Victoria Mckeithan Parrott

Menopause: The Process

"The human menstrual life can be compared, with safety, to the life of a rose. Both lie dormant as the host grows, begin to bud in the exuberance of youth, flower in the fullness of adulthood, bear fruit for generation and then draw back to support newer buds along the stem. And although a rose is supposedly sweeter in the bud than in full bloom, nothing is more exquisite than the fragrance of an open rose --- particularly an open autumn rose --- and, to prolong the floral allegory further, long after the bloom is off the rose, the attar of its petals lives on to perfume the days of winter," writes Clark Gillespie of a woman's reproduction cycle and menopause (1). An anatomy and physiology book would define menopause as " the permanent cessation of menses, " which basically means the female reproductive cycle has found its retirement (Tortora 959). This cessation does not occur overnight but over a period of time. Just as it takes time to reach puberty and begin the first menses or menarche, so does it take an average of ten years from the beginning to the end of actual menopause. The process includes perimenopause which some may confuse as premenopause; peri is the correct prefix. Perimenopause is then followed by menopause and postmenopause, the later state being continuous (Gillespie 3-4). Let us now journey into a more detailed account of menopause and how it works, or its physiology.

Around the ages of forty and fifty the female gonads, referred to as ovaries become less responsive to hormones released by the pituitary gland in the brain. Hormones are steroids or chemicals released into the blood that travel to specific organs where they alter or maintain activity. The ovaries then slowly begin to produce less of the female hormones estrogen and progesterone until finally the ovaries produce very little at all. To some greater or lesser degree this is when women begin to experience hot flashes, severe sweating, muscle pain, insomnia, depression and mood swings. The ten years before and the ten years after menopause along with these symptoms are referred to as climatic. When estrogen production declines women experience some shrinking of the ovaries, uterine tubes, uterus and associated reproductive organs (Tortora 959).

During the decline of estrogen, breast tenderness increases, skin becomes dry and bone loss accelerates. According to Dr. Clark Gillspie, clinical professor of obstetrics and gynecology at the University of Arkansas School of Medicine, "susceptible women can lose as much as two percent of their bone mass each year, producing in time osteoporosis, which now destroys more American women than cancer of the uterus and breast combined" (6).

The decline of progesterone also causes changes. There may be a decrease in the premenstrual symptoms experienced by some and periods most often become irregular. If the ovaries continue to produce estrogen, even in tiny amounts, after the decline of progesterone, cancer of the lining of the uterus and breasts is more likely to occur (Gillpsie 5).

Age is not the only factor that can bring about menopause. Premature ovarian failure, total hysterectomy and oophorectomy also summon menopause. Hysterectomy is the removal of the uterus while total hysterectomy is the removal of the uterus and ovaries. Oophorectomy is the removal of the ovaries. This type of menopause referred to as " surgical menopause," occurs only if the ovaries are removed. Removal of the uterus alone will not beckon menopause (Hordern, "Hysterectomy" 3).

Premature ovarian failure, POF for short is also referred to as early menopause. As the name implies the ovaries stop functioning before their time and matured ovum are no longer produced, rendering a young women infertile before her time. Estimates show that one in a hundred women experience premature ovarian failure before the age of forty. However, unlike menopausal women in their fifties, a women with POF may occasionally produce an egg and therefore may still have a chance to bear children (Hordern, "Before" 5-6). Temporary ovarian failure or TOF may be brought about by several factors. Stress is the most common cause of TOF, from emotional stress to the stress put on the body by anorexia or obesity. Disorders such as high blood pressure, diabetes, anemia and even surgery may cause short-term TOF. Most causes of temporary ovarian failure may be treated and the ovaries will begin to function properly again (Gillespie 11).

Perimenopause refers to the years before menopause. During this time, menstruation seems to remain on a reasonably regular schedule and the symptoms of menopause appear, deepening as menopause moves closer. Premenstrual syndrome symptoms such as water retention, breast tenderness, headaches, irritability, depression, fatigue and "considerably more," writes Dr. Gillespie, may become even worse and last longer the closer menopause becomes. Upon that foundation place the menopausal symptoms of hot flashes, night sweats, heart palpitations, more emotional instability and forgetfulness (Gillespie 4).

A hot flash or flush is an intense heat that seems to start in the chest and move throughout the upper body. The hot flash lasts a few seconds and may occur every few minutes or hours. It is followed by some degree of sweating and short periods of weakness (Gillespie 35). A hot flush is produced when there is a disruption in the body's thermostat. "Researchers believe that as the ovaries secrete less estrogen, the pituitary [gland] reacts by producing more of its hormones. This makes the body think it is cooler than it is and activates the get-warm mode" (Henig 5). Night sweats are essentially the same as the hot flush except they occur during sleep. The flush during sleep usually causes the sufferer to kick off blankets and sheets. The sweating that follows the flush and the lack of bed coverings produce chills that may be referred to as the "classic nocturnal cold sweat" (Gillespie 36). Heart palpitations may be the result of the skin temperatures rise and fall which signals the adrenal glands "involuntary fight or flight" response (Gillespie 35). This is the same response to being frightened or fighting for your life. A large variety of other symptoms such as insomnia, loss of memory for recent events, depression, irritability, anxiety, tension, headaches, antisocial behavior, lack of sex drive, nervousness and aggressiveness may all find a common thread. The link to these symptoms seems to be in the rise and fall of hormonal levels during menopause and the lack of sleep and rest caused by hot flashes and night sweats (Gillespie 40). Many doctors offer estrogen replacement therapy, know by many as HRT (hormone replacement therapy) to curb or possibly diminish some or all of the menopausal symptoms. While the benefits of HRT are great there are many concerns of the possible side effects.

Gail Sheehy of the National Institute of Health writes that "almost all women experience some menopausal symptoms, but few have severe problems" (27). It is estimated twenty percent of women move through these symptoms with little difficulty, ten percent are incapacitated and seventy percent come and go through the medium of range of difficulty (28).

Actual menopause, complete absence of menstruation, occurs somewhere between the ages of forty-five and fifty-five years of age. At this point menopausal symptoms have reached full intensity (Gillespie 34). There are a few factors that may produce an earlier natural menopause. Thin women, malnourished women and women who smoke tend to have an earlier menopause. Women who live in areas of high altitudes usually have an earlier menopause. Contrary to belief, ethnic variations, family history, family size and long-term birth control pill usage has no known influence on the time of menopause (Gillespie 35).

The years following all the menopausal events is defined as postmenopause. At this point there is virtually a complete absence of ovarian hormones, except for minute amounts as mentioned earlier. Postmenopause brings its own signs and symptoms (Gillespie 217). Postmenopausal symptoms include vaginal dryness, bone loss, dry skin and hair, incontinence and cardiovascular and nervous system changes (Henig 6).

Vaginal dryness is caused by a thinning of the vaginal lining; this results in lubrication failure and a higher chance of infections. Bone loss occurs with age but even more so in the postmenopause state due to the loss of estrogen (Henig 6). The decrease of bone mass results in frailty of the bones. Osteoporosis is a condition where calcium leaves the bones, without estrogen calcium leaves the bone at a very rapid rate, increasing bone loss, dramatically (Gillespie 222). After menopause, the skin may become thin, dry and itchy. Hair may become thin while facial hair may increase. Incontinence, a condition where the bladder cannot be controlled occurs due to shrinkage in the bladder and weakening pelvic muscles. Urinary tract infections may increase. Cardiovascular changes include rising levels of cholesterol and triglycerides, which are lipids or fats in the blood. Blood vessels become less flexible and arteriosclerosis or hardening of the arteries may increase rapidly. Changes in the nervous system mainly concern the perception of touch, which may become more or less sensitive (Gillespie 217).

Postmenopause is also the time when many other symptoms related to menopause such as hot flashes, for the most part, disappear (Gillespie 211). Postmenopause is a continuous process that lasts the lifetime. Management of the signs and symptoms of postmenopause include hormone replacement therapy, calcium supplements, diet and exercise. Some patients may seek counseling, making for a "safe journey into maturity" (Gillespie 212).

In summary, menopause should be looked upon as a process. Perimenopause folds into menopause. Menopause flows into postmenopause. Postmenopause is a continuum. There is no distinct line between the three. Treatment of the symptoms and signs may be found through adequate counseling in diet, exercise and many other aspects. Hormone replacement therapy can prove to be important in fighting against osteoporosis and arteriosclerosis, as well as the more common symptoms of menopause (Gillspie 207-17). Women experiencing menopause in these modern times should consider themselves fortunate in comparison to their female ancestors. Their grandmothers and great-grandmothers were not only without the options of treatment but suffered without knowledge of their condition. Today's menopausal or postmenopausal woman looks forward to a long, healthy and fulfilling "journey into maturity" (Gillspie 217).

Bibliography

Gillespie, Clark. Hormones, Hot Flashes and Mood Swings. New York : Harper 1994.

Henig, Robin Marantz. "Myths About Menopause." Seasons Aug. 1991 : 4-6

Hordern, Barbara. "Hysterectomy Before 40." Seasons Jan. 1994 : 3-6

--- . "Before My Time." Seasons July 1995 : 4-8

Kalat, James W. Introduction to Psychology. 3rd ed. Belmont : Brooks, 1993.

Sheehy, Gail. The Silent Passage. New York : Pocket, 1993.

Tortora, Gerard J., and Reynolds Grabowski Principals of Anatomy and

Physiology. New York : Harper, 1993.