which are osteoporosis symptoms), heart disease, and other conditions increases as you age.

To prevent bone loss:
Maintain a healthy diet and exercise. Other treatments for preventing bone loss and osteoporosis symptoms include calcium tablets and Vitamin D. These can be taken separately or combined in a pill.

Some studies have shown other preventive roles for estrogen. More studies are needed to learn how effective estrogen might be in preventing these diseases. For example:

Estrogen loss may be linked with Alzheimer's disease, a fact that led to the notion that taking estrogen after menopause might help to prevent this disease. However, the Women's Health Initiative data suggest that women who initiate hormone therapy at age 65 or older have worsening dementia than women who take no hormones. Whether there is an optimal age to initiate estrogen treatment, or whether the results would have been different if estrogen had been started at the time of the menopause is unclear. Until more is known, hormone therapy cannot be recommended for prevention of Alzheimer's disease.
Taking estrogen plus progestin lowers the risk of developing colon cancer.
Taking estrogen lowers the risk of developing age-related macular degeneration, a degeneration of the retina of the eye.
Taking estrogen lowers the risk of bone fractures, one of the leading symptoms of osteoporosis.
It should be remembered that each woman is different, and the benefits of hormone therapy need to balanced against its risks as well as the complete health status of each and every woman to come up with the best plan.

*A note on estrogen
Short-term goals of estrogen treatment are different from the long-term goals. Short-term hormone therapy is designed to relieve symptoms; long-term therapy helps to prevent bone loss. If you take hormones for less than three to five years, the risks are relatively low. If you are concerned about bone loss and are thinking about taking hormone therapy for more than five years, consult with your doctor to see whether hormone therapy or an alternative treatment is best for you.
You should not take estrogen if you have had breast cancer or are at risk for breast cancer. There is an increased risk of breast cancer if taken with progestin, increased risk of uterine cancer if not taken with progesterone and increased risk of blood clots for women taking estrogen.