Guest Author - Denise Howard, M.D., M.P.H.

Menopause is defined as “the period of permanent cessation of menstruation”. Culturally, however the condition is most often discussed in the context of the perimenopausal phase. This is the transition phase when a woman’s periods are becoming irregular prior to the actual permanent cessation of menses. The troublesome symptoms that accompany this transition are responsible for the infamy of this change.

Menopause results once the ovaries have stopped producing eggs. The hormonal consequence is a significant reduction in the circulating levels of estrogen, progesterone and testosterone. In women these hormones are primarily created by the ovaries. Estrogen and testosterone can be produced in smaller quantities from other sites within the body.

Once the transition to menopause is complete there maybe some health consequences that can be directly associated with the hormonal deficiency. Historically, estrogen has been identified as the culprit. The role of progesterone is discussed in the lay literature but has largely been ignored in the medical literature despite anecdotal evidence to support its function. The role of testosterone appears to be minimal.

The medical concerns surrounding menopause are both a result of the potential health risk and the bothersome symptoms that can interfere with the quality of life. It is important to distinguish the difference.

Most of the problems that are of concern are a consequence of aging but certainly can be exacerbated by the resultant hormonal deficiency. There are other issues that are specific to hormonal deficiency. Finally, there are the annoying symptoms that are not life threatening but can impact the quality of life.

Issues specific to hormone deficiency
• Vaginal Dryness
• Decreased Libido

Problems that occur with age that might be exacerbated by hormone deficiency
• Loss of bone density
• Loss of muscle mass and strength
• Hair loss
• Weight gain

Quality of life issues
• Hot flashes/Night sweats
• Mood swings
• Urinary symptoms

Menopause is the post reproductive stage of a woman’s life. For some it is a time of great joy and celebration and for others it brings much sadness and mourning. Since this coincides with aging there are many potential health risks that arise during this time. The best advice that I have is to identify these risks, eliminate or minimize these risks and develop good health habits that may counterbalance these risks.