Perimenopause and Menopause_Final
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>> Hey, it's great to see you again.
In this section of the course,
we're going to discuss an important topic that affects all women
as they progress through the middle age years.
You guessed it, menopause.
This word and this stage of womanhood is often viewed negatively.
Hot flashes, anyone?
But the fact is it's a healthy and a normal part of aging
in woman over the age of 40.
Menopause is unavoidable
because it's a natural part of woman's lifecycle,
while the symptoms can be unpleasant,
there are a variety of things women can do
to ease their discomfort as hormone production declines.
The term menopause can be used collectively
to refer to three stages,
menopause, perimenopause, and postmenopause.
In this lecture, we'll go over the fundamental basics of each.
Menopause is a process that can be broken down to include
perimenopause and postmenopause.
Perimenopause is the time leading up to menopause
when hormonal changes are occurring and symptoms begin to appear.
Postmenopause is the time after menstruation has ceased for 12
or more consecutive months.
This continues for the rest of woman's life.
Going by these definitions,
by the time a woman is diagnosed with menopause,
she's already in the postmenopausal period.
This can be confusing because a woman can continue to have
symptoms for some time once she's postmenopausal or she may not.
For this reason, some medical professionals prefer
to define postmenopause as the time after symptoms have subsided.
Menopause can be loosely defined as
the period of time in a woman's 40s or 50s
when hormonal changes occur
that lead to the loss of reproductive function.
Simply put, this is the time in a woman's life
when she stops menstruating.
Her ovaries are no longer releasing an egg each month,
and therefore, she's no longer able to conceive.
Menopause marks the end of a woman's reproductive years.
On average, this process takes one to three years.
A woman doesn't just stop getting her period one month
and then never has one again.
Menopause refers to a process
that gradually occurs over several years.
So while menopause itself is clinically defined as the point
at which a woman hasn't had her period for 12 consecutive months.
When we refer to menopause conversationally,
we're usually talking about the time before, during,
and after this happens,
including perimenopause and sometimes including postmenopause.
This is a time of hormonal changes and symptoms
that can often be upsetting
and difficult for a woman to experience.
The average Caucasian American woman will undergo menopause
between the ages of 50 and 52.
Latin American woman typically average a bit earlier
at 47 to 49 years old.
And African-American women
tend to average a bit later at 53 to 55 years old.
Nutritional and environmental factors throughout the life
can also affect the timing of menopause.
Symptoms of menopause can include night sweats,
heart palpitations, hot flashes, dry and or itchy skin,
thinning of the skin, weight gain, breast tenderness,
stiff or sore joints, back pain, incontinence,
urinary urgency, vaginal dryness, painful intercourse,
low sex drive, disrupted sleep, dizziness, poor memory,
difficulty concentrating, anxiety,
depression, irritability, and mood swings.
Wow! That's quite a list.
No wonder so many women lament this phase of life,
and no wonder so many women are seeking Health Coaches
for support during this time of change.
Why do all of these unpleasant side effects happen
when a woman reaches the end of her reproductive period?
Let's take a look.
The hormone changes that occur in a woman's body
and the time it leading up to and during menopause
are what signals the ovaries to close up shop
and are the cause of all the symptoms associated with menopause.
The key players involved in this process
are estrogen and progesterone.
FSH and LH also play a role.
In the time leading up to menopause,
estrogen can be all over the map.
Over the years, it declines but will spike at times too.
As you know, estrogen is the captain
of the female reproductive system.
So when estrogen declines, ovulation becomes irregular.
When ovulation doesn't occur,
the ovaries don't produce progesterone.
Now you have low estrogen, low progesterone,
plus the balance between the two is out of whack.
During perimenopause,
the ovaries become less responsive to LH and FSH.
You'll recall that these two hormones
are necessary in the right balance for the menstruation to occur.
After a while, LH and FSH lose their ability to do their jobs
and can no longer regulate estrogen,
testosterone, and progesterone.
Now the whole gang is off balance.
The average age of natural menopause in the United States
is 50 years old.
The age of onset varies however from country to country.
This is likely due to variations in diet and lifestyle.
You may have noticed that I said
the average age of natural menopause,
what I mean by that is under certain circumstances,
menopause can be brought on early.
Let's explore some of these conditions.
The first is induced menopause.
This refers to the early and sudden onset of menopause
as a result of surgical removal of the ovaries
known as oophorectomy.
This most often happens in the case of uterine cancer
or a total hysterectomy due to endometriosis.
Note that women who have a regular hysterectomy,
removal of just the uterus, will stop having the period,
but this will not induce menopause.
The ovaries must be removed
in order for induced menopause to occur.
Radiation or chemotherapy for cancer treatment
that damages the ovaries
can also have the effect of induced menopause.
The second circumstance that can cause early menopause
is premature ovarian failure.
This refers to a condition where the ovaries stop releasing eggs
before the age of 40,
triggering an early onset of menopause.
This condition may not be permanent,
but it's a serious medical condition
that requires a doctor's care.
Natural menopause is a gradual process that has three stages,
perimenopause, menopause, and postmenopause.
Now that we've covered the main event, menopause,
let's talk about the changes that happen leading up to it.
This is a phase called perimenopause.
You can think of perimenopause as the menopause transition.
This is a time when the ovaries gradually begin producing
less estrogen in preparation for menopause.
Perimenopause typically begins when a woman is in her 40s,
but it can start as early as 10 to 15 years
before a woman's last period.
In early perimenopause, as these changes start occurring,
estrogen and progesterone levels may fluctuate,
declining and then rising back up.
This can cause spikes in these hormones.
The first symptoms of perimenopause,
a woman will experience, are mood swings and irregular periods.
Once in full swing, women in perimenopause
may experience hot flashes, vaginal dryness,
urinary urgency or leakage,
decreased sex drive, and sleep disturbances.
Basically, the same symptoms as menopause.
When a woman suspects she's in perimenopause,
it's an excellent time for her to have
a complete medical examination
by a qualified health professional.
The diagnosis of perimenopause can be usually made
by reviewing a woman's medical history, her menstrual history,
and her signs and symptoms.
It's crucial that a woman gets a proper evaluation
if she suspects she's in perimenopause
rather than just assuming that's what's going on.
This is because thyroid disease can mimic perimenopause.
Similarly, a woman may be experiencing
an unrelated hormonal imbalance
or condition that has the same symptoms.
The average length of time
a woman spends in perimenopause varies.
This phase occurs until a woman reaches menopause.
Again, menopause is marked
by the absence of a menstrual period for one year.
In the last year or two of perimenopause,
the decline in estrogen begins to speed up,
until finally the ovaries stop releasing eggs altogether.
This end stage of perimenopause is typically the time
that women begin to experience noticeable symptoms of menopause.
Now let's fast forward to postmenopause.
This is the time in a woman's life
from the point she's reached menopause
and her periods have completely stopped for some time.
Her estrogen and progesterone levels are low
but stay more or less stable.
At this point, most woman stop experiencing the symptoms
associated with menopause like hot flashes,
night sweats, and mood instability.
Their energy may also return,
but many women in their older years
are still at risk for health issues associated with low estrogen,
including osteoporosis and heart disease.
A doctor can confirm when a woman is in postmenopause
by measuring her FSH levels for the blood test.
As the ovaries stop working, FSH levels will rise dramatically.
Now I'd like to dispel the common misconception
that the body stops producing estrogen
altogether after menopause.
Well, a woman's levels of estrogen and progesterone
decrease significantly, they don't disappear altogether.
The body still produces these hormones
which, as you've learned,
are necessary for a variety of critical bodily functions
just in smaller amounts.
So a menopausal woman may have an estrogen deficiency,
but it would be incorrect to say that
she stops producing estrogen altogether.
Makes sense?
Before we wrap, I'd like to briefly touch on a topic
that I know a lot of Health Coaches are really curious about,
and that's hormone replacement therapy or HRT.
There are two types of hormone replacement therapy.
One, traditional hormone replacement therapy, or HRT,
and two, bio-identical hormone replacement therapy, or BHRT.
These are medications that are used to help alleviate
the symptoms that occur during menopause.
They can be derived from synthetic compounds, soy, animals,
or some combination of these.
Hormone replacement therapies provide a dose of estrogen,
specifically estradiol or estrone and progesterone.
Some formulas may also include testosterone,
DHEA or adrenal hormones.
The main difference between the two is that BHRT is compounded,
meaning that a doctor will run lab test
to determine a patient's specific deficiencies
and then prepare a unique dosage mixture just for her.
Hormone replacement therapies attempt to turn back the clock
and provide women with a more youthful level of hormones.
There are many products on the market
which come in a variety of forms
such as creams, gels, pills, patches, and sprays.
These products help women to delay
or lessen the symptoms of aging
and make the transition more manageable.
While this may sound great,
keep in mind that it's not the body's natural path of aging.
And there's still much debate over
whether these products are safe.
The common thought is that bio-identical hormones
are safer than traditional
because they are derived from natural sources,
but the FDA has stated that
hormones marketed as bio-identical or natural
don't appear to be any safer or more effective
than hormones used in
traditional hormone replacement therapy products.
Today, there haven't been any clinical trials
showing that BHRT is better.
In fact, HRT trials are often used to make claims
that BHRT is safe since they use the same products.
But custom formulations can't be regulated,
and the FDA isn't there to see how the product is being mixed.
Therefore, this is more a speculation than proof.
Either way, while a final verdict is still out.
There are studies demonstrating that there may be risks
associated with hormone replacement therapies
both traditional and bio-identical.
In particular, women with a history or risk of breast cancer
or cardiovascular disease
could be put at a greater risk of these diseases
by using these products.
The bottom line is that while there are some women
for whom the risk would outweigh the benefits,
most women don't need hormone replacement therapy.
And this need is something
that should be determined by the client's doctor.
If the need is not there, there are wealth of natural remedies
that can be helpful for coping with menopausal symptoms.
We'll go over these in an upcoming lecture.
Hormone free interventions
are often a great place for women to start,
but if a female and her doctor decide
that hormone replacement therapy is right for her,
that's a medical decision that wouldn't be appropriate
to get in the middle of as their Health Coach.
Ultimately, it's not up to you as a Health Coach
to tell a client that she should
or shouldn't use hormone replacement therapy.
This is a decision best made by consulting their doctor.
Interfering would put you in danger
of stepping outside of your scope of practice.
As you'll learn in the upcoming lectures,
the best thing you can do for your clients
whether they take hormone replacement therapy or not,
it's to support them with diet and lifestyle recommendations
and hold space for them to navigate the transition of menopause.
To recap, menopause is the phase of a woman's life,
typically, during her late 40s or early 50s,
when she stops getting her period and can no longer reproduce.
Menopause can also be induced earlier in life
by surgical removal of the ovaries or premature ovarian failure.
Menopause is preceded by perimenopause
which is the phase when sex hormones begin to decline
in preparation for menopause.
Once a woman consistently stops menstruating
for a period of 12 months or more,
she enters her postmenopausal years.
This is the time when symptoms lessen,
and healthy women gain a renewed feeling of energy.
Menopause comes with a hose of unpleasant symptoms
as the result of hormonal changes that occur,
notably, the decline in estrogen,
which triggers a subsequent decline of progesterone.
Estrogen deficiency in a woman's later years
is an inevitable part of life.
Some women choose to take hormone replacement therapy
during menopause to artificially raise levels of estrogen,
and therefore, mitigate the effects of menopause.
This is a personal choice that a woman must figure out
with her doctor.
But ultimately, a woman cannot escape the fate
of her female body.
Have you or has anyone close to you,
perhaps a friend or a family member, experienced menopause?
What was this experience like?
Share your observations and reflections in the Facebook group.
Thanks for tuning in.
See you next time.