American Medical Association Family Medical Guide - American Medical Association [570]
Women of childbearing age who have had both of their ovaries removed during a hysterectomy (see page 870) experience an abrupt menopause called surgical menopause. Because their hormone production ends so quickly, these women may experience the symptoms of menopause more severely than women who go through menopause naturally.
If you are sexually active, remember that you may still be fertile as you start menopause. Continue to use contraceptives for 12 to 24 months after the date of your last period.
Symptoms
Most women experience some symptoms during menopause. Only about 10 percent of women aren’t aware of any changes at menopause other than an end to their periods. You may begin to notice some signs during perimenopause that come and go before your periods stop completely. Hot flashes are the most common symptom of menopause, affecting more than 60 percent of menopausal women in the United States.
See your doctor right away if you bleed between periods, have prolonged or excessive menstrual bleeding, or have any bleeding 6 months or more after what appeared to be your last period. These symptoms could signal a number of disorders, including a precancerous condition or cancer of the uterus (see page 869).
Hot flashes
A hot flash is a sudden physical sensation of intense heat that usually affects the upper part of the body but can affect the whole body. Your face and neck may become flushed, and red blotches may appear on your chest, back, and arms. Hot flashes, which can last from a few minutes to half an hour, cause profuse sweating, sometimes followed by chills as your body struggles to readjust its temperature. Hot flashes happen unexpectedly—more often at night—and usually start several years before other symptoms of menopause. They should gradually decline in frequency and intensity as you get older. Most women who have hot flashes experience them for no more than 2 years. Hot flashes seem to be the body’s response to a falling estrogen level, which affects the body’s temperature regulator in the brain. They usually occur without warning, but some women find that alcohol, stress, or caffeine can trigger hot flashes or make them worse.
Hormone therapy (see next page) relieves the discomfort of hot flashes for most women. Some women find that taking vitamin E provides minor relief. Taking a herb called black cohosh (sold as a vitamin supplement) and eating foods containing soy seem to help reduce the intensity and frequency of hot flashes in some women. To better cope with hot flashes, dress in layers so you can take off a layer when you feel a hot flash coming on. Drink a glass of cold water at the first sign of a hot flash, and keep a pitcher of ice water or an ice pack next to your bed.
Changes in the vagina and urinary tract
As you age, the walls of your vagina become thinner, dryer, and less elastic, sometimes causing pain during intercourse. You may find it helpful to lubricate your vagina before intercourse with a water-soluble lubricant to help reduce the risk of infection. Don’t use petroleum jelly; it can damage latex condoms and cause allergic reactions in some women.
The tissue in your urinary tract also changes at menopause, making you more vulnerable to stress incontinence (the involuntary leaking of urine; see page 877). Activities such as jogging or heavy lifting—or even sneezing, coughing, or laughing—can put enough pressure on your bladder to release a small amount of urine. Doing Kegel exercises (see page 874) regularly can help alleviate or reverse mild stress incontinence in menopausal women.
After menopause, your vagina and urinary tract may also become