Menopause from the Gynecologic Perspective
Posted September 21, 2020
With Dr. John A. Bazley, Obstetrician-Gynecologist
Menopause is the time in a woman’s life after menstrual periods cease and fertility has ended. This occurs, on average, at age 51 which means that many women will spend as many years of their life (or more) in menopause as they spent having menstrual periods. Improvements in health care and disease prevention, increased awareness of physical fitness, and decreased maternal mortality over the last century have resulted in a significant increase in the number of women spending a very significant number of years living with the physical and physiologic changes associated with menopause.
Menopause is the result of the loss of ovarian function. Part of ovarian functioning is the production of various hormones which are vital to a woman’s reproductive capacity. One of the primary ovarian hormones is estrogen which has effects upon numerous tissues and organs including skin, bones, bladder, heart, breasts, and even the brain. While most people are aware of the common symptoms such as hot flashes, night sweats, and vaginal dryness, menopause results in numerous other symptoms which range from mild inconveniences to severe, sometimes debilitating, conditions. These symptoms affect women both physically and psychologically during menopause, and whether perceived as mild or severe, over time, the loss of ovarian hormones leads to inevitable changes that influence a woman’s quality of life.
Volumes have been written about the various changes that occur with menopause and so this brief discussion will attempt to highlight a few of the most common and potentially treatable changes. The most notable skin changes occur in the genital area including the vulva and vagina. Estrogen is important in the maintenance of tissue tone and elasticity. Thus, loss/lack of estrogen results in a thinning of the skin. This thinning, along with direct effects of estrogen on the lower portion of the bladder and the entire urethra can contribute to bladder control issues. While various surgical interventions may improve bladder conditions, estrogen therapy can play a crucial role in therapy.
After menopause, bone density diminishes and the risk for fractures increases. Estrogen has been shown to be helpful in the prevention of the decrease in bone density. Everyone now knows the important role that exercise plays in health maintenance, but often unrecognized is the fact that exercise is difficult or impossible with broken bones. Whether it is a hip fracture with the long-term recovery process or the cumulative effects of years of microfractures in the vertebrae (we have all seen the elderly woman stooped over from osteoporosis), the women who experience these are unable to continue to engage in the cardiovascular exercise that is so important to long term quality of life.
Estrogen has also been shown to have a positive direct effect on heart health and function, and has been shown to decrease the risk of a heart attack. Tissue tone in the breasts is affected by the loss of estrogen after menopause resulting in a decrease in breast volume and fullness. The effects of menopause on brain health are far from completely understood and the exact effects of estrogen on brain health are likewise not yet clear, however, studies have shown a beneficial effect on mental acuity and a decrease in dementia with the use of supplemental estrogen during menopause.
In summary, many women today and many more women in the future, will spend years living after menopause and many will be affected by the physical changes that come with menopause. Estrogen therapy has been shown to decrease the vasomotor symptoms (hot flashes, night sweats, and vaginal dryness) of menopause. Additionally, estrogen therapy has been shown to decrease the risk of osteoporosis, heart attack, colon cancer, breast cancer, dementia, and blindness from age-related macular degeneration. There are numerous nuances that must be evaluated for each individual woman to determine whether and what type of estrogen therapy is appropriate. Women should discuss these issues with their physicians so that they can continue to have the best quality of life possible.