Perimenopause and Menopause_Final

>> 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.