Coastal Medical Clinic - Myrtle Beach, SC.

Since your last menstrual cycle was over 1 year ago we can establish the diagnosis of menopause. But as you know the changes of menopause have actually been occurring over the last few years and will continue to occur for the rest of your life. While menopause is an inevitable part of the aging process, the signs and symptoms you present with are not. Some women continue to menstruate normally until the onset of menopause and then simply cease to have periods. But for most women, the transition is not so easy. You can expect to see a variety of changes. What they are, why they happen and what you can do to balance your hormonal "symphony" is the subject of Bio-Identical Hormone Replacement Therapy.

A woman's egg supply, as much as 2 million in the ovaries at birth, is programmed for self-destruction. When the supply is almost exhausted because of the aging process, or if the ovaries are surgically removed, the menstrual cycle comes to an end. In fact, the reproductive cycle begins to change several years before menopause, a period referred to as perimenopause. During this time, typically starting in the late 40's, the ovaries' response to the various stimulating hormones produced by the brain becomes unsynchronized, until eventually the aging ovaries fail to respond at all. They start to produce less progesterone, losing their ability to ovulate.

When ovulation stops, estrogen levels decline and menstruation ceases. As ovulatory cycles become more irregular throughout perimenopause, the body's sensitive hormonal rhythm is thrown off and menstruation may vary more from month to month. In addition, hormones known as androgens, or Testosterone, begin to play a bigger role. Though referred to as male sex hormones, they are in fact produced in small amounts by the female body as well. As levels of the female hormones decline, the impact of these "male" hormones can increase.

The bottom line is that fluctuating blood levels of hormones during the transitional years can create a number of physical changes. Women who once worried about oily skin may now find their skin dry and itchy and may need to apply moisturizers and hand creams. As estrogen level declines, the fatty layer beneath the skin surface begins to shrink so the outer skin layer begins to fold and wrinkle. The skin may also develop a rougher texture.

Vaginal Changes are the first sign of perimenopause for some women, while many do not notice changes until five to ten years after menopause. As estrogen levels drop, the vulva and vagina lose elasticity, resulting in vaginal dryness, itching and a shrinking process known as vaginal atrophy in which the vagina becomes shorter and narrower at the opening. Vaginal membranes also become thinner, hold less moisture, and lubricate more slowly. The result of all these changes can be discomfort, vaginal infections, and painful intercourse.

As estrogen levels fall so do the breasts! Stimulation of the breast tissue is reduced, causing glandular tissue to shrink. Loss of elasticity causes the breasts to droop and flatten, losing their earlier fullness. Nipples become smaller and flatter and may lose their erectile properties. Women who have been bothered by breast tenderness and cysts related to the menstrual cycle are often relieved to find that these symptoms disappear after menopause.

Muscles atrophy and lose strength. Abdominal wall tone may lessen gradually as we age, resulting in a protruding stomach. Regular exercise to strengthen your muscles can help maintain your lean mass and lessen the chance of injury.

An increase of androgens can result in darker, thicker and wiry body hair on the pubis, underarms, face, chest, lower abdomen, and back. The softer hair on the head also begins to change in texture. A loss of luster occurs because individual hair shafts begin to thin and dry. Hair growth becomes slower, and new replacement hair is generally dryer, with less shine. Many women also note a thinning of pubic and underarm hair after menopause

As estrogen and progesterone levels fall drastically, the bones begin to lose mass. This causes them to become progressively more fragile. Backaches may be the first sign of bone loss. Severe loss of bone is called osteoporosis, which strikes at least half of all women age 50 and older. By the time a woman is 80, she may have lost 40 percent of her bone mass. Osteoporosis leaves a woman vulnerable to bone fractures, especially in the hip, spine, and wrist.

Dental problems that occur around midlife, such as receding gums or loose teeth, may be related to declining levels of estrogen and a loss of bone mass. Gingivectomy, a procedure to repair the gums after periodontal disease, is a common oral surgery procedure for women in midlife, especially for those prone to osteoporosis.

Hot flashes or night sweats are the most common characteristics of menopause. Some women experience a simple warming sensation throughout the body. Others feel acute flushes followed immediately by an outbreak of sweating. In most cases, hot flashes are mild but may take up to three years to resolve. Frequency can vary from 1 or 2 a week to 1 or 2 per hour. Estrogen must be present, and then withdrawn, for hot flashes to occur. The feeling may be precipitated by a hormonally induced imbalance in the brain's temperature- control center, resulting in a drop in core body temperature and a subsequent attempt by the body to activate heat centers to re-adjust the body's "thermostat." Heavier women tend to experience hot flashes less often, perhaps due to the estrogen produced in fatty tissue.

Short term memory loss is a common problem for women in midlife. Forgetfulness may be related to stress or lack of sleep. Women on estrogen replacement are 40% less likely to get Alzheimer’s disease. Estrogen helps cognition and maintains your ability to learn new things. Studies show there is no increase in serious psychiatric disorders in women experiencing menopause. Minor emotional distress, however, may be a natural response to the changes a woman faces. Two changes in physical function that occur around the time of menopause may take a particularly heavy toll on a woman's psychological state. Hot flashes may keep you up at night, leading to chronic sleep deprivation. Vaginal changes that result in painful intercourse may interfere with your sexual pleasure and psychological health.

There is a natural redistribution of fat over the abdomen and hips. This is due in part to changes in hormone balance but also from reduced muscle tone, reduced physical activity, increased appetite and calorie intake, and other effects of the aging process. Increased physical activity and a nutritious, balanced diet, can minimize fat gain.

Women in peri- and postmenopause may experience mild stress incontinence, defined as the loss of a little urine in response to sudden muscular stress, such as jogging, sneezing, coughing, laughing, or emotional distress. Many women also experience urge incontinence, the sensation that they need to urinate with great urgency, even though the bladder may be empty. These problems occur when declining estrogen levels cause cell deterioration and diminished muscle control in the urethra, bladder, and vagina.

Women rarely die of heart disease before menopause because estrogen provides protection against it -- partially by helping to keep cholesterol levels in check. For reasons not completely understood, there is a relationship between hormone levels and the development of the plaque-like substances inside the blood vessels that can cause blockage and lead to heart disease. A women's risk of cardiovascular disease rises dramatically after menopause. Surgical menopause likewise increases the risk for heart disease, even in young women. In fact, the younger a woman is when her ovaries stop functioning, the greater her risk for heart attack and although women tend to worry more about breast cancer, heart disease is considerably more lethal -- it is the number one killer of American women. One in seven women, ages 45 to 64, has some form of heart disease. This number increases to one in three over the age of 65. Thus menopause itself should be considered a risk factor for cardiovascular disease, along with high blood pressure, smoking, family history, poor diet, high blood cholesterol, diabetes, and obesity.

Hormone replacement therapy (HRT) may help to promote cardiovascular health; but reducing the risk factors that are within your control can be equally important. Proper nutrition, regular exercise, maintaining your proper weight, and not using tobacco products are key strategies for ensuring your cardiovascular health during midlife and beyond.