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Some cycles could have heavy menstrual discharge but sometimes

menstrual periods are completely skipped.

These changes occur over a period of five to eight years, called

perimenopause, and finally end in menopause.

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7. What are the Risk Factors for Menopause?

Menopause is a normal biological process. Yet, there are certain

factors that could affect the onset of menopause.

Genetic

If you have a family history of premature menopause, you stand a

greater risk of having it too. Premature menopause is where you

enter menopause before the age of forty.

Medical Treatments

If you are treated for any ailment where you undergo radiation and

chemotherapy treatments, this may cause you to enter menopause

sooner.

Surgery

If you undergo surgical removal of the ovaries as in total

hysterectomy and bilateral oophorectomy, you will enter menopause

early. A hysterectomy removes only your uterus and not your

ovaries. Such an operation may not cause menopause, as your

ovaries continue to produce estrogen and progesterone hormones.

Smoking

Nicotine levels in your body may help to induce early menopause, as

they are believed to restrict free production of hormones. This could

disrupt your regular menstrual cycle and you may enter

perimenopause and menopause earlier.

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Medications

Specific medications that reduce estrogen levels in your body could

cause early onset of menopause.

Autoimmune diseases

Certain autoimmune diseases disrupt normal physiological

functioning of your body and some may be involved in the early

onset of menopause.

Premature Ovarian Failure

This is a very rare condition where your ovaries could stop

functioning well before the age of forty due to specific genetic or

other medical conditions. This may causes menopause to start

earlier.

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8. Myths and Misconceptions about Menopause

Menopause marks the start of a new phase in your life. Many

women treat menopause as something unwanted or uncalled for but

menopause is a normal biological process and you cannot run away

from it.

There are numerous myths and misconceptions about menopause.

Myth: Menopause causes weight gain

Your metabolic rate normally decreases with age. There could be a

little gain in weight during menopause but it not be due to

menopause alone.

Eating the right type of foods and exercising for thirty to forty-five

minutes every day can help you maintain your weight.

Myth: Menopause marks the end of sexual life

Menopause causes vaginal dryness and lowered libido. However,

reduction of hormone levels does not mark the end of your sexual

life. You can maintain normal sexual relations with your partner.

Myth: Menopause denotes you have become old

Menopause is a normal process and every woman has to experience

it. Some women experience severe symptoms while some encounter

few or no symptoms.

Menopause usually starts in your forties and fifties when you have

completed almost half your lifespan. Although you are aging by

then, you can learn to age gracefully.

It is the second innings of your life. Learn to relax and enjoy it.

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Myth: Menopause causes memory problems.

Menopause may not be the sole or even the main cause for your

memory problems. Various nervous diseases or stress about life

issues such as retirement, familial problems etc., cause problems in

retaining facts.

Menopause causes hormonal changes. Some of these changes may

contribute in part to problems in concentration.

Myth: Menopause is a disease

Menopause is not an illness or ailment. It happens to every woman.

Develop and maintain a positive attitude towards a different chapter

in your life.

Learn to accept life as it comes and you will be able to sail through

your menopause smoothly.

Myth: Menopause is natural, so it does

not have major consequences

Menopause is a natural process. But, it could be a factor in the

occurrence of various ailments like osteoporosis, colon cancer,

vaginal and urethral atrophy, diabetes, heart disease, Alzheimer’s

disease, and impaired vision.

Low estrogen levels may make you more vulnerable to these

diseases.

However, there is no need to panic. Proper management of

symptoms and prompt medical care can help you overcome almost

all possible ailments.

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Myth: Hormone replacement therapy is bad

Hormone replacement therapy may have serious side-effects with

some individuals. But, it is not always a bad option.

Hormone replacement therapy is a conservative option.

Doctors advise such therapy treatment to women in dire need of it.

It can bring huge relief from most menopausal symptoms like hot

flashes, night sweats and vaginal dryness.

Myth: Menopause causes depression

Depression is risk factor among women with a family history of

depression and a common ailment among women in their late

forties and fifties.

Menopause can aggravate depression symptoms in women with a

prior history of depression but this does not mean that menopause

causes depression.

Depression can be an after-effect of various other ailments like

heart disease.

Myth: Menopause could mean the end of an active life.

This is an unfortunate myth.

Menopause is a part of your life.

You can continue with your active life schedule. Regular exercise,

good and nutritious food, adequate rest and remaining connected

with different issues can help you continue with your active life

without much disturbance.

Regular visits to your doctor and regular checkups can help you lead

a healthy life for many years after menopause.

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Part-III: Diagnosis and Clinical Aspects

9. When to Seek Medical Advice

Menopause normally starts between the ages of 45 and 55. It

could start with irregular periods.

Visiting your doctor and seeking medical advice can tell you if you

are pregnant or in the perimenopause stage.

Women in their perimenopause and menopause stages should

undergo a thorough annual medical check-up that includes

mammogram, pelvic examination and breast examination.

The perimenopause stage could bring different changes in your

body. Seeking medical advice helps you to understand those body

changes and what, if any, treatments may be necessary to reduce

the possibility or effects of major symptoms.

Menopause and perimenopause are transitional stages and your

body needs sufficient time to adjust to these changes.

Your doctor can give you advice about what to expect and how to

deal with these changes.

Menopause signifies low estrogen levels in your body. You may be

at a greater risk for different ailments like heart disease and cancer.

Professional advices from your doctor can help you make suitable

dietary and lifestyle changes as a preventive measure.

Menopause could cause irregular periods due to low estrogen levels.

Yet, you can still become pregnant. Doctors sometimes advise birth

control pills with low estrogen levels to prevent pregnancy and get

some relief from hot flashes, a common symptom of menopause.

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Seeking medical advice at all stages of perimenopause and

menopause is essential to maintain good health.

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10. How Is the Menopause Diagnosed?

There are many tests and examinations that help in determining

menopause.

Most of these tests involve drawing a little blood from your veins

and arteries. You could feel slight pain and discomfort as a result.

In some cases, it could cause excessive bleeding. Infection is

possible. Sometimes, though rarely, you could experience dizziness

or could lose consciousness for some time.

But, doctors take all necessary precautions before undertaking any

of these tests.

Diagnosis of menopause includes reviewing your medical history,

present symptoms and ruling out other possible causes for your

symptoms.

Irregular periods are a common menopausal symptom, although it

does not necessarily indicate menopause.

Other Tests to Diagnose Menopause

Urine test: Doctors advise a specific urine test to detect hormone

levels because high hormone levels in urine could indicate

menopause.

Blood Test: A blood test to determine the amount of follicle-

stimulating hormone (FSH) can indicate if symptoms pertain to

menopause. This test is specifically for women who have had a

hysterectomy operation without removal of ovaries. The result is

that the ovaries of these women continue to produce estrogen and

progesterone.

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Pituitary glands produce FSH and stimulate ovaries to produce

estrogen. However, in women over the age of forty, estrogen

production declines although their FSH level may increase.

Excess FSH then enters your blood.

Sometimes, a single FSH test is not enough for diagnosis of

menopause.

Further, some doctors may advise that you should not be taking

birth control pills when you are tested as hormones present in those

pills could affect test results.

Your FSH levels can help to identify symptoms of menopause if you

are in this group.

Bone Tests: Menopause may lower the density of your bones,

sometimes leading to osteoporosis.

Bone tests detect and calculate bone density levels and compare it

with normal levels.

This involves taking an x-ray of hipbones and those in the lower

parts of your spine. Before this, simple screening of bones through

ultrasound machines can detect bone density. However, this simple

screening is insufficient to detect actual levels necessary to

determine menopause.

If levels are between 1 and 2.5 standard deviations below the

average value, it may indicate osteoporosis.

Heart Tests: Menopause could place you at risk of heart ailments.

Doctors prescribe normal blood tests to determine cholesterol

levels. High cholesterol may indicate the possible existence of heart

disease.

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Pregnancy Test: Doctors conduct pregnancy tests to determine if

you are pregnant or in menopause if you miss your regular

menstrual periods.

Thyroid Test: Thyroid problems in women often show the same

symptoms as those of menopause. Therefore, doctors recommend a

thyroid-stimulating hormone test to check if irregular periods are

due to thyroid problems or due to menopause.

Urine test: There is a specific urine test that determines hormonal

levels in urine. High hormone levels may indicate menopause.

Transvaginal ultrasound test: This test detects abnormalities in

uterus or any extra growth around uterus that could be responsible

for excessive and abnormal bleeding during or in-between

menstrual periods.

Menopause may induce such irregular periods with excessive

bleeding. This test can help doctors determine if the bleeding is due

to menopause or other problems associated with the uterus.

Endometrial biopsy: This test detects the functioning of the

uterine lining. Normally, progesterone and estrogen form a thick

lining around uterus to house a fertilized egg. If there is no

fertilization, this lining comes off as menstrual bleeding. This biopsy

can therefore detect if such uterine lining takes place and thereby

can give some indication if you are into menopause or not.

Estradiol test: Estradiol is an important form of estrogen secreted

in the ovaries, adrenal cortex and placenta. This test detects

estradiol levels in blood. This hormone promotes growth and

development of uterus, breasts, vagina and fallopian tubes. It also

promotes distribution of body fat.

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You should not take birth control pills or be on estrogen therapy

while taking this test. This test can check functioning of ovaries,

adrenal glands and placenta. It also detects any abnormal growth

around ovaries or placenta.

This helps doctors analyze if you are going through menopause or

having other problems related to your ovaries like ovarian cancer, a

tumor or any other problem.

LH (Luteinizing Hormone) Blood Test: This test detects levels of

the luteinizing hormone or LH. Your anterior pituitary gland

releases a special protein hormone, LH. Increase in LH levels during

mid-cycles of menstruation causes ovulation.

Doctors conduct this test on a specific day of your menstrual cycle.

Doctors detect such levels through blood test. If levels of LH

hormones in your blood test are very high, it may indicates

menopause.

But, these levels also could be high if you have ovarian cancer, a

tumor or possibly the formation of cysts around the uterus.

Doctors analyze these test results with regard to your other

menopause-linked symptoms to detect if you are into menopause or

not.

You should refrain from using any birth control pills or hormone

replacement therapy while undergoing this test.

Pelvic Examination: Doctors conduct a thorough pelvic

examination to detect any abnormalities in your pelvic region and

around the uterus. Excess growth, pain or discomfort could prompt

doctors to go into deeper examinations to detect the actual cause of

your problem.

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Normally, women into menopause have fat deposits in the pelvic

region that may result in some weight gain. This test can detect

changes in vaginal lining that take place during menopause.

Breast examination or mammography: Breast examination can

detect abnormalities or pain around or in the breasts. Menopause

induces a tender feeling in the breasts while making them softer.

Mammography can detect any such abnormalities for doctors to

diagnose the root cause of your problem.

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12. Self-Testing for Menopause

You can use a self-testing method to detect if you are in

menopause or not.

Some of the home tests are said to be similar to those used by

doctors. However, doctors have greater knowledge and are better

able to analyze test results in conjunction with your other symptoms

to come to the most reliable conclusions.

Even if your self-testing gives a positive response, you cannot be

sure that you are into menopause and therefore stop using any

contraceptives.

Getting your doctor’s confirmation and opinion is essential.

Similarly, do not assume that a negative result indicates you are not

yet into menopause. There could be other reasons that cause such a

result.

A simple home-testing kit measures follicle stimulating hormone

(FSH) levels in your urine. Your pituitary gland produces FSH and

these levels every month increase to stimulate your ovaries to

ovulate. During menopause, your ovaries stop ovulating and the

FSH levels increase in your urine.

This self-testing involves checking your first morning urine. After

putting a few drops of urine on the test device, dip it into a cup of

urine. Chemicals in the device react and produce a specific color,

which indicates current FSH levels.

Although this test may deliver good results most of the time, your

results also depend on other factors like:

• the amount of water you had before the test,

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• if it is the first morning urine,

• if you are on any contraceptives, estrogen supplements

• if you are on any estrogen supplements or

• if you have undergone hormone replacement therapy.

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13. Medical History for Menopause Diagnosis

Your medical history assumes great importance in your menopause

diagnosis. Doctors need to know if you suffer from any chronic

illnesses like arthritis, hypertension, diabetes, thyroid disease, or

urinary tract infections. You should give all details of therapies,

medications, and allergies.

Menopause diagnosis requires information about the start of your

menstruation cycles, length of cycles and bleeding during cycles.

Information about pregnancies, abortions, fibroids, pelvic surgeries,

contraceptives in use and sexually transmitted diseases is also

essential.

Doctors would also inquire about your lifestyle and dietary habits.

Family related details like your mother’s and sister’s age at

menopause, fertility problems and any genetic disorders inherent in

your family also play a part in your menopause diagnosis.

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14. Is It Possible to Delay the Menopause?

Menopause is a natural biological process and you cannot delay it.

However, a very recent news item offers an alternative prospect.

Robert Winston, professor of fertility studies at Imperial College,

declared that researchers found a new protein that may be able to

delay the onset of menopause.

Professor Winston stressed that risks with use of this pill or injection

might be fewer than with some other treatments.

Some researchers suggest that, as they believe that many women

today are much healthier than fifteen years back, menopause might

be delayed without much risk.

If further research and controlled testing bears out this theory, you

might be able to prolong your fertile years. This could enable

women to have healthy pregnancies and smooth deliveries even in

their forties.

But, the risk factors remain.

Women who smoke may have menopause two to three years

earlier. Drug addiction may cause premature menopause. Alcohol

abuse and high caffeine consumption may cause menopause to set

in earlier by two to three years.

Maintaining good health through adequate nutrition and a sensible

lifestyle and dietary changes may help to protect you from major

diseases like cancer.

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15. Life after Menopause

When there has been complete cessation of menstrual periods for

over twelve months, you enter the post-menopause period.

Women undergoing surgical removal of ovaries, chemotherapy

treatments, or hormone replacement therapy enter menopause

much early in life. Although they stop having periods during such

treatments, some start their menstrual periods once again after

completion of therapy. Hence, they may experience menopausal

symptoms during the intervening period and also later in life.

The post-menopause period is not the same for all women.

Menopausal symptoms like hot flashes and night sweats could also

occur in your sixties and seventies.

Life after Menopause

Post menopause is a new life and often, there is more publicity

about the supposed negatives of this period than its positives.

This period has these positives for most women:

9 allows you to be free of worries like unexpected

pregnancies,