The medical definition of menopause is the end of menstruation. The changes leading up to this can occur over several years. Many women have heavier and more irregular periods during this time. Women also have many emotional and other physical changes that begin to occur. The following discusses many of these changes.
During the time proceeding menopause, called the perimenopause, the menstrual cycle becomes unpredictable. Heavier bleeding may be experienced due to continued estrogen production which stimulates the uterine lining. Ovulation is necessary for the production of progesterone which counteracts the growth of the uterine lining. Declining ovulation may also shorten the menstrual cycle such that bleeding can occur throughout the entire month. It is wise to keep a log of your bleeding and be evaluated by your doctor to make sure it is due to changing hormone levels rather than fibroid tumors, uterine polyps, uterine or cervical cancer. After ruling out any abnormalities, treatment can include low-dose birth control pills, progesterone therapy and hormone replacement therapy.
Hot flashes and night sweats are the most common symptom of the perimenopause. The hotflash often starts as a sudden sensation of intense warmth, that may increase in intensity until a feeling of burning radiates from the face to the neck and chest. An outbreak of sweating may follow the hot flash which cools down the skin temperature, causing shivers. Hot flashes may vary in frequency and duration. The average length of a hot flash is 4 minutes though it may last ten minutes. Hot flashes can occur as early as age 42. Eighty percent of women are troubled by hot flashes for one year. 25 percent may suffer for 5 years. The greatest problem with hot flashes is the disturbed sleep patterns, which can cause sleep deprivation, memory and concentration difficulties. Women may feel mentally and physically exhausted. Estrogen is the only way to eliminate hot flashes. Women who cannot take estrogen may be helped by other medications such as clonidine and bellergal.
Vaginal thinning and dryness is due to a decline in the estrogen that accompanies menopause. Some women experience vaginal problems during perimenopause, but it usually becomes a significant problem 5 -10 years into menopause. With aging, lubrication of the vagina in response to sexual arousal, occurs more slowly. With the drop in estrogen the vaginal lining becomes thinner, less elastic and the vagina become smaller. Burning and itching can also occur which can also make intercourse more painful and difficult. The best way to combat vaginal atrophy is with estrogen replacement. Other treatments include regular intercourse which increases blood flow to the vagina and using water-soluble vaginal lubricants such as K-Y jelly or Astroglide.
Urinary incontinence becomes more common at menopause due to loss of muscle tone in the bladder and urethra. When increased abdominal pressure occurs due to sneezing, coughing or laughing, urine can escape requiring the continual use of a pad. This is called urinary stress incontinence. Estrogen therapy and Kegel exercises can help control incontinence. More about urinary incontinence and Kegel exercises can be learned from your doctor.
Osteoporosis begins to occur in the years prior to menopause. The bones become progressively more porous, making them more likely to break. Osteoporosis can go undetected for years because it occurs silently. With osteoporosis, the slightest trauma can cause a debilitating bone fracture. Hip fractures leave many women permanently disabled. Within the 6 months following injury, 20 percent of patients will die due to complications from a hip fracture. Once bone is lost it cannot be replaced. Risk factors include being Caucasian or Asian, having a small frame, undergoing early menopause, having a family history of osteoporosis, smoking and consuming more have two alcoholic drinks daily. Good nutrition with adequate calcium, exercise and estrogen replacement can minimize osteoporosis.
Women are much more likely to suffer from heart disease after menopause than before menopause. One third of all deaths of American women each year are attributable to heart disease. Many studies have found that women on estrogen replacement therapy have a lower risk of heart disease and of strokes.
Another complaint that occurs with menopause is weight gain. Weight gain occurs due to a change in the body's metabolism combined with decreased exercise or increased caloric intake. Increased physical activity and a nutritious, balanced diet can minimize weight gain. The amount of weight gain is the same whether a women is on hormone replacement or decides against it.
Introduced in September 1998, this comprehensive 50-page "booklet" has been developed by North America's leading nonprofit scientific organization devoted to improving women's health through menopause and beyond. This guidebook provides current, unbiased information on a wide variety of menopause issues -- including perimenopausal changes (such as irregular menstrual periods, hot flashes, vaginal dryness, and changes in sexual function), advice about postmenopausal health (including prevention of heart disease, osteoporosis, and cancer), and menopause treatment options (such as lifestyle changes, prescription and nonprescription remedies, and alternative/complementary treatments). Also includes additional organizations that can provide help. Consumers can receive the Menopause Guidebook along with many other helpful items in the Society's "MenoPak." This packet is free, but there is a $5 shipping/handling fee (U.S. and Canada). Order your MenoPak by calling toll-free 1-800-774-5342 (use VISA or Mastercard for the fee) or write and include a check or money order.
Building Better Bones: A Guide to Active Living
The Osteoporosis Society of Canada
P.O. Box 280, Station Q
Toronto, ON M4T 2M1, Canada
Published by Canada's leading nonprofit organization dealing with osteoporosis, this 16-page booklet is available to individuals free of charge by writing or calling 416-696-2663. In Canada, call the osteoporosis/menopause information line toll-free: 1-800-463-6842.
Menopause and Osteoporosis
National Osteoporosis Foundation
II 50 17th Street, NW, Suite 500
Washington, DC 20036-4603
Devoted to improving osteoporosis prevention and treatment, this nonprofit organization offers a helpful 22-page booklet. Individual copies are available free of charge by calling 202-223-2226.
Menopause Handbook
Montreal Health Press Inc.
P.O. Box 1000
Station Place du Parc
Montreal, PQ H2W 2N1, Canada
Published in 1997 by a woman's collective that has produced books on health and sexuality for over 25 years, this 50-page booklet offers good advice as well as insights into a variety of social and political issues which affect the health and well- being of midlife women (especially those in Canada). Order a copy for $4 by writing or calling 514-282-1171.
Menopause. Let's Talk about It
The Society of Obstetricians and Gynecologists of Canada
774 Echo Drive
Ottawa, ON K1S-5N8, Canada
This colorful 20-page booklet -- written especially for Canadian women but appropriate for all -- is a concise overview of the key issues. Individual copies are available to the public free of charge by writing or calling 613-730-4192 (in Canada, call toll-free 1-800-561-2416).
Taking Hormones and Women's Health
National Women's Health Network
514 10th Street, NW, Suite 400
Washington, DC 20004
This informative booklet about menopause and hormones -- published in 1995 by a leading public-interest, nonprofit organization dedicated to protecting women's health and health rights -- is available to members for $6 (nonmembers for SS) plus a $1 handling fee. Call 202-628-7814 for information regarding availability of the updated version.
Written by a psychologist and two general internists, this hardback book is a comprehensive treatment of menopause as a normal stage of life. The inclusive tone is consistently supportive, and pays special attention to the emotional and social aspects of midlife.
Dr. Susan Love's Breast Book
Susan M. Love, MD, and Karen Lindsey
New York, NY: Addison-Wesley, 1995 (2nd ed.)
Written by a breast surgeon, this hardback book is widely considered to be the best consumer book addressing breast health and breast cancer.
The Essential Heart Book for Women
Morris Notelovitz, MD, PhD, and Diana Tonnesen
New York, NY: St. Martin's Press, 1996
In Canada:
Toronto, ON: McClelland & Stewart, Inc.
Good, nonpatronizing hardback book from a menopause specialist that will help women cut through the heart health myths, determine their risks, and begin informed self-care. Contains references and resource information.
Estrogen: The Natural Way
Nina Shandler
New York, NY: Villard Books, 1997
This hardback book (and the paperback expected in mid- 1998) contain excellent recipes using foods such as soy and flax seed with mild estrogen-like effects. Although more research is needed to prove that these foods can prevent osteoporosis or heart disease, they are widely considered part of a healthy diet emphasizing plant protein, and may relieve hot flashes for some women.
Fit Over Forty. A Revolutionary Plan to Achieve
Lifelong Physical and Spiritual Health and Well-being
James M. Rippe, MD
New York, NY: William Morrow and Company, 1996
Based on a landmark study that established the first-ever standards for persons over forty, this book (and the Quill paperback published in 1997) offer both women and men excellent, fun-to-read advice as well as ten self-tests for evaluating one's personal fitness level. Written by a Harvard-educated cardiologist who directs the Center for Clinical and Lifestyle Research at Tufts University, these lifestyle guidelines include the first essential steps anyone should take toward a healthy future.
A Gynecologist's Second Opinion: The Questions and
Answers You Need To Take Charge of Your Health
William H. Parker, MD, with Rachel L. Parker
New York, NY: Plume, 1996
Written in a question-and-answer format, this hardback book is an easily understood reference book providing clear descriptions of a wide variety of common gynecologic problems and their causes, as well as multiple options about treatment. Not the best reference regarding menopause specifically.
The Harvard Guide to Women's Health
Karen J. Carlson, MD, Stephanie A. Eisenstat, MD, and Terra Ziporyn, PhD
Cambridge, MA: Harvard University Press, 1996
Although not an in-depth discussion of menopause, this book (and the 1997 paperback) provides a basic review of the many varied issues affecting their health at various stages in their lives. Includes over 300 topics covered A-to-Z, over 250 illustrations, and listings of resources.
The Healthy Woman: Menopause and Other Things We
Don't Talk About
Susan Davis, MD
New York, NY: Brunner Mazel, 1996
The writing is clear and readable -- and the approach broadminded, allowing for use of alternative remedies as well as hormone therapy.
Menopause
Isaac Schiff, MD, with Ann B. Parson
New York, NY: Times Books (Random House Div.), 1996 (paperback)
in Canada:
Toronto, ON: Random House of Canada Limited, 1996 (paperback)
Written by a former president of The North American Menopause Society, this comprehensive and easy-to-read book guides readers through menopause and its effects, hormone replacement therapy, and alternatives.
Menopause, Me and You: The Sound of Women Pausing
Ann M. Voda, RN, PhD
Binghampton, NY: Haworth Press, 1997
This paperback book, written by a pioneer in women's health research and a past-president of The North American Menopause Society, has a wonderful mixture of personal advice and anecdotes, combined with excellent discussion of the processes of menstruation, reproductive aging, and the menopause. It's especially good for women just approaching the menopause transition.
Menopause, Naturally: Preparing for the Second
Half of Life
Sadja Greenwood, MD
Volcano, CA; Volcano Press, 1996 (rev. ed.)(paperback)
First published in 1984, and often cited as the first book written by a physician to treat menopause as a natural event, this updated paperback book suggests medical intervention only when the woman herself decides that it's needed, and gives many useful suggestions for self-care. Winner of numerous Book of the Year Awards. Also available in Spanish (published in 1997 by Panorama Mexico).
150 Most-Asked Questions About Menopause. What
Women Really Want to Know
Ruth S. Jacobowitz
New York, NY: Morrow, 1996 (paperback)
The result of 35,000 questionnaires, this consumer-oriented book by an award-winning medical writer and lecturer provides answers to the most common questions about menopause in an accessible Q&A format. Translated into 16 languages.
(The New) Ourselves Growing Older
Paula B. Doress-Worters, Diana Laskin Siegal, and the Midlife and Older
Women Book Project
New York, NY: Peter Smith, 1996
A spin-off from Our Bodies Ourselves, this widely acclaimed reference book concentrates on health issues for the aging woman. Sections on sexuality and how to manage stress, insomnia, and pain are particularly well-written.
the pause: Positive Approaches to Menopause
Lonnie Barbach, PhD
New York, NY: Plume Books, 1995 (rev. ed.)(paperback)
A sexologist and best-selling author offers a life- and sanity-saving guide for making the "third third" of life productive and fulfilling. Includes traditional as well as alternatives for symptom relief. Plus, there's a chapter for men to help them cope and understand.
Perimenopause: Changes In Women's Health After 35
James E. Huston, MD, and L. Darlene Lanka, MD
Oakland, CA: New Harbinger Publications, 1997
Written by gynecologists, this paperback book focuses on the perimenopause (literally, the "time around menopause"), presenting explanations of why menopause-related changes start as early as in a woman's 30s, gather pace in the 40s, and culminate with reaching menopause (confirmed when periods have ceased for 12 consecutive months at an average of age 51) as well as ways to deal with them.
The PMS & Perimenopause Sourcebook. A Guide to
the Emotional, Mental and Physical Patterns of a Woman's Life
Lori A. Futterman, RN, PhD, and John E. Jones, PhD
Los Angeles, CA: Lowell House, 1997
Thorough discussion of premenstrual syndrome (PMS) and the perimenopause transition that can help women in their 30s, 40s, and beyond take personal responsibility for their health through these physiologic/emotional changes.
The Simple Soybean and Your Health
Mark Messina, PhD, and Virginia Messina, RD, with Ken Stechell, PhD
Garden City Park, NY: Avery Publishing Group, 1994
Some aspects of science have gone beyond this paperback book's content, but it's still the best reference for information about soy and its potential health benefits, as well as recipes for tasty dishes made from soy-containing foods.
Strong Women Stay Young
Miriam E. Nelson, PhD
New York, NY: Bantam Books, 1997
This book (and the paperback available in early 1998) present a scientifically tested exercise program for women who are beginners or jocks from the School of Nutrition Science and Policy, Tufts University. It will motivate and help women understand the importance of strength training, and discusses specific exercises for both home and gym routines.
Transformation through Menopause
Marian Van Eyk McCain
New York, NY: Bergin & Garvey, 1991
Considered mandatory reading by many, this timeless book does not deal with the physical changes and physiologic effects associated with menopause, but rather works through issues such as self-image and empowerment.
Understanding Menopause
Janine O'Leary Cobb
New York, NY: Plume, 1993 (paperback)
In Canada:
Toronto, ON: Key Porter, 1996 (rev. ed.) (paperback)
A bestseller in Canada since 1988, this book has been revised and updated for American readers. The author has spent more than a decade gathering information about the menopause experience from thousands of women who subscribe to her newsletter, A Friend Indeed
What Every Women Needs to Know About Estrogen:
Natural and Traditional Therapies for a Longer, Healthier Life
Karen Anne Hutchinson, MD, and Judith Sachs
New York, NY: Plume, 1997
Offered in a question-and-answer format, this paperback book from a Yale endocrinologist/gynecologist and a best-selling health writer answers women's questions about estrogen -- both in prescription medicine and in botanical and food sources -- and its effects on everything from sexual desire to memory loss.
What Every Woman Needs to Know About Menopause:
The Years Before, During, and After
Mary Jane Minkin, MD, and Carol V. Wright
New Haven, CT, and London: Yale University Press, 1996
This hardback book, written by a Yale gynecologist and her former patient, presents solid facts in a question-and-answer format -- and is primarily useful for its in-depth review of potential gynecological surgeries. Bibliography and resource list.
What Every Woman Should Know: Staying Healthy
After 40
Lila E. Nachtigall, MD, Robert D. Nachtigall, MD, and Joan Rattner Heilman
New York, NY: Warner Books, 1996 (paperback)
Easy-to-read presentation from gynecologists emphasizing how women can preserve wellness through perimenopause and beyond. Covers far more than menopause-related issues.
The Woman's Guide to Hysterectomy: Expectations
& Options
Adelaide Haas, PhD, and Susan L. Puretz, EdD
Berkeley, CA: Celestial Arts Press, 1995
Any woman facing hysterectomy (surgical removal of uterus) will find this paperback book a thorough, sophisticated treatise of what to expect during and after surgery -- and should make sure, prior to surgery, that the nonsurgical options mentioned here are considered.
Women of the 14th Moon: Writings on Menopause
Dena Taylor and Amber Coverdale Sumrall (eds.)
Capitola, CA: The Crossing Press, 1991
This anthology of women's experiences of menopause provides a wide range of perspectives and a surprising amount of basic information about how to cope. Great bedtime reading.
A Friend Indeed
P.O. Box 1710
Champlain, NY 12919-17 1 0
In Canada:
Box 515, Place du Parc Station
Montreal, QC H2W 2P1
Publisher: A Friend Indeed Publications, Inc. (Janine O'Leary Cobb)
In business since 1984, this "grandmother of all menopause newsletters" is a recommended resource in more than 35 books about menopause. Each issue comprises a feature article, 3-4 pages of letters, a summary of research findings, and other news. The cost is $30 for an annual subscription of eight 8-page issues. Over 60 back issues cover a wide range of topics and are available for $3.50 each.
Harvard Women's Health Watch
P.O. Box 420234
Palm Coast, FL 32142-0234
This comprehensive newsletter, published by an organization associated with Harvard University, addresses issues relating not only to menopause but also to a myriad of health concerns through all stages of a woman's life. The cost is $32 for an annual subscription of twelve 8-page issues.
HerbalGram
American Botanical Council
P.O. Box 201660
Austin, TX 78720
This newsletter addresses the worldwide use of herbs for all sorts of health effects, and provides a comprehensive list of books and pamphlets on botanicals. Published by two nonprofit organizations -- the American Botanical Council and the Herb Research Foundation -- with an editorial board of leading scientists in the field of herbal pharmacology, this newsletter is a reliable source of information. The cost is $25 for an annual subscription of four issues.
Menopause News
2074 Union Street
San Francisco, CA 94123
Publisher: Judith Askew
A collection of short, pithy articles with a sense of humor. Each issue contains a page of letters as well as book reviews. Occasionally, an interview format is used for longer articles, taking advantage of many California-based resources -- particularly in the area of alternate remedies. The cost is $24 for an annual subscription of six 6-page issues ($30 for institutions).
Tufts University Health & Nutrition Letter
53 Park Place
New York, NY 10007
Published by perhaps the world's leading nutrition research center, this newsletter offers current, scientifically valid advice regarding how diet affects our health, with some articles reaching beyond into other lifestyle issues. The cost is $24 for an annual subscription of twelve 8-page issues.
The North American Menopause Society invites everyone to visit the NAMS WebSite, where much information is available for consumers and healthcare providers alike -- including links to over 50 other sites that are considered worthwhile by the Society.
Copyright 1998 The North American Menopause Society.
All rights reserved.
The North American Menopause Society (NAMS), P.O. Box 94527, Cleveland, OH
44101
Permission is granted by NAMS to publish or reproduce this list in a
noncommerical effort, provided that the NAMS copyright line remains in place.
Excerpts may be published only with written permission from NAMS.
Published September 1998 - C024