The first indication of menopause is a broken thermostat. It’s either that or your weight. In any case, if you don’t do something, you could be dead by August.“ - D.B.Frank
Discuss health challenges experienced by women in the menopause transition with reference to current aetiological theories, underlying mechanisms, and how it affects women’s lives.
Introduction
Menopause occurs when a woman reaches the age at which she is no longer in her reproductive prime. However, menopause does not have a sudden onset; rather, it occurs gradually over time as hormone balances shift. This period of time, when hormones are in flux is called menopause transition, or perimenopause (ASRM, 2015). This period traditionally begins with changes in menstruation frequency, length, and flow, and culminates with the onset of full menopause, or the postmenopausal stage or a 12 month period in amenorrhea (Harlow & Paramsothy, 2011).
More specifically, there are three stages of reproductive decline in aging women: premenopause, perimenopause, and post menopause (Harlow et al., 2012). During the premenopausal stage, women are still reproductively active, with regular menstrual bleeding, signalling routine ovulation in the most recent 12 months. In the perimenopause stage, or the active menopausal transition, bleeding becomes disrupted signalling changes in ovulation frequency, and marked by fluctuating hormones. Finally, in the postmenopause stage, amenorrhea signals the end of both ovulation and menses.
Though often it is perceived as an oestrogen-deficiency disease, the menopausal transition occur because of a natural change in hormones that occurs as women’s fertility status changes, and their body prepares for the end of their fertile years (Wenger, 2002). For most women, menopause transition begins at roughly the age of 50, however, there are also women who begin menopause transition earlier, during their thirties or forties, or those who experience it after their 50s.
More specifically, it is a non-pathological condition, created by a physiological process, for which exact aetiology is still being studied (Okeke, Anyaehie, & Ezenyeaku, 2013; Sassarini, 2013; Balch et al 2011). The decline in ovarian activity results in a reduced level of ovarian hormone production and release, triggering a set of hormone related symptoms (Nelson, 2008). Symptoms experienced during menopause transition include alternation in menstruation, vaginal dryness, hot flushes, sleep disturbances (McKinlay, Brambilla, & Posner, 1992). This paper will further consider the specific physiological changes that individuals experience during menopausal transition and the long term health impacts of those changes.
Discussion
The changes that occur in a woman’s body during the menopausal transition are the reflection of specific chemical and physiological changes that occur in a woman’s body, as her egg supply depletes and her body begins to prepare for the cessation of ovulation. As the primordial follicles the ovaries become exhausted, the anovulatory cycles space out, and overall hormonal balance shifts (Wong, 2013).
One set of symptoms most commonly related to menopause transition are VMS symptoms, or vasomotor symptoms (Thurston & Joffe, 2011). These include hot flushes, night sweats, emotional disturbance, and inability to sleep, most prominently. It is estimated that between 60 and 80 % of all women, regardless of cultural background, health, and related risk factors experience some or all of the VMS symptoms associated with menopause transition (Thurston & Joffe, 2011).
Other research indicates that pathophysiology consistently demonstrates that the emotional impacts of menopause transition are directly tied to the trajectory of hormonal changes during the transitional stage. For example, emotional or depressive symptoms though usually increase during the transition stage and they tend to decrease after menopause Such symptoms are related to such hormonal factors as decreasing levels of inhibin that suppresses follicle-stimulating hormone fluctuations in estradiol and increasing level of FSH It allows to draw a conclusion that many symptoms experienced by women during menopause are linked to the changes of reproductive hormones (Avis, Crawford, Stellato, & Longcope, 2001),
It is also interesting to note that Freeman found a connection between the VMS symptoms experienced during menopause transition and women’s ethnicity For example it was reported that African-American women for example are more likely than white women to have such symptom as hot flush that is associated with the disruption of the thermoregulation function. Also, they also more often have body aches and fatigue during the transition phase. Moreover, one study in which 3,302 African-American Chinese-American and Japanese-American participated showed that African-American women are more likely to have night sweats aches and hot flushed than women of other groups while the percentage of Japanese-American and Chinese-American women with the same symptoms was relatively low At the same in general it was determined that African-American women have more positive attitude to menopause that female representatives of other ethnic groups which decreases a risk of different emotional problems associated with menopause (Freeman et al., 2011).
Another scholar who also studied the symptoms that women experience during the transitional phase of menopause, Vered Stearns (2002), hot flushes, which represent the changes that occur in vasomotor pathology. More specifically, the reduced production and release of oestrogen in the body sets of a hormonal chain reaction that also reduces the total endorphin concentration in the bran. This in turn, generates a release of nonrepinephrine and serotonin, which reduces the thermoregulatory neutral zone in the hypothalamus (Nelson, 2008). This alters the brain’s perception of body temperature, setting off an inappropriate heat response, or response to temperature stimulus (Sassarini, 2013).
Statistically approximately 70 of all women experience hot flushes during menopause transition. According to his theory the reason that hot flushes occur is the decline in hormone levels which alters the body’s CNS thermoregulatory set point. As it is suggested by Stearns (2002), however, treatment to reduce the symptom of hot flushes including the use of oestrogen or progestin compounds to stabilize changing hormone levels, can reduce hot flushes by 85% while also offering relief from fatigue, emotional upset, and other related symptom.
All in all, this research demonstrates that many of the pathological symptoms exhibited by women during menopause transition are closely related to the decrease in estradiol that occurs (Avis, Crawford, Stellato, & Longcope, 2001). However, since hormone replacement therapy has a noted connection to breast cancer prevalence, has created a need for alternative treatment for the pathologies, or symptomologies tied to hormone fluctuation, instead of use of hormone replacement therapies (Marsden, 2002).
As an alternative, SSRI’s, or Selective serotonin reuptake inhibitors can be used as a pharmaceutical intervention to reduce or eliminate the VMS symptoms that a patient is experiencing (Sassarini, 2013). These can include reducing hot flushes, sleep disturbances and emotional impacts of menopausal transition. Though this is currently off label use of SSRI’s there is compelling evidence to suggest that it is an effective pharmaceutical approach to giving relief from VMS related symptoms.
There is a second body of symptoms, or pathologies, however, which should also be considered. These are non-vasomotor related systems, including most prominently, loss of bone density, increased risk of heart disease (Do et al, 2000; Farhat & Cauley, 2008). Research suggests that as the physiological changes occur in a woman’s body, during menopause transition, their risk of osteoporosis and cardiovascular disease both increase.
One of the pathological impacts that this menopause transition has on the female body is loss of bone density. In a study by Perrien et al., (2005) here is an increase in bone turnover that occurs during perimenopause, which directly corresponds with elevated FSH, and other hormonal changes. As a result, women become less capable of forming and resorption of density in the bone increasing their susceptibility to bone fragility and bone diseases like osteoporosis.
Conclusion The research consistently indicates that women go through a significant natural, biological change as they transition to the post-menopausal stage of life. Menopause transition, as a natural physiological process, however, as certain pathological effects on the body. As any physiological process happening in the human body menopause, is characterized by hormonal changes happening in the body as a result of the cessation of menstruation and the transition out of the fertile stage of life. This results in VMS related symptoms, and non-VMS related pathologies, for which risk factors increase during menopause transition. While hormone replacement therapy is most consistently capable of reducing both sets of symptomology, their prolonged use can increase the risk factors for cancer and deep vein thrombosis, leading to a reduction in prescription. SSRIs, while not specifically designed for use to treat the symptoms of menopause transition hold great promise for increasing the physical comfort of those suffering from VMS symptoms during transition.
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