1. Menopause Why is understanding menopause important?
The basics: Perimenopause
The basics: Menopause
The change - A misunderstood period of life

2. I. Why is understanding menopause important?
A. Numbers:
% Increase in US population aged over 55
Source: US Bureau of the Census, International Database

3. B. Menopause is related to health
increased risk for developing two significant diseases: osteoporosis and heart disease

4. II. The Basics: Perimenopause
Overview:
Years immediately preceding and following the last menstrual period -
during this time the following processes are occurring within a woman's body:
ovaries release eggs less regularly
ovaries gradually produce less estrogen and other hormones
fertility decreases
menstrual cycles shorten, there are fewer ovulations, and more cycle irregularity

5. B. Perimenopausal symptoms
mood changes
changes in sexual desire
difficulty in concentrating
joint and muscle aches, frequent urination
similar symptoms as experienced with premenstrual syndrome (PMS)
Treatment of symptoms
low-dose birth control pills

6. III. The Basics: Menopause
Overview:
Cause?
Decreasing # of follicle cells –
Hypothalamatic changes in the brain cause ovaries to increase the # of follicle cells recruited premenopausally, thereby rapidly depleting the follicle cells
Result:
Most women enter & complete menopause between the ages (mean age = 51),
Premature menopause –

7. B. Modes of induction
Natural menopause – ovaries begin to fail to respond to the LH & FSH which are still released
Surgically induced menopause – total hysterectomy, bilateral sapingo-oophorectomy, and/or chemotherapy
Ovaries not present to respond to LH/FSH

8. C. Symptoms of menopause
Different for each woman!
Hot Flashes – a sensation of internally generated heat beginning in the chest and moving to the neck & head or spreading throughout the body
Accompanied by increased heart rate, temperature, shallow breathing, & sweating followed by chills
Early symptom of estrogen deficiency
Treatment:
Deep breathing, reduced stress

9. Changes in hair growth & skin (estrogen effects collagen)
Vaginal atrophy –
May impact sexual desire
Vaginal lubricants can help this, sexual activity lessens the effect
Atrophy of the urinary tract & urinary incontinence – diminished muscle tone
Sleep disturbance,
Increased weight
Changes in hair growth & skin (estrogen effects collagen)

10. D. Menopause Management
Lifestyle changes

11. Non-prescription options
Vitamins & minerals
Vaginal lubricants & moisturizers
Acupuncture
Phytoestrogens (plant estrogens)
Watch out for “herbal alternatives” that claim to cure cancer, prevent heart disease or reverse the effects of osteoporosis…

12. Hormone Replacement Therapy (HRT) – medically supervised drug treatment of menopausal women which involves supplementing hormone levels

13. Benefits of EPT and ET reduce the risk of osteoporosis.
relieve hot flashes and night sweats.
relieve vaginal & urinary atrophy.
improve cholesterol levels.
reduce the risk of cancer of the colon.
may reduce macular degeneration.
Women's Health Initiative (WHI) clinical trial – a turning point!
Researchers found combination

14. Risks of HRT It's all in the timing: Age is an important factor:
EPT and ET modestly increase risk of breast cancer while they are being used; long-term use may pose the greatest risk.
EPT and ET may increase the risk for blood clots.
EPT and ET can have unpleasant side effects, such as bloating and breast tenderness.
EPT and ET in pill form can raise level of triglycerides (a type of fat in the blood).
ET may increase the risk of dementia.
ET increases the risk of stroke.
ET increases the risk of cancer of the uterus.
It's all in the timing: Age is an important factor:
ET –
For some women — such as those who experience moderate to severe hot flashes or other menopausal symptoms —

15. IV. The change – Currently, a misunderstood period of life
Cultural bias
Neglected as a research area – we still don’t know what triggers menopause or how symptoms should be treated best

16. B. Not simply “the end of the road” – A time of freedom & empowerment
“Freed up & energized”
“To airbrush age off a woman’s face is to erase woman’s identity, power and history.” Naomi Wolf
“My fantasy of aging is to age well enough so that younger women would think, “Gee, I wish I were her age.” I want the stigma of aging to be removed from women and for myself, I intend to do it with as much panache as I can. I am going to put everything I’ve got into it.” Claire Braz-Valentine
“In my fifties, I feel ripely quiet. Life seems simpler; I am more appreciative.” Ruth Zaporah

17. For discussion
Why has medical research been slower to understand the physiological dimensions of menopause than other reproductive health matters?
What can be done to continue to change societal images of menopause, aging, and older women?
How should menopause be viewed?