The Facts of Life: Examining Reproductive Health

Health Concerns for Middle-age and Up

The Facts
Menopause is a result of hormonal changes that occur gradually over several years for most women. The pituitary gland of a healthy woman produces a substance called FSH, follicle-stimulating hormone, which triggers the growth of follicles in the ovaries. The ovaries, in response, secrete the hormone estrogen. As menopause approaches, the ovaries become less responsive to FSH so the pituitary gland produces more in an attempt to maintain estrogen levels. These hormonal changes result in an increasingly irregular menstrual cycle and infrequent ovulation until menopause occurs.

Physical Symptoms
Menstrual Changes

For most women the first sign of menopause is a noticeable change in the menstrual cycle. Bleeding may occur more often or less than it previously had. The length of the menstrual period can become shorter with lighter bleeding, or longer with heavier bleeding. Occasionally, premenstrual symptoms intensify or change.

The menstrual period may become highly unpredictable; periods may stop for several months and then reappear. One in five women will experience no changes in the menstrual cycle until menstruation stops suddenly and completely. Menopausal women who have irregular periods are at risk of pregnancy until their menstrual cycle has been inactive for 24 months.

Abnormal bleeding may be caused by something other than menopause. Problems in the uterus or its lining could be indicated. A woman should notify her physician if she experiences bleeding that is unusually heavy, lasts longer than normal, occurs more often than every three weeks, or bleeding after intercourse.

Hot Flashes

Even after ovulation stops, the pituitary still secretes large amounts of FSH. The resulting hormonal imbalance affects the blood vessels in the skin, causing them to dilate and constrict irregularly. This is thought to be the cause of the hot flashes, sweating, and headaches which are experienced by many women during menopause. Stress, a hot environment, eating spicy food, or drinking coffee or alcohol can trigger hot flashes by effecting change in the blood vessels.

Women describe hot flashes as a sensation of heat either in the face or moving through the upper half of the body. Sometimes sweating, a feeling of suffocation, or chills follow. These physical sensations range from extreme (sweating so profuse that a change of clothes is necessary) to negligible. Hot flashes may begin at approximately the same time a woman notices changes in her menstrual cycle, or after menstruation has completely stopped. Approximately 20% of women report no sign of hot flashes during menopause, and of those who do experience them, only 10% describe the flashes as uncomfortable. Whether extreme or largely unnoticeable, hot flashes generally continue after menstruation ends and for some women they last for twenty years or more.

Vaginal Changes

Many menopausal and postmenopausal women experience changes in the vagina. Thinning of the vaginal walls, loss of elasticity, flattening out of ridges, foreshortening or narrowing of the vagina and dryness or itching have all been reported. It is unknown whether these changes are caused by the lower estrogen levels of menopause or aging in general.

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