1 Karen L Johnson, D.O. Menopause and Midlife Challenges Definitions 1. Menopause- the final menstrual period, average age is 51. 2. Perimenopause or climacteric- transitional process leading up to the last menstrual period, can occur between age 38-58 and last several years. 3. Post menopause- no menstrual bleeding for over one year. 4. Premature menopause- last menstrual period occurs before age 35. 5. Hormones- chemicals released by endocrine glands that control other body systems. The female reproductive endocrine glands are the hypothalamus in the brain, the pituitary at the base of the brain, and the ovaries in the pelvis. The two most common female hormones secreted from the ovaries are estrogen and progesterone. 6. FSH or follicle stimulating hormone- produced by the pituitary gland and stimulates eggs or follicles in the ovaries to begin to grow. As the eggs develop, they produce estrogen which thickens the lining of the uterus to prepare for possible implantation of a fertilized egg or embryo. When estrogen levels fall in menopause, FSH blood levels rise. 7. LH or luteinizing hormone- produced by the pituitary gland and surges about 14 days into the menstrual cycle which causes the developed egg to be released from the ovary- an event known as ovulation. At this time estrogen levels decrease and progesterone levels increase to further prepare the uterus for a fertilized egg. If there is no embryo implanted that month, estrogen and progesterone fall which triggers the uterine lining to shed and bleed- the event known as menstruation. LH blood levels also rise in menopause. 8. Endometrium- the lining of the uterus. 9. Endometrial hyperplasia- an increase in the number of cells in the lining of the uterus, usually caused by estrogen. If this continues without progesterone to cause the lining to shed regularly, it could lead to uterine cancer. 10. Endometriosis- endometrial tissue growing somewhere other than inside the uterus. It may cause menstrual pain or dysmenorrhea, pain with intercourse or dyspareunia, midcycle spotting, and infertility. It usually disappears after menopause. 11. Dysfunctional or anovulatory uterine bleeding- Irregular uterine bleeding that occurs when ovulation does not happen each month. This usually occurs in perimenopause when the eggs are becoming depleted. The bleeding can be prolonged, heavier, lighter or spotting, or absent for several months. Treating with cyclic progesterone pills can regulate the bleeding and prevent hyperplasia. 12. Fibroid or myoma- a growth in the uterine muscle wall that is in most cases benign. It can slowly grow during the menstrual years and cause heavier menstrual bleeding. They will shrink in size after menopause. 13. Polyp- a growth emerging from a mucous membrane surface such as the uterine lining or cervix and is generally benign. 2 Karen L Johnson, D.O. 14. Pedunculated- a polyp or fibroid growing on a stalk. 15. Polypectomy- surgical removal of a polyp. 16. Myomectomy- surgical removal of fibroid(s) or myoma(s). 17. Hysterectomy- surgical removal of the uterus. Total hysterectomy includes removal of the fallopian tubes and ovaries also. 18. HRT or hormone replacement therapy- the replacement of estrogen and progesterone by pills or patches in a woman who has her uterus intact. If she has had a hysterectomy, she may not need the progesterone. 19. Bioidentical hormone replacement therapy- hormones that mimic the exact hormones produced by a woman’s body and can be in the form of pills, creams and sublingual (under the tongue) preparations made in a compounding pharmacy. These are usually not covered by medical insurance. 20. Hot flashes- a symptom of estrogen deficiency, but they are probably caused by changes in the hypothalamus gland in the brain around the time of perimenopause and can last years after menopause. A flash may be a passing feeling of warmth in the face or upper body, or it may be a drenching sweat followed by chills. Night sweats are hot flashes that occur while sleeping. HRT is very effective in relieving severe hot flashes. 21. Vaginal atrophy- thinning of the vaginal tissues due to estrogen deficiency. This can cause pain with intercourse, or dyspareunia. This can be treated with estrogen creams or a ring that is placed in the vagina. Also using water based lubricants during intercourse is helpful. 22. Libido- sexual desire. The hormone testosterone may be used to help increase libido. 23. Insomnia- sleep disturbances. This may or may not be related to night sweats. 24. Urinary incontinence- leaking urine. “Stress incontinence” occurs when the bladder is full and then stressed by some activity such as laughing, sneezing or running. “Urge incontinence” occurs as soon as the urge to void is felt. “Mixed incontinence” is a combination of the two. 25. Osteoporosis- loss of bone mass. This is a gradual process but increases after menopause due to estrogen deficiency. Calcium and Vitamin D are important to build healthy bones. 26. Anemia- low blood iron, often due to heavy menstrual periods. 27. Hypothyroidism- too low thyroid hormone that causes increased fatigue, constipation, irregular menstrual periods, weight gain, skin, hair and nail changes, and depression. TSH (thyroid stimulating hormone) blood levels increase. 28. Hyperthyroidism- too high thyroid hormone that causes weight loss, increased blood pressure, diarrhea, and anxiety. TSH blood levels decrease.
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