According to Drs. Lauren Nathan and Howard Judd, contributors to "Current Diagnosis and Treatment: Obstetrics and Gynecology," menopause is the permanent end of menstruation due to loss of ovarian function. It is diagnosed after one year of no menstrual periods. In the United States, the average age of menopause is 51. The period immediately preceding menopause is called perimenopause. The menopause is the final menstruation. Postmenopause refers to the stage of life that comes after the menopause and is characterized by changes in the reproductive tract, urinary tract, breasts, mental function, skin, bones and cardiovascular system.
Reproductive Tract
The medical textbook "Comprehensive Gynecology" says estrogen, which is normally released primarily from the ovaries, functions as the major growth factor of the female reproductive tract. Thus, postmenopausally, there are substantial changes in the appearance of all the reproductive organs. After menopause, most women have some degree of atrophy and thinning of the vaginal wall. This may be symptomatic as atrophic vaginitis (inflammation of the vagina). The cervix and uterus also atrophy. Additionally, there is less secretion of mucus by the cervix. The excessive vaginal dryness and inflammation can cause painful sexual encounters.
Urinary Tract
As with the reproductive tract, estrogen plays an important role in maintaining the integrity of the bladder and urethra. Substantial estrogen deficiency, as occurs with menopause, can cause atrophy of the bladder and urethra. As a result, a postmenopausal woman may experience atrophic cystitis, with symptoms such as urinary urgency, frequency, incontinence and painful urination. Recurrent urinary tract infection may also occur as a result of estrogen deficiency.
Breasts
According to "Comprehensive Gynecology," estrogen serves as a hormone that influences growth of breast tissue. Thus, the postmenopausal woman may experience regression of breast size during and after menopause.
Brain/Mental Function
According to Dr. Rogerio Lobo, contributing author of "Comprehensive Gynecology," in regard to mental functioning, estrogen plays a role in cognition, mood and a general feeling of well-being. Declining estrogen in the brain is classically manifested as hot flashes, an acute sensation of increased body temperature. Though a hot flash is merely the perception of being hot, it will often be accompanied by sweating and can disrupt sleep. Hot flashes generally occur for two years following the start of estrogen decline, but can last up to 10 years. Additionally, estrogen deficiency can contribute to a feeling of depression after menopause as well as cognitive decline. Although estrogen has a role in these mental status changes, it should not be considered the sole cause.
Skin
Estrogen affects collagen, an important component of connective tissues such as the skin. "Comprehensive Gynecology" says that nearly 30 percent of skin collagen is lost within the first five years after menopause, and collagen decreases approximately 2 percent each year for the first 10 years after menopause.
Bones
Estrogen deficiency has long been known to cause bone loss. Osteoporosis is a major health care concern. Dr. Rogerio Lobo writes that in Caucasians, 35 percent of all postmenopausal women have been estimated to have osteoporosis, with a lifetime fracture risk for these women of 40 percent.
Cardiovascular Risk
According to the journal Comprehensive Gynecology, many studies clearly demonstrate that cardiovascular disease risk increases for women after menopause. Prior to menopause, women have a three times lower risk of cardiovascular disease than men, but by age 75, the risk is equal. The risk also increases for women who experience menopause prematurely, either physiologically or due to removal of the ovaries. These findings are attributed to an accelerated increase in total cholesterol in postmenopausal women.
References
- "Current Treatment and Diagnosis: Obstretics and Gynecology"; Lauren Nathan and Howard Judd; 2007
- "Comprehensive Gynecology"; Rogerio Lobo; 2007
