About the course of menopause
1. I am 52 years old and do not feel any symptoms associated with menopause. Regular exercise (jogging and swimming) there a real influence on the smooth running of menopause?Answer First, it seems very important to say that many women have no symptoms associated with menopause. Nobody knows, moreover, not clear why some women have severe symptoms and others do not. Then, a simple reminder of what menopause is the cessation of ovarian function associated with ovulation. The ovaries stop producing eggs for breeding. It also ceases to secrete female hormones in the same proportion as during the fertile period. The decrease in secretion of these hormones have different effects on both tissues (skin, mucous membranes) on the bones (osteoporosis of variable intensity) and brain (disappearance of premenstrual syndrome and headaches associated with it) . But again, all women are not equal. In Japan and Asia, it seems that the symptoms accompanying menopause (mood disorders, hot flashes, in particular) are much rarer than in North America or Western Europe. Furthermore, menopause is not in itself the sole cause of tissue aging in women. Aging is a phenomenon that affects all living beings, of both sexes. And this aging is variable from one person to another and, for women, regardless of hormone secretion, but depending on their genetic makeup, their physical activity, health status, prior to their living conditions, their smoking! Better health at age 50, menopause is less difficult to cross. And the cross, a regular physical and mental activity is of course desirable. Walking alone, promotes blood to the brain. We now understand without difficulty that other activities (cycling, jogging, swimming), and smoking cessation are also important.
2 - What causes the menopause? I have often heard that menopause occurs when all oocytes available (or fertilized) were used. Is this true?
Answer No it is not. Menopause is programmed into the human genome for millennia. It is now believed that this is an evolutionary advantage due to the need for humans to raise their young for many years. Unlike most primate relatives (chimpanzees, gorillas ...), humans give birth to small immature, unable to move about and feed themselves and the brain to reach maturity, takes many years support (it seems more and more evidence that the brain reaches its adult size at 25 years!). This need to accompany children long said that humans are more likely than monogamous chimpanzees (which only females care for their young). The presence of the father is indeed a sign of improved survival for the child or children. But if women remained fertile beyond the age of 50, they would run an increased risk with age, to die while giving birth to children. It is believed however that the menopause (which seems to exist as a phenomenon genetically programmed, only in humans, because of his long life) has made an evolutionary advantage to humans by allowing mothers to become great mothers and provide support for younger women to raise their children. Especially since the life expectancy of women has always been longer than men. Moreover, germ cells (oocytes women, sperm of men) get older over time and are increasingly victimized by ambient cosmic rays (like the skin ...). With age, the risk of malformations increases - you know, thinking of the Down syndrome (trisomy). Menopause is in itself a protection against the fact of giving birth late in life, deformed children. Menopause is programmed, but it is likely that age of onset was increased with the generations. Chronic diseases, malnutrition, harsh working conditions were probably all a negative effect on fertility. When I started practicing medicine in France, in 1983, age of menopause was often situated around 45 years. Today in most developed countries, it routinely exceeds 50 years, indicating that the duration of fertility is directly linked to the health of women. As the number of oocytes, with an estimated 30 000 in women after puberty. Assuming that a woman begins to ovulate at 13 years and she is postmenopausal at age 55, it is (at a rate of one egg a month) ... 500 eggs. Suffice to say that the ovary is a lot more than is necessary. Therefore, neither the pill nor the number of pregnancies can not "preserve" or "exhaust" the number of oocytes available. If women go through menopause, it is not "a lack of oocytes, but because our genetic program (that of all mankind) is like that.
3 - What are the signs that indicate the arrival of menopause? Does that change the menstrual cycle is an index?
This response is any indication, it is not so irregular cycles (many women have irregular cycles several times in their life, well before the menopause) that the abrupt rules, alone or with hot flashes brutal. The first thing to do in case of cessation of menstruation midlife is to verify that you are not pregnant. Because pregnancy is possible very late (again, it depends on the health of the woman) and may go unnoticed during the first weeks. And that, especially in the absence of contraception. It is common for women over 45 years cease all contraception, thinking that they risk nothing. It is a mistake. Until menopause has not been confirmed (and it may be difficult in the absence of characteristic symptoms), a woman may be pregnant. Even if ovulation spaced out, just get one for a pregnancy begins.
4 - How are we sure that is menopause?
Answer In general, we consider that a woman over 45 to 50 years has reached menopause if she has more rules for at least 12 consecutive months in the absence of any pregnancy or any external cause (medical or surgical treatment , for example). So that 1 or 2 months without rules (which can happen at any time of life) are not at all indicative of menopause or "perimenopause." Indeed, cycles "anovulatory (without ovulation) that are followed by several weeks or months without rules are possible at any time of life. Hormone assays are not completely reliable either, because of possible variations. So essentially subjective symptoms experienced by women who are the best indicator of menopause.
Menopause and Libido
5 - Is this normal for menopause to have less and less inclined to make love?Answer There is really no "standard", but the loss of libido in menopause is a phenomenon observed in many women. It is obviously related to the fact that the libido is what makes us have sex to reproduce ourselves. When the function of reproduction goes, the desire (stimulated by hormonal changes, in particular) is decreasing. However, libido is not just hormonal. The proof is that while many pregnant women have decreased libido (while all their body, brain included, is bathed in hormones of pregnancy), many others continue to have sexual desire and frequent reports. Today, many researchers have shown that the desire is not just hormones, but especially emotional interaction with a (e) partner. People over age 70, widowed for a long time, can find with the desire (on) another partner; of people having a lack of libido for several months found a satisfactory sex as a miracle. Why? Because the center of emotions is sensitive to many stressors and that the age of menopause (the fifties, basically) is also the age when external events in life (job changes, children leaving home, death or sick relatives) can affect desire and compromise. So yes, a decrease in libido at the menopause is common, but it is not "normal" nor "inevitable" nor compulsory. Just as sexuality at age 40 is not the same as 18 or 20 years, sexuality at age 50 requires adaptations, transformations and especially a good relationship with the person with whom one lives. All this is at least as or more than menopause itself.
Hot flashes, mood swings and sleep disturbances
6 - Why do we have mood swings and depression passages with menopause?Answer For the same reasons we can have at puberty, while pregnant or during the week shutdown of its oral contraceptive, or at the end of its cycle. These are not hormones themselves that influence mood, but the intensity of their variations and their effects on the brain. The "fall" of hormones at the end of the menstrual cycle causes two parallel phenomena: the occurrence of the rules (linked to the withdrawal of hormones in the womb) and a feeling more or less marked irritability or sadness (due to withdrawal of hormones in the brain).
7 - What causes hot flashes?
Response is a mysterious phenomenon, which is not known exactly what, but now we tend to think that menopause, the brain reacts to the cessation of ovulation by secreting neurohormones in large quantities, as to "restart" the ovary. These neurohormones would cause (by their excess) of hot flushes and (by the alternation of secretions and stops) the "ups and downs' morale. A bit like hypoglycemia accompanied by drowsiness, and excessive consumption of sugar per excitation ...
8 - What is the best treatment against hot flashes?
Answer: As the cause and nature of hot flashes is not known (it seems that it is a neurological phenomenon, and non-vascular), there is no miracle cure. Replacement therapy makes them disappear, of course, but because it "fools" the brain on the functioning of the ovary. When treatment is stopped, hot flashes may return. And it is not possible to continue this replacement therapy indefinitely. Other drugs have been proposed, particularly psychotropic drugs (antidepressants, tranquilizers), but again, their effectiveness has not been proven and their side effects are numerous. And unfortunately, no other drug has shown a convincing effect against hot flashes. Indeed it appears that their duration is variable and unpredictable among women who suffer, and studies on postmenopausal women indicate that other symptoms of menopause are also highly variable.
9 - Why is most of the hot flashes night?
Answer There are explanations that are obvious: in a bed, it's hot (in principle). Digestion (especially of a meal washed down with liquor) may, with or without menopause cause "hot flashes". And finally, when you're having trouble sleeping, and that one is lying in bed, it is more oriented toward what we feel during the day, when you're in business. Finally, once again, the frequency of hot flashes varies greatly from one woman to another. It is therefore unclear that hot flashes are more common at night with all those who have.
10 - Does menopause cause sleep problems?
Answer So say many women, but not sure. Several studies have found sleep disturbance more often in women than in postmenopausal women who were not. You should also know that sleep duration decreases statistically with age, while worries them, increase with age. And sleep disorders may be due to many causes: drugs, diet, esophageal reflux, chronic snoring, overweight, smoking, stimulants (tea, coffee) taken late in the day, etc..
Treatments for Menopause
11 - Is it safe to take hormones cons hot flashes if my mother had breast cancer at 49 years?AnswerFirst, recall that hormone replacement does not cause breast cancer. Between the occurrence of a first cancer cell and tumor development as big as a ball, it can take 15 years to 20 years. But there are many arguments to suggest that female hormones are fattening fast pre-existing cancer. The daughter of a woman who had suffered breast cancer before age 50 is, by definition, at increased risk of breast cancer. Therefore, use of hormone replacement therapy at menopause is strongly discouraged.
12 - When a woman has been through menopause early (40 years), she must take hormones until menopause, although it has no symptoms?
She did not answer "should" not (nothing is mandatory, medicine), but it can. Delays with osteoporosis (loss of bone density), which is normal after menopause, but is not earlier. But in any event, it is not justified in taking such treatment after 48 years or 50 years to avoid increasing the risk of breast cancer associated with hormone therapy.
13 - What to do to treat vaginal dryness when you do not want to take replacement therapy?
Answer Many observations have shown that vaginal dryness is not systematic in all postmenopausal women. It is observed that the less women have sex regularly (at least 1 time per week). When she appears, it can be treated temporarily by estrogen creams, which provide only a tiny amount of estrogen. Or be soothed by gels or other topical treatments moisturizers.
14 - Since I'm menopausal, my heat and my insomnia is controlled by medication, but my concentration and my memory is still failing. Will they improve or will I continue to live with the disorder that I currently have?
Answer The concentration and memory can falter at many moments of life, but it does not appear that menopause is alone responsible for memory problems and concentration durable. However, many medications (especially those prescribed for insomnia or depressive phases) have a negative effect on memory and concentration. Discontinuation of drugs and maintaining a physical and intellectual activity can set things right. If the elderly are more likely to use computers, even late in life, it was because their neurons are still healthy.
Menopause and Breast Cancer
15 - I'm 50 and I was treated for breast cancer (surgery, chemotherapy, radiotherapy). At diagnosis, I was in perimenopause. Is my illness has increased the speed, intensity and concentration of the symptoms of menopause I'm going through?Answer Chemotherapy and radiotherapy for breast cancer can cause premature menopause. It is very possible that your menopause is installed quickly because of your treatment. Are treatments intensify the symptoms? It's hard to say because it is not possible to distinguish which symptoms are attributable to menopause and which to illness or treatment. But women treated for cancer and cured following treatment were not more symptoms than postmenopausal women not having suffered
16 - The discovery of microcalcifications on mammography after menopause, "she justifies a preventive operation to avoid the risk of breast cancer?
Answer microcalcifications can be a sign of breast cancer, but not always. When these microcalcifications are found in the absence of other signs suggestive of cancer (or in the absence of an abnormal biopsy), there is consensus today that an intervention is not justified because consequences of overdiagnosis (interventions by excess) are too heavy for women who experience it. Regular monitoring (ultrasound every 6 months, for example) is sufficient.
Menopause and Osteoporosis
17 - At menopause, a bone densitometry examination is necessary? And how to prevent fractures related to osteoporosis? Must take medication as a preventive measure?The BMD response is not at all a critical review. Unfortunately, it is recommended by many doctors in order to avoid complications of osteoporosis. However, it does not predict fracture risk and its interpretation is subject to strong security. The only good criteria predictive of fractures by osteoporosis are age (over 70), overweight and size (it is smaller and more overweight, the greater the risk of vertebral fracture is great). Sunbathing regularly do physical activity, absorb calcium as dairy products all year round and vitamin D in winter are the best preventions. Drugs (bisphosphonates) sold in large numbers to prevent fractures from osteoporosis have an interest after a first fracture, to avoid a second. But they have no proven efficacy in prevention among women who suffer from anything. Moreover, evidence is accumulating of their negative side effects, particularly the fact that they ... cause fractures!
Bleeding after menopause
18 - Is it normal to have bleeding even if you are postmenopausal for several years?Answer Apart from the situation where a person takes hormone replacement therapy (which, if taken intermittently, accompanied by rules and can sometimes even cause bleeding if taken continuously), a gynecologic bleeding after menopause is not normal and should inspire you to consult a doctor. It may reflect inflammation or disease of the cervix or inside the uterus, which must be treated appropriately. The accentuation or recrudescence of bleeding in a patient taking hormone replacement therapy should also encourage them to consult a doctor.
The contraceptive pill after 40 years and 50 years
19 - Should I still take the pill at age 51, is it dangerous and how will I know if I'm in menopause (or perimenopause)?Answer In principle, because of adverse side effects of oral contraceptives (which are combinations of hormones), we tend to discourage their use after 50 years. Indeed, the risk of stroke (infarction, stroke, phlebitis) is much higher after that age. Some doctors prescribe to healthy women, not postmenopausal, without vascular risk factors and birth control pills do not smoke until age 53 or 55 years, while monitoring closely. That makes sense, given the fact that the health of women age 50 and older is much better today than they were 30 or 40 years. However, this requirement may actually mask the symptoms of menopause hormones for birth control are perceived by the brain does not realize that the ovaries secrete hormones much more than before. And sometimes, when women stop their oral contraceptive, they discover that their life does not reappear, as they are postmenopausal. But the use of birth control pills at this time of life (50 years to 55 years) is questionable because it is no different from the use of hormone replacement therapy for postmenopausal women. However, these treatments are currently much debate, due to increased risks of breast cancer and vascular disease that they pose to their users ...
20 - When it was over 40 years if it does not want to take hormones contraceptives, contraceptive use what?
The most effective response is the IUD (intrauterine device) to copper. Advantage: it does not disrupt the cycle and it has no side effects and does not raise the vascular risk of cancer. And in case of delayed menstruation, it avoids the fear of pregnancy late: after 35 years, the risk of failure of a copper IUD is less than 0.5%. We can keep more than 10 years (IUD put in 40 years may be left in place until the menopause is installed).
Answers to the questions provided by Marc Zaffran, MD
Menopause, too much media attention?Do not you think that menopause and its accompanying symptoms are overhyped, especially in women's magazines?Reply Menopause is a natural phenomenon, as natural as pregnancy or puberty. But as it occurs in "midlife" and closes the period of female fertility, it is a way more serious, more melancholy than puberty. But many women do not know what to expect when they arrive at age 50. I therefore find it beneficial to inform them of what menopause, so they are forewarned and reassured. In this sense, the information supplied by consumer magazines can be valuable if it is accurate and not misleading. However, the press should contribute to the medicalization of menopause? Because that is where lies the problem: Many journalists are, sometimes unknowingly, as a springboard to information "medical" which are actually disguised advertising. The vast majority of pseudo-information that bombard women over 45 have essentially to feed their concerns (old, no longer be beautiful or sexual performance, etc..) In order to sell miracle cures. It starts with the wrinkle creams or gels against cellulite. It continues with hormone replacement therapy and drugs against osteoporosis. The reality is this: Aging does not hit all individuals (men or women) equally. The previous way of life, food, working conditions, having smoked or not, weight, physical activity and genetic background are all important. When a woman is severely hampered by a symptom, it is justified to help fight it. It is less legitimate to make him take drugs in anticipation of something that will perhaps never be (a fractured vertebra, for example). Especially since all drugs are consumed by people over 60 are sources of injury and toxicity. There is much talk of conflict of interest for physicians. Journalists in the mainstream press should also ask what their own conflicts of interest when reporting treatment "spectacular" (or simply "promising"). The public interest would they check carefully that they do not take bladders for lanterns. But spectacular verify information is to take the risk of discovering that it is false (or exaggerated) and thereby miss the opportunity to make a headline and a big draw. Health, conflict of interests worthy of the press, too, to be clearly identified. |
