Mechanisms of Menopause

[Wise Young]

Menopause is something that all women undergo as they age. Their hormonal levels of estrogen declines while their fertility and menstrual cycles diminish, and their resistance to many degenerating conditions declines. The mechanisms of menopause are not well understood but many studies have yielded important insights into the process. Let me discuss some of the manifestations and mechanism.

Hot flashes. Many women experience and complain of "hot flashes" with the onset of menopause. These are associated with vasodilation, a sensation of flushing sensation that often begins in the face and descends down the body. Some women perspire and then feel cold. Others get dizzy, weak, tired, insomnia, headaches, palpitations, and other symptoms. Internal body temperature may drop several degrees. The episodes usually last 1-30 minutes but may persist for longer periods, and may recur daily and multiple times, more often in summer and in evenings. Not everybody gets hot flashes. About 20-25% of women don't have hot flashes and several studies suggest that most women in Asia don't get hot flashes (something that has been attributed to the presence of estrogen in soybean (tofu). Hot flashes may be triggered by spicy foods, alcohol, emotional stress, heat. Although many doctors attribute "hot flashes" to loss of hormonal regulation, many studies now suggest that they result from the release of pro-inflammatory cytokines that are normally suppressed by estrogen. That is why one of the recommended treatments is estrogen replacement. Birth control pills may be useful for suppressing irregular menstrual cycles and symptoms.

Vulnerability to neurodegenerative disorders. The incidence of many degenerative disorders appear to increase after menopause for women. For example, the incidence of Alzheimer's disease increases dramatically in women after menopause. While some of these are undoubtedly age-related, it is likely that estrogen is protective and suppresses both inflammatory and immune responses in the body. For example, it is known that many women suffer macular degeneration and deterioration of their eyesight after menopause. Hormonal replacement therapy apparently significantly reduces the incidence of macular degeneration (Source (http://www.bmj.com/cgi/content/full/310/6994/1570)) in women who have or are undergoing early menopause. Women may also have memory problems, have trouble finding words, have attention deficit, and show mood swings during menopause (Source (http://www.nymemory.org/menmemandmoo.html)). While there is controversy about the usefulness of hormone replacement therapy and estrogen therapy does increase the risk of breast cancer, some doctors believe that the benefits of hormonal replacement therapy outweigh the risks, at least during the transition into menopause.

Osteoporosis. This is one of the most common problems associated with menopause. Bone loss is accelerated after menopause. The mechanism is again attributed to reduction of estrogen levels. Almost all women have this problem. While there are phosophonates, calcitonin, vitamin D, calcium, phosphorus, and other drugs may be able to slow down the calcium loss, and can prevent weakening of bone or prevent the vulnerability to fracture and other problems (Source (http://www.endocrineweb.com/osteoporosis/menopause.html)). Estrogen therapy can retard the bone loss.

Coronary Artery Disease. The risk of heart disease climbs precipitously for women after menopause. The best way to deal with this is adopting a healthy diet and reducing risk factors such as obesity, smoking, and cholesterol.

Breast cancer. The risk of breast cancer increases in post-menopausal women. Many women (and doctors) are afraid of hormonal replacement therapy for fear of increasing the risk for breast cancer. However, large scale studies of tens of thousands of women have not confirmed this risk. While no woman who has a strong family or personal history of breast cancer should be taking hormonal replacement therapy, there is no convincing evidence of a significant risk increase. One study in fact suggests that the risk of breast cancer in women on hormonal replacement therapy may be lower than in women who are not on such therapies (Source (http://www.emedicine.com/med/topic3289.htm)).

Therapies. Hormonal replacement therapy and symptomatic treatments are usually used. Recent studies have focused on the pituitary sex hormones such as FSH and LH, and even replacement of these hormones (Source (http://www.endocrineweb.com/osteoporosis/menopause.html)). A number of clinical trials are looking at the risks and benefits of such therapies. Birth control pills are sometimes useful at premenopausal periods to suppress irregular menstrual cycles and symptoms. A huge number of remedies have been touted for "hot flashes". Not all of them work and none work for everybody. Herbal remedies are often recommended (Source (http://www.power-surge.com/headlines/hotflash.htm), particularly soy and other foods that contain phyto-estrogens. In cases of severe "power flashes", estrogen replacement may reduce the severity of the episodes, anti-inflammatory drugs and even steroids may be help reduce the symptoms, and exercise seems to help. Use of birth control pills may also help reduce some pre-menopausal symptoms.

Wise.

[ColMoss]

I read in a book that for many women, menopause is often preceded by uncomfortable, if not alarming, physical upsets. Its debut marks a transition period that can actually begin at age 40. Called pre-menopause, it is characterized by powerful hormonal changes with wide-ranging effects on a woman’s bodily systems and hot flashes are the number one complaint. If anyone is interested in hot flashes relief (http://vitanetonline.com/description/NT0103/vitamins/Hot-Flashes-Menopause-Relief/) methods, I recommend this article: No More Hot Flashes 10 Ways to Relieve Menopausal Hot Flashes (http://womenshealth.about.com/cs/hotflashes/a/nomorehotflashs.htm)

[Liz321]

Help...

Ok, I have no friends in chairs other than through message boards. My AB girlfriends are describing heavier/longer periods. (we're in our late 40's)

I have this clotting like I am birthing leeches thing going on and the abdominal pain is bad (I don't take anything for pain other than Tylenol, ibuprofen or Nyquil as needed).

I need to KNOW that what I am going through is "normal" SCI women crap. Gyno's office said, "She can't see you during your period".

I'm sweating, not hot flash sweats but AD sweats I am assuming from the pain.



_ help

[Wise Young]

Help...

Ok, I have no friends in chairs other than through message boards. My AB girlfriends are describing heavier/longer periods. (we're in our late 40's)

I have this clotting like I am birthing leeches thing going on and the abdominal pain is bad (I don't take anything for pain other than Tylenol, ibuprofen or Nyquil as needed).

I need to KNOW that what I am going through is "normal" SCI women crap. Gyno's office said, "She can't see you during your period".

I'm sweating, not hot flash sweats but AD sweats I am assuming from the pain.



_ help

Liz,

It doesn't sound like an SCI thing. Most women start to get irregular periods, ranging from heavy to light, in their forties.

Wise.

[SoFla]

That was a part of normal change of life for me, while I was AB. It almost feels like giving birth when passing those clots. Be aware that this can lead to anemia. Now, more than ever, you need to take your vitamins. Maybe even change to one in the "silver" bottle. Welcome to senior life!

[Wise Young]

Premenstrual syndrome
http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=435&CFID=3843104&CFTOKEN=76897634
http://www.msrc.co.uk/images/gallery/pms.jpg

[Juke_spin]

Funny, weird, Wise.http://www.sitcomsonline.com/ubb/biggrin.gif

[JCAT]

Just when I started to adjust to life here is comes Menopause. The hot flashes are odd it's like you're blood is hot yet you're skin is cold, best way to discribe it would be cold sweats. I haven't
had a period in 5 months which I don't mine, it's kind of a relief not to worry when it's going to arrive.

After reading the article I have some concerns regarding my physical health, I smoke and drink a bit.

I'm more wearysome for my mental health.

J.

[betheny]

I thought the hot flashes would kill me. I slept with a soaking wet towel on my wheelchair to slap on my naked body, under the ceiling fan set at Mach 9. I got menopause and Graves disease on the same day apparently LOL, hot flashes are symptoms of both. Had my butt KICKED. And oh I envied women that could sweat! Good nutrition really helped me. Lots of soy, evening primrose oil and protein.

Then after you burn up, you get cold to the bone. It is more miserable than I can describe.

Some research says SCI women go through it earlier. I was 45 when it got bad. Don't miss those periods, what a hassle for quad fingers!

[Wise Young]

Funny, weird, Wise.http://www.sitcomsonline.com/ubb/biggrin.gif

My apologies. I should have said that I was just responding to the post:
I read in a book that for many women, menopause is often preceded by uncomfortable, if not alarming, physical upsets. Its debut marks a transition period that can actually begin at age 40. Called pre-menopause, it is characterized by powerful hormonal changes with wide-ranging effects on a woman’s bodily systems and hot flashes are the number one complaint. If anyone is interested in hot flashes relief methods, I recommend this article: No More Hot Flashes 10 Ways to Relieve Menopausal Hot Flashes

I thought this cartoon may be was illustrating an eleventh way to relieve menopausal hot flashes. Wise.

[Wise Young]

Betheny, the two could have been related and aggravated each other. I am so glad that you have it under control. Wise.

I thought the hot flashes would kill me. I slept with a soaking wet towel on my wheelchair to slap on my naked body, under the ceiling fan set at Mach 9. I got menopause and Graves disease on the same day apparently LOL, hot flashes are symptoms of both. Had my butt KICKED. And oh I envied women that could sweat! Good nutrition really helped me. Lots of soy, evening primrose oil and protein.

Then after you burn up, you get cold to the bone. It is more miserable than I can describe.

Some research says SCI women go through it earlier. I was 45 when it got bad. Don't miss those periods, what a hassle for quad fingers!

[Wise Young]

There may be cultural and possibly racial differences of menopausal symptoms. The typical description of menopause for women in the western world is as follows:
http://www.fda.gov/fdac/features/1999/699_meno.html
The Journey Begins

Menopause is a gradual process, says Richter, a journey that takes years to navigate. Most women notice their bodies are changing by their mid-30s. Hormone fluctuations cause disruptions in the menstrual cycle, such as lighter or heavier bleeding, and longer, shorter or skipped periods.

As ovarian function decreases, hormone production becomes erratic and diminishes, causing the onset of menopausal symptoms. Most women begin experiencing these symptoms two to 10 years before menstrual periods end. These years mark the "perimenopause."

As estrogen levels wane, many woman experience only a few changes, while others find themselves plagued by the full array, which include:

* Hot flashes--This is the hallmark symptom of menopause, and experts say 85 percent of women will experience these personal heat waves. Starting in the center of the body, a flash of heat spreads like a wall of flame to the top of the head, flushing the face, neck and arms a fiery red, and making skin warm to the touch. The flash can last from seconds to 30 minutes and is accompanied by increased heart rate, shallow breathing, and sweating. A chill and exhaustion usually follow. Hot flashes can occur as many as 50 times a day.
* Night sweats--These hot flashes that occur during sleep cause a woman to wake drenched in sweat, sometimes several times a night. Because of these sleep disturbances, daytime fatigue can become a problem.
* Vaginal atrophy--The loss of estrogen causes the tissues of the vagina and vulva to become thin and dry. Sex often becomes painful. Additionally, the vagina can become inflamed and irritated from a high alkaline content, a condition called "atrophic vaginitis."
* Urinary tract changes--Thinning of the lining of the urethra and weakening of surrounding pelvic muscles may lead to more frequent urination, frequent bladder infections, painful urination, sudden urinary urgency, and frequent urination during the night. Urinary incontinence may also become a problem.
* Loss of libido--In addition to losing their ability to secrete estrogen, the ovaries no longer produce testosterone--the hormone responsible for sex drive in both men and women. Some women's bodies may produce the tiny amount needed through the adrenal glands. Many women, however, lose all testosterone, and with it their sex drive.
* Emotional changes--Irritability, mood swings, anxiety, and depression are frequently the result of fluctuating hormones.
* Formication--This bizarre symptom, the feeling that ants are crawling over the skin, occurs in about 20 percent of women, according to Lois Jovanovic, M.D., in her book A Woman Doctor's Guide to Menopause.

These changes may continue up to three years following a woman's last menstrual period, a time known as the "climacteric."

http://www.fda.gov/fdac/features/1999/699_meno.html


In Asia, where the diets are high in soy (which contain natural estrogens)
The benefits of soy protein first drew interest when studies showed that in Asian countries, where diets are high in soy, both the incidence of breast cancer and the heart disease mortality rate are four times lower than in the United States. In addition, Asian women report fewer hot flashes and night sweats during menopause. These women get about 30 to 50 milligrams of isoflavones daily, the levels found in half a cup of soy milk or tofu or a quarter cup of roasted soy nuts.

In 1998, FDA proposed allowing health claims about the role soy protein may play in reducing the risk of heart disease on the labels of foods containing soy protein. Studies show that 25 grams of soy protein per day may lower blood cholesterol levels.

According to the following article:
http://wwwsshe.murdoch.edu.au/intersections/issue5/bulbeck2.html
Speaking Menopause: Intersections Between Asian and Western Medical Discourses

Chilla Bulbeck

1. In 1995, when Mary Farquhar and I conceived the research project on which this article is based, very little had been written about the midlife experiences of 'other' women, women from beyond western Europe, North America and Australasia. The First International Congress on Menopause was held in 1976.[1] In 1994, the International Menopause Society (IMS) was founded and Maturitas became its official publication, until 1998, when the IMS started another journal Climacteric.[2] Medical and psychological journals, such as these, reveal an almost 'virtual absence' of other than the bio-medical model[3] and almost nothing on midlife experiences of women beyond the 'west'.[4]

2. It could be argued that, where western women's menopause is an inexhaustible topic of the medical literature, the 'other' woman experiences a social passage, a climacteric, although here, too, the references to menopause are scanty. In 1996, Pranee Liamputong Rice and Lenore Manderson Rice[5] suggested of the sociological and anthropological approaches, that, 'Despite the burgeoning literature on ageing', the literature on menopause and other non-reproductive aspects of women's bodies and health is 'relatively rare'. This is especially so when compared with the literature dealing with reproduction. In June 1997, a search for texts on Indian and Chinese women at the School of Oriental and African Studies, University of London, bore out this claim. The search yielded six titles on the shelves for Indian women, including one of the only book length studies in the field, Brian du Toit's (1990) Aging and Menopause among Indian South African Women.[6] There was nothing on menopause in any of the other books, two of which had entries on ageing, noting there was little research on ageing in India. A bibliography on Chinese women, Lucie Cheng's Women in China, indexed neither ageing nor menopause. Two books on sexuality in China published in the mid-1990s devote a handful of pages to menopause. Harriet Evans covers 'sex and the older woman' in three pages.[7] Frank Dikötter devotes only two pages to menopause.[8] Veena Das intimates that there is no conception of the female menopausal body in India.[9]

3. The first widely quoted cross-cultural study was Yewoubdar Beyene's comparison of Mayan women in Yucatan Mexico and rural Greek women on the island of Evia. Beyene discovered that no Mayan women reported hot flushes and there is no word for this in the Mayan language.[10] Other studies include Pranee Liamputong Rice's of the Hmong women of Laos, Siriporn Chirawatkul's of Thai women and Gabriella Berger's comparison of Australian and Filipino women.[11] The classic text on Asian women's experiences of menopause is Margaret Lock's Encounters with Aging.[12] Lock found that far fewer Japanese than North American women reported hot flushes; various explanations for this became a preoccupation of subsequent research.[13]


According to this author, the change is more than just a dietary one. It is also cultural attitudes and the author is pointing out tha there is increasing "western medicalization o the Asian woman's menopause".

Wise.