Menopause is defined as permanent cessation of menses due to loss of ovarian function.
Most women experience menopause between the age of 45 - 55.
However, many women under the age of 50 experience symptoms related to estrogen deficiency while they still have menses. This is known as Peri-menopause Syndrome.
There is a slow decline in ovarian function over several years before there is a complete cessation of menses.
Normally, ovaries primarily produce estrogen, progesterone and small amount of testosterone.
Symptoms of Menopause Syndrome
Main symptoms of Menopause Syndrome are:
1. Menstrual irregularities
2. Hot flashes
3. Emotional swings
4. Decreased libido
5. Vaginal dryness which can lead to painful intercourse
Some women experience migraine headaches during this period of their life.
Menstrual irregularities vary from one woman to another. Usually menses become shorter in duration and less frequent until they finally stop. In some women, menses stop abruptly. In others, menses become quite erratic before they finally cease.
Hot flashes are a feeling of warmth that comes on suddenly
and usually lasts a few minutes. It usually is accompanied by excessive perspiration. Sometimes, a woman may experience transient redness of the skin, especially of the face and neck area.
Hot flashes can be quite discomforting and can interfere with usual daily activities. Insomnia due to interrupted sleep is a major problem. Fights over controlling the thermostat in the house are quite common. Frequent hot flashes at night can lead to insomnia and daytime tiredness.
Mood swings are a frequent symptom of Menopause Syndrome. Usually a woman becomes irritable for no obvious reason. Usually, she is aware of her mood swings, but sometimes, her family members, friends or coworkers may bring these changes to her attention. Irritability, coupled with decreased libido and vaginal dryness, can lead to serious damage to a woman's relationship with her husband.
Irritability and tiredness due to insomnia can cause problems at work. These interpersonal relationship issues can lead to serious anxiety and at times, depression.
One must be aware that certain other medical disorders can give rise to the above described symptoms.
The following actual case histories from my practice illustrate some of these issues.
Case History #1
W.R was a 45 years old female who experienced episodes of feeling hot and excessive perspiration. She also felt irritable and was told by her husband and children that she had a bad attitude most of the time. She also noticed a slight irregularity in her menses and a markedly decreased sex drive.
She thought she might be having menopause and discussed these problems with her family physician who told her that she could not be having menopause because she was still having her menses. Her family physician prescribed an anti-depressant for her.
Two months later, she was feeling worse. She decided to discuss her symptoms with her gynecologist who did a blood test, reassured her that she was not having menopause and told her to continue taking her anti-depressant.
A week later, she also developed palpitations of her heart for which she was referred to a cardiologist who did a 24 hour monitoring of her heart and an echocardiogram which were normal. The cardiologist told her that "nothing is wrong with you and that it's all in your head."
Another month passed by. Her symptoms were worsening. She again consulted her family physician who referred her to a psychiatrist. The psychiatrist changed her anti-depressant medication. Her symptoms continued to get worse.
A co-worker advised her to see an endocrinologist. Once she came to see me (an endocrinologist), we did a blood test for her thyroid function and found out that she was suffering from hyperthyroidism (overactive thyroid gland).
I placed on anti-thyroid medications and four weeks later, she started feeling much better.
Case History # 2
M.L was a 44 year old female who over the past six months started experiencing episodes of feeling hot, especially at night. She often threw off her bedsheets and at times, opened windows in the middle of the night. Her menses were still normal.
She raised the question of menopause to her primary care physician who reassured her that she was not having menopause as she was still having her menses.
Her symptoms got worse. She saw her gynecologist who also assured her that as long as she was having her menses, she was fine.
Her co-worker advised her to see an endocrinologist. I performed a blood test and found that her ovaries were not functioning optimally and that she had developed estrogen deficiency. I started her on appropriate treatment and within 4 weeks, her symptoms improved remarkably.
Case History # 3
N.H was a 43 year old female who for the past six months started experiencing episodes of feeling hot. She mentioned this problem to her primary care physician who blamed it on the hot weather.
Months later, as winter arrived, her symptom had not improved. She also had insomnia and felt irritable. Her libido had markedly decreased.
She had undergone a hysterectomy at the age of 28 for endometriosis and of course, had not had menses since that time.
Her sister advised her to see an endocrinologist. I did a blood test and told her that her ovaries had stopped functioning and that her symptoms were due to estrogen deficiency. I started her on estrogen therapy and her symptoms improved significantly within a month.
In Summary, these case histories illustrate the complexity of the symptom of "hot flashes" and menopause.
When a woman experiences episodes of feeling hot, it is not always due to menopause.
Certain other medical conditions such as an Overactive Thyroid, Tuberculosis, Panic Attacks and some rare medical disorders can cause episodes of feeling hot.
A woman may have hot flashes due to estrogen deficiency while still having menses. With proper laboratory testing, an accurate diagnosis can be made.
This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, Endocrinology and Metabolism.
Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.
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