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Menopause A-Z: Staying in Control

Menopause A-Z: Staying in Control

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Menopause A-Z: Staying in Control

164 pagine
1 ora
Mar 29, 2012


You have seen the books. The hint of triumphalism is hardly ever subtle and the theme is always familiar: I defied ‘them’ and I won. It is typically a description of a personal journey through menopause that may have been against medical advice. It is meant to inspire and maybe it does, but is that an ideal template on which one should base their decision on health matters? Logic says no.
Every woman is unique. The only way you retain full control of your body and health is to have command of the full facts. Choosing a book on the subject of ‘Menopause’ can be an exhausting exercise. There are just so many out there. This book has been written in full awareness of that fact but the author was also aware that many of those books have a fatal weakness of expressing the authors’ opinions (rather than proven evidence-based facts), are too narrow in focus or are hopelessly out of date.
Menopause is a vast, rather complex subject with many distinct facets to it. It is also the case that unlike those who read a book as a purely academic endeavour, many readers may have particular interest in a specific area of the subject of menopause. This is why this book is as comprehensive as it is , covering in exhaustive detail, the various aspects of the menopause. The author of this book is a practising specialist and as such has gone about the exercise of writing this book to ensure it is fully accessible by the non-medical reader without sacrificing on quality or detail. In other words; in plain English. The result is a book full of up to date facts covering the full spectrum of this important and interesting area. Some of the areas covered include:
•Understanding menopause
•The physiological basis
•Premature menopause
•Conventional HRT
•Non-hormonal solutions
•Alternative and Complementary Therapies
•HRT for breast cancer (and other cancers) survivors
•Sexual Health after the menopause
•Fertility after the menopause
There is currently no book on the market that is as comprehensive in span, detailed in facts and up to date as this book, while remaining fully accessible to any reader. Being informed is being empowered and, on the subject of Menopause, you won’t find anything better.

Mar 29, 2012

Informazioni sull'autore

I live with my wife and kids on the Wirral in the beautiful outskirts of the city of Liverpool, morth-west England. I work as a Consultant Obstetrician and Gynaecologist at Macclesfield Hospital, Cheshire. Alongside that, I hold an honorary clinical lectureship with the University of Liverpool School of Medicine. Breaking down the artificial doctor-patient information barrier is a passion to me.

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Anteprima del libro

Menopause A-Z - Joe Kabyemela


In most developed countries, including the United States and the whole of Western Europe, at least 30%, which is nearly a third, of all women are 50 years of age or over. All these will either be at the verge of or are already post-menopausal.

It is easy to take it as a given that everybody knows what the term ‘Menopause’ means. That is probably largely true but, because there are many related terms and terms that derive from the word menopause, it doesn’t do any harm to get clarity at the outset as to what each term actually means. That way, we eliminate that little risk of confusion. As a reader, please don’t feel patronised by these descriptions.

Descriptively, ‘Menopause’ means the complete and permanent cessation of menstruation. Medically, as a natural occurrence, menopause is only diagnosed - or more aptly, confirmed (since it is not a disease) – 12 months after that last period. This convention is based on the fact that natural menopause is not an abrupt event. Changes occur in the lead up to the final cessation of menstruation. Those changes may and often include erratic menstrual periods with phases of absent period which could last several months at a time. It is because of that tendency that it was felt appropriate to have a minimum length of time after apparent cessation of menstruation beyond which we can have the confidence to declare that menopause has taken place. 12 months is the conventionally agreed interval between the last period and confirmation of menopause. As such, if a woman presents to a doctor 5 or 6 months after her last period, the doctor cannot, in the strict sense of the word, conclude that she is in the ‘menopause’ even if she has many of the other signs and symptoms (to be discussed a little later). The doctor can only allude to the possibility that the woman could be in the menopause.

Menopausal Transition? Perimenopause? Climacteric?

As discussed above and as most women who have gone through the experience will know quite well, the lead up to the menopause is characterised by a variety of signs and symptoms. These will vary greatly from person to person, both in intensity and duration. In fact, some women, well, the ‘lucky’ minority, literally glide into menopause with minimal and barely noticeable symptoms. Suddenly, the periods cease and life goes on as normal. However, for the majority, there will be changes that in some cases can be quite disruptive, even distressing, in the lead up the menopause. This transitional period could last from a few months to as long as three or four years. The average is about 12-18 months. This phase is variably known as the ‘Menopausal Transition’ (MT), the ‘Perimenopause’ or the ‘Climacteric’. These three terms mean exactly the same thing.

Menstrual irregularities

Symptoms encountered during the transition include increasingly irregular periods. However, it is important to clarify this feature. Many women will experience changes to their menstrual pattern from the late 30s. The main reason for this is because; it is at this point in a woman’s life when the release of eggs (ovulation) starts to become increasingly irregular. This, in turn, affects the hormone balance which determines the regularity of the menstrual cycle. Periods start to become less regular with some prolonged cycles and others abnormally shortened. There could be unscheduled bleeding (inter-menstrual bleeding), prolonged periods, heavier and even more painful periods. Again, the severity of these symptoms varies from woman to woman. For many, they are mild, barely causing concern but for others, they could be so disruptive and distressing, requiring medical intervention. These changes should not be confused with impending menopause. Probably every gynaecologist would have been consulted by many women with such symptoms in their 30s or early 40s who believe they may be seeing signs of early menopause. For most, that concern is unjustified as menopause may be well over a decade away.

Other Perimenopausal Symptoms

Apart from menstrual irregularities, other common features of the menopausal transition phase include:

Hot flushes (flashes) and/or night sweats:The medical term for these symptoms is ‘vasomotor symptoms’. These are the most well known symptoms associated with this phase of life. They almost always start before cessation of menstruation and could continue for several months or even a few years after the menopause. In a few cases, vasomotor symptoms do not resolve and can persist for the rest of the woman’s life. However, this is quite uncommon.

Mood changes:This may include low mood or becoming tearful and emotional, typically for no apparent reason or following an uncharacteristically minor trigger. Mood changes are thought to be compounded and even complicated by life events that tend to occur at around this time in life. These may include the loss of elderly parents or their becoming seriously ill, children leaving home (the so-called ‘empty nest syndrome’) and, in some cases, divorce and/or loss of a job. On top of all that, the prospect of menopause and, the hard-wired notion of loss of fertility closely associated with it, is unsurprisingly often associated with mood issues.

Sleep disturbances:These are also often reported during the peri-menopause with a disturbed sleep pattern often but not always associated with night sweats. For some this problem is a straight-forward development of insomnia. Lack of sleep means the person is often tired and irritable during the day, problems that can feed into the other perimenopausal feature of mood changes discussed above.

Memory problems:Problems with short-term memory are often encountered during the perimenopause. This tends to cause frustration, irritability and even mild panic with the woman worrying that my mind is going. Lack of sleep can exacerbate this problem. However, this tends to stabilise and even resolve entirely after some time, the length of which is variable.

Sexual dysfunction:It is often said that women in the perimenopause may experience a variety of sexual problems. These may range from reduced and complete loss of desire to discomfort during sex brought about by vaginal dryness. In fact, the latter (vaginal dryness) is actually rare in this period because levels of circulating estrogen are, to a large extent, normal. It takes a prolonged period of low estrogen levels for vaginal dryness to develop to an extent of causing discomfort and/or pain. That is normally seen in women who are in established menopause. The reduced desire can be attributed to all the other changes taking place as detailed above. Again, this is not a common feature of the peri-menopause.

What is happening? The menopause physiology

It is widely known that cessation of menstrual periods at this time in a woman’s life marks the menopause. Why do periods stop and why at this time?

Since time immemorial, the age at which a woman gets into menopause has not changed. It has always been around the age of 51-52 years (the quoted average age of menopause is 51.3 years). It means, therefore, that women many women in pre-industrial times actually died before reaching the menopause. Only a minority of women actually experienced post-menopausal life. There is and there has always been a minority of women who depart from this norm with menopause arriving significantly earlier than the stated average age. An estimated 1% of women go into menopause before the age of 40. This is termed ‘Premature menopause’. It is a topic that will be discussed in more detail in a dedicated section later in the book. An even smaller group of women will not get into menopause until well after the age of 55. This is termed ‘delayed menopause’. There are issues, not all of them positive, associated with this and we will look at those in a little while.

Menopause occurs because the ovaries run out of follicles. It is as simple as that. We already know that a woman is born with all the eggs (ova) that she will ever have. The eggs are contained in follicles, a few of which start maturing in each menstrual cycle. Only one (occasionally two) follicle goes on to become predominant, mature and release the egg (ovulation). The other follicles that started the maturation process in that ‘month’ undergo shrinkage, called ‘atresia’ and are re-absorbed in the ovary. After 30-35 years of this, ovaries exhaust their follicles.

It is the estrogen...

The cells in the follicles are responsible for producing the bulk of the estrogen hormone. As the numbers and the quality of the remaining follicles decline, estrogen production goes down and the symptoms associated with estrogen deficiency start to manifest. This will vary

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