Menopause: What is happening to me?

Dr. Catherine Hansen
Dr. Catherine Hansen

After talking to a group of women at a wellness clinic last night, I realized how a little information about our bodies can go a long way!  Enjoy this information about menopause and watch for more in the series:

 Not all women realize they are “menopausal” and many women go through these changes without needing to seek medical advice or note any problems at all.  If you are in this category, don’t worry about the lack of symptoms and don’t go looking for answers to questions you don’t have.  There is no need to test your “hormones” or start any medications but some of the following advice may help to maximize your preventative health strategies as you negotiate menopause gracefully.

 In simplified terms, the ovaries, in response to follicle stimulating hormone (FSH) from the brain, work tirelessly to produce follicles (cysts) throughout your reproductive life.  Ovarian cysts form and subsequently rupture during ovulation monthly and secrete both estrogen and progesterone in the process.  As the follicle dies off, the estrogen and progesterone levels fall signaling the uterus to shed it’s lining and we get a period (yahoo!).  A human female has a limited number of eggs to ovulate throughout her lifespan and when these run out the estrogen and progesterone produced by ovulation declines.  The brain continues to send FSH but the ovaries can no longer respond with cyst formation or hormone production.  The main blood marker for having reached menopause is, therefore, an elevated FSH. Most women, however, have huge fluctuations in this hormone for many years prior to actually stopping menses so testing this level is not as relevant or as important as symptoms and the cessation of a menstrual cycle.

 Menopause, by definition, is one full year without a period but the process leading up to that point in time can last 10 years (called the climacteric if you care to know).  Since the average age of menopause is 51 years, the entire process can begin in the early 40’s.  It is important to realize that women can still get pregnant throughout this process until the ovaries have completely stopped hormone production and that is not assured until menopause proper.  Using reliable contraception is a must unless you want a “little oops.” 

 If the ovaries are removed surgically or damaged (with radiation or chemotherapy), menopause can come sooner and more rapidly than if they slowly stop functioning.  Also, women who have had a hysterectomy with ovarian conservation, and smokers, may have disrupted blood supply to the ovaries and a slightly earlier “natural” menopause.

 For the women who experience menopausal symptoms, they are almost all related to a reduction in estrogen levels.  Testosterone production from the ovary is, also, reduced with menopause but continues to be produced by the adrenal gland, a small endocrine gland that sits above the kidneys, well beyond natural menopause.  The main indicators include vasomotor symptoms (hot flashes and night sweats) and vaginal dryness or bladder changes but can also include memory or cognitive decline, insomnia with or without night sweats, generalized fatigue, joint and muscle aches and pains, labile mood and decreased libido.  I suspect the latter two may be related.  The remainder of the series will review options for treatment depending on which symptoms are the most bothersome for you, personally.

 While all of this may sound horrible, many women gently and gracefully welcome the changes in their bodies that signify a new era for them and their partners.  Along with a leveling off of the hormones comes greater patience, inner peace and a calm presence not previously known during the chaotic reproductive years and the rocky peri-menopause.  Our brain becomes ready to re-focus inward and re-direct our energy to new frontiers now that children have grown and careers are well under way.  Women today spend over one third of their lives in menopause and with a little guidance from within (or above), these can be our most satisfying years.

Dr. Hansen is an assistant professor in the UTMB Department of Obstetrics and Gynecology, and a member of the care team at the Pelvic Health and Continence Center

About Dr. Hansen

Dr. Hansen completed a clinical fellowship in Sexual Medicine and has an interest in all aspects of sexual health, female sexual dysfunction, hypoactive sexual desire disorder, marital issues, family planning and menopausal assessment and treatment. Although an MD trained in obstetrics and gynecology, she supports her patients with medical, non-medical, and counseling treatment options. She completed a Master’s of Public Health at Johns Hopkins with an interest in Maternal and Child Health and International Health. Dr. Hansen takes an active and passionate role in the health and quality of life of the patients and the community she serves.
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