The American Medical Association Essential Guide to Menopause

Overview

The American Medical Association sorts through a wide array of professional views to compile solid, clear-cut information on menopause in one comprehensive volume. Now, every woman can make informed health-care decisions with her doctor during this life-changing condition, and weigh individual needs and health risks in choosing the best treatments. From recognizing its earliest symptoms to reducing the potential of menopause-related health problems, here is everything you need ...

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Overview

The American Medical Association sorts through a wide array of professional views to compile solid, clear-cut information on menopause in one comprehensive volume. Now, every woman can make informed health-care decisions with her doctor during this life-changing condition, and weigh individual needs and health risks in choosing the best treatments. From recognizing its earliest symptoms to reducing the potential of menopause-related health problems, here is everything you need to know about:

  • Physical symptoms throughout all phases of menopause
  • Feeling good emotionally
  • Early detection of heart disease, breast cancer and other health risks
  • Osteoporosis prevention-how to maintain strong, healthy bones
  • Treatments including hormone replacement therapy, other prescription medications and complementary therapies
  • Gynecological problems and procedures
  • Lifestyle recommendations for fitness, nutrition and stress management
  • Staying sexually active during menopause.

The American Medical Association Essential Guide to Menopause includes a listing of brief touchstones to good health, "Your Menopause Health Priorities Checklist," as well as a detailed glossary of medical terms made easy. Now you can be prepared for the changes that come with menopause -- and feel assured and empowered -- with this authoritative, indispensable guide.

"...discusses hormone-replacement therapy and the prevention of osteoporosis...a comprehensive reference in an easy-to- use format, offering a balanced and objective look at a life-changing condition."

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Product Details

  • ISBN-13: 9780743403580
  • Publisher: Pocket Books
  • Publication date: 4/1/2000
  • Format: Mass Market Paperback
  • Pages: 272
  • Product dimensions: 4.13 (w) x 6.74 (h) x 0.73 (d)

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Chapter 1: Hormones and the Female Reproductive System

To understand menopause and the changes it brings, it is important to have a basic understanding of the body's hormonal, or endocrine, system and the female reproductive system. This information will help you understand more about how your body works, how it changes at menopause, what you can do to minimize the effects, and how various medications work in your body.

WHAT ARE HORMONES?

Hormones are chemical substances produced in the body by organs called endocrine glands. When a hormone is released by an endocrine gland into your bloodstream, it produces an effect in a specific part of the body (sometimes called a "target" organ). Hormones act as "chemical messengers" that help control and coordinate various body functions, such as metabolism (the way the body turns food into energy), growth and development, sex and reproduction, composition of the blood, reaction to emergencies, and the release of hormones themselves. If the body does not produce the needed amount of each hormone, serious health problems can occur.

The major endocrine glands include the adrenal glands, the pituitary gland, the thyroid gland, the parathyroid glands, and the ovaries.

As the body develops from infancy to adulthood, complex physical changes take place; hormones play a major role in regulating these changes. Puberty, the period of sexual development, begins between ages 10 and 15. At the start of puberty, the hypothalamus (the part of the brain that controls many basic bodily functions, including the endocrine system) secretes more gonadotropin-releasing hormone (GnRH). This hormone stimulates the pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are the gonadotropic hormones. These hormones in turn act on the ovaries.

Under the influence of FSH and LH, the ovaries develop and begin to release large amounts of sex hormones into the bloodstream. The female sex hormones are progesterone and estrogen. The adrenal glands also secrete some sex hormones, especially androgens (male sex hormones). The ovaries also secrete some male sex hormones, including testosterone.

The sex hormones control the rapid changes that occur during puberty. For example, they help trigger the increases in height and weight that occur and, at the end of puberty, they help to stop this growth.

ESTROGEN AND PROGESTERONE

The female reproductive system depends primarily on two hormones: estrogen and progesterone. Both are produced in the ovaries. The main role of estrogen and progesterone is to help regulate the menstrual cycle and prepare the uterus for pregnancy. Like all hormones, estrogen and progesterone circulate throughout the body and interact with other hormones and with the body's metabolism. Estrogen affects many tissues throughout the body, including the urethra, bladder, vagina, breasts, bones, skin, liver, arteries, and brain.

When a girl begins puberty, her ovaries start to release increasing amounts of estrogen into her bloodstream. Estrogen stimulates the development of the breasts and causes the genital organs to enlarge and mature. Estrogen also stimulates the endometrium (the lining of the uterus) to thicken.

Estrogen plays an important role in the menstrual cycle and affects almost every part of a woman's body. It influences height and weight, skin tone, muscular strength, digestion, heart rate, and circulation. The ovaries produce varying levels of estrogen throughout a woman's life span. Fat tissues also produce some estrogen.

Estrogen provides several benefits:

  • Estrogen helps prevent heart disease by increasing the level of "good" cholesterol in the blood and decreasing the level of "bad" cholesterol, and by keeping coronary arteries open and resistant to plaque (patches of fatty tissue on the inside of arteries) (see Chapter 4).
  • Estrogen helps keep breast tissue firm.
  • Estrogen helps maintain calcium in the bones, which helps make them dense, strong, and resistant to breaking.
  • Estrogen helps keep the vaginal lining moist, keeping it resistant to infection and more comfortable during sexual activity.

Progesterone is produced mainly by the ovaries during a woman's reproductive years and by the placenta during pregnancy. Small amounts are also produced by the adrenal glands.

Progesterone helps prepare the uterus for pregnancy. About midway through a woman's monthly menstrual cycle, one of the two ovaries releases an egg. This process, called ovulation, results in high levels of progesterone being released into the blood for 10 to 12 days. Progesterone stimulates growth of the endometrium (the lining of the uterus) so that the egg, if it has been fertilized, can implant (attach to the uterine wall). If pregnancy does not occur, the ovary stops producing high levels of progesterone. The uterine lining then breaks down and passes out of the body as menstrual fluid.

The increase in progesterone levels after ovulation also causes other cyclic changes. The woman's body temperature increases slightly and her breasts may feel fuller or become sensitive.

MENARCHE

Menarche, or the onset of menstruation, is the result of a series of hormonal changes that take place over the course of several years inside a young girl's body. Before age 8, only small amounts of estrogen are released into the bloodstream. When a girl reaches puberty, her pituitary gland begins to produce the hormones that are vital to sexual development. One of them is FSH (follicle-stimulating hormone), which will play an important part in the reproductive cycle. Another hormone, growth hormone, accelerates body growth, causing the typical "growth spurt" of the teenage years.

As puberty continues, the pituitary gland produces more FSH, causing the ovaries to produce estrogen. The higher level of estrogen in the bloodstream causes the development of female sex characteristics in classic sequence: first, the breasts develop and pubic hair begins to grow; then, underarm hair appears and menstruation begins; and finally, the hips begin to broaden, producing the characteristic female shape.

Estrogen also produces other changes in the body. By closing the ends of the bones, it stops skeletal growth. Generally, girls stop growing in height one or two years after menstruation begins. Estrogen also causes fat to be deposited in the labia, making them thicker. Pubic hair becomes denser and coarser in texture. The clitoris enlarges and becomes more sensitive. The vagina increases in length, and growth occurs in the uterus, fallopian tubes, and ovaries. Finally, as the body, brain, and endocrine glands mature, menstruation begins.

The first menstrual period usually occurs between ages 11 to 14, but this varies widely. It may be influenced by diet, exercise, genetics, and other factors. Ovulation is rare during the first year of menstrual cycles, which are often irregular, and sometimes heavy.

MENSTRUATION

The female reproductive system (see illustration) consists of the ovaries, fallopian tubes, uterus, and vagina. At birth, a female infant has about 2 million eggs (or ova) in her ovaries. By puberty, the ovaries contain just 300,000 eggs, each surrounded by a casing of cells called a follicle.

During a woman's reproductive years, about 450 eggs reach maturity and travel through the fallopian tubes, where they can be fertilized by sperm. The rest of the eggs slowly disintegrate, and by menopause, only about 3,000 remain.

As mentioned above, menstrual cycles (see illustration) depend on the interrelationships and functioning of the various endocrine glands. Menstruation is initially triggered by hormones released from the hypothalamus.

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Table of Contents

FOREWORD
INTRODUCTION
1 HORMONES AND THE FEMALE REPRODUCTIVE SYSTEM
What Are Hormones?
Estrogen and Progesterone
Menarche
Menstruation
2 THE ARRIVAL OF MENOPAUSE
Perimenopause (Premenopause)
Menopause
Other Reasons for Menopause
Identifying Menopause
3 SYMPTOMS OF MENOPAUSE
Irregular Menstrual Cycles
Hot Flashes
Vaginal Dryness
Insomnia
Emotional Symptoms
Changes in Libido
Other Body Changes
4 HEALTH RISKS OF MENOPAUSE
Heart Disease and Menopause
Stroke
Osteoporosis
Osteoarthritis
Breast Cancer
Alzheimer's Disease
5 HORMONE REPLACEMENT THERAPY
What Is Hormone Replacement Therapy?
The History of Hormone Replacement Therapy
How Hormone Replacement Therapy Works
Forms of Hormone Replacement Therapy
How Hormone Replacement Therapy Is Administered
The Benefits of Hormone Replacement Therapy
The Drawbacks of Hormone Replacement Therapy
The Risks of Hormone Replacement Therapy
Making the Decision
Life with Hormone Replacement Therapy
6 OTHER MEDICATIONS
Calcium Metabolism
Bisphosphonates
Calcitonin
Calcitriol
Raloxifene
Sodium Fluoride
Tamoxifen
Clonidine
Ergotamine, Belladonna Alkaloids, and Phenobarbital
Complementary Therapies
7 A HEALTHY LIFESTYLE
Getting Fit, Staying Fit
Starting an Exercise Program
Healthy Eating
Managing Stress
8 MENOPAUSE AND SEXUALITY
Physical Changes That Affect Sex
Changes in Desire
Aging-Related Problems
9 GYNECOLOGIC PROBLEMS AND PROCEDURES
Abnormal Bleeding
Hormonal Fluctuations
Uterine Fibroids
Polyps
Pelvic Support Problems
Urinary Incontinence
Hyperplasia and Endometrial Cancer
Ovarian Cancer
Gynecologic Surgical Procedures
YOUR MENOPAUSE HEALTH PRIORITIES CHECKLIST
GLOSSARY
INDEX
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First Chapter

Chapter 1: Hormones and the Female Reproductive System

To understand menopause and the changes it brings, it is important to have a basic understanding of the body's hormonal, or endocrine, system and the female reproductive system. This information will help you understand more about how your body works, how it changes at menopause, what you can do to minimize the effects, and how various medications work in your body.

WHAT ARE HORMONES?

Hormones are chemical substances produced in the body by organs called endocrine glands. When a hormone is released by an endocrine gland into your bloodstream, it produces an effect in a specific part of the body (sometimes called a "target" organ). Hormones act as "chemical messengers" that help control and coordinate various body functions, such as metabolism (the way the body turns food into energy), growth and development, sex and reproduction, composition of the blood, reaction to emergencies, and the release of hormones themselves. If the body does not produce the needed amount of each hormone, serious health problems can occur.

The major endocrine glands include the adrenal glands, the pituitary gland, the thyroid gland, the parathyroid glands, and the ovaries.

As the body develops from infancy to adulthood, complex physical changes take place; hormones play a major role in regulating these changes. Puberty, the period of sexual development, begins between ages 10 and 15. At the start of puberty, the hypothalamus (the part of the brain that controls many basic bodily functions, including the endocrine system) secretes more gonadotropin-releasing hormone (GnRH). This hormone stimulates the pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are the gonadotropic hormones. These hormones in turn act on the ovaries.

Under the influence of FSH and LH, the ovaries develop and begin to release large amounts of sex hormones into the bloodstream. The female sex hormones are progesterone and estrogen. The adrenal glands also secrete some sex hormones, especially androgens (male sex hormones). The ovaries also secrete some male sex hormones, including testosterone.

The sex hormones control the rapid changes that occur during puberty. For example, they help trigger the increases in height and weight that occur and, at the end of puberty, they help to stop this growth.

ESTROGEN AND PROGESTERONE

The female reproductive system depends primarily on two hormones: estrogen and progesterone. Both are produced in the ovaries. The main role of estrogen and progesterone is to help regulate the menstrual cycle and prepare the uterus for pregnancy. Like all hormones, estrogen and progesterone circulate throughout the body and interact with other hormones and with the body's metabolism. Estrogen affects many tissues throughout the body, including the urethra, bladder, vagina, breasts, bones, skin, liver, arteries, and brain.

When a girl begins puberty, her ovaries start to release increasing amounts of estrogen into her bloodstream. Estrogen stimulates the development of the breasts and causes the genital organs to enlarge and mature. Estrogen also stimulates the endometrium (the lining of the uterus) to thicken.

Estrogen plays an important role in the menstrual cycle and affects almost every part of a woman's body. It influences height and weight, skin tone, muscular strength, digestion, heart rate, and circulation. The ovaries produce varying levels of estrogen throughout a woman's life span. Fat tissues also produce some estrogen.

Estrogen provides several benefits:

  • Estrogen helps prevent heart disease by increasing the level of "good" cholesterol in the blood and decreasing the level of "bad" cholesterol, and by keeping coronary arteries open and resistant to plaque (patches of fatty tissue on the inside of arteries) (see Chapter 4).
  • Estrogen helps keep breast tissue firm.
  • Estrogen helps maintain calcium in the bones, which helps make them dense, strong, and resistant to breaking.
  • Estrogen helps keep the vaginal lining moist, keeping it resistant to infection and more comfortable during sexual activity.

Progesterone is produced mainly by the ovaries during a woman's reproductive years and by the placenta during pregnancy. Small amounts are also produced by the adrenal glands.

Progesterone helps prepare the uterus for pregnancy. About midway through a woman's monthly menstrual cycle, one of the two ovaries releases an egg. This process, called ovulation, results in high levels of progesterone being released into the blood for 10 to 12 days. Progesterone stimulates growth of the endometrium (the lining of the uterus) so that the egg, if it has been fertilized, can implant (attach to the uterine wall). If pregnancy does not occur, the ovary stops producing high levels of progesterone. The uterine lining then breaks down and passes out of the body as menstrual fluid.

The increase in progesterone levels after ovulation also causes other cyclic changes. The woman's body temperature increases slightly and her breasts may feel fuller or become sensitive.

MENARCHE

Menarche, or the onset of menstruation, is the result of a series of hormonal changes that take place over the course of several years inside a young girl's body. Before age 8, only small amounts of estrogen are released into the bloodstream. When a girl reaches puberty, her pituitary gland begins to produce the hormones that are vital to sexual development. One of them is FSH (follicle-stimulating hormone), which will play an important part in the reproductive cycle. Another hormone, growth hormone, accelerates body growth, causing the typical "growth spurt" of the teenage years.

As puberty continues, the pituitary gland produces more FSH, causing the ovaries to produce estrogen. The higher level of estrogen in the bloodstream causes the development of female sex characteristics in classic sequence: first, the breasts develop and pubic hair begins to grow; then, underarm hair appears and menstruation begins; and finally, the hips begin to broaden, producing the characteristic female shape.

Estrogen also produces other changes in the body. By closing the ends of the bones, it stops skeletal growth. Generally, girls stop growing in height one or two years after menstruation begins. Estrogen also causes fat to be deposited in the labia, making them thicker. Pubic hair becomes denser and coarser in texture. The clitoris enlarges and becomes more sensitive. The vagina increases in length, and growth occurs in the uterus, fallopian tubes, and ovaries. Finally, as the body, brain, and endocrine glands mature, menstruation begins.

The first menstrual period usually occurs between ages 11 to 14, but this varies widely. It may be influenced by diet, exercise, genetics, and other factors. Ovulation is rare during the first year of menstrual cycles, which are often irregular, and sometimes heavy.

MENSTRUATION

The female reproductive system (see illustration) consists of the ovaries, fallopian tubes, uterus, and vagina. At birth, a female infant has about 2 million eggs (or ova) in her ovaries. By puberty, the ovaries contain just 300,000 eggs, each surrounded by a casing of cells called a follicle.

During a woman's reproductive years, about 450 eggs reach maturity and travel through the fallopian tubes, where they can be fertilized by sperm. The rest of the eggs slowly disintegrate, and by menopause, only about 3,000 remain.

As mentioned above, menstrual cycles (see illustration) depend on the interrelationships and functioning of the various endocrine glands. Menstruation is initially triggered by hormones released from the hypothalamus. At puberty, the hypothalamus begins to release GnRH (gonadotropin-releasing hormone), which signals to the pituitary gland to secrete FSH (follicle-stimulating hormone) and LH (luteinizing hormone). These two hormones act on the ovaries and help coordinate the menstrual cycle.

In the first phase of the menstrual cycle, called the proliferative phase, the pituitary gland releases more FSH than LH. When FSH reaches the ovaries, it causes one of the follicles to grow and secrete estrogen. When the amount of estrogen in the bloodstream reaches a certain level, it stimulates the pituitary gland to secrete more LH. Then the egg is mature and ready to leave the follicle. The follicle ruptures and the egg is released from the ovary. This is known as ovulation, and it occurs 14 days before the next menstruation, regardless of the length of the cycle, or at the halfway point of a 28-day menstrual cycle. The egg passes into the fallopian tube, where it can be fertilized if sperm are present.

In the second, or luteal, phase of the menstrual cycle, the cells that lined the follicle from which the egg was released are transformed into the corpus luteum. Beginning just hours after ovulation, the corpus luteum secretes small amounts of estrogen and large amounts of progesterone to help thicken the endometrium (lining of the uterus). The corpus luteum also produces inhibin, a hormone that, along with estrogen and progesterone, signals the pituitary to stop secreting FSH and LH. As a result, the amount of both FSH and LH in the blood falls to low levels.

If the egg is fertilized by a sperm, it implants in the uterus and secretes a hormone called human chorionic gonadotropin (HCG). This hormone stimulates the continued secretion of estrogen and progesterone so that the developing embryo will be nourished.

If the egg is not fertilized, the corpus luteum disintegrates and estrogen and progesterone secretion decreases. The sudden drop in blood levels of these two hormones, in turn, causes the endometrium to break down. A day or two later, the uterine lining is shed and menstruation begins. Periods, on average, last from 3 to 7 days.

During menstruation, the pituitary gland starts secreting FSH and LH again, stimulating the development of another follicle and beginning the menstrual cycle over again. In general, the entire cycle takes about 28 days, but no woman is always regular; cycles as short as 21 days or as long as 35 days are not uncommon -- even in the same woman.

During the days before a menstrual cycle begins, some women have emotional or physical symptoms that may include mood swings, anxiety, fatigue, irritability, headache, swelling, and/or breast tenderness. This condition is often referred to as premenstrual syndrome (PMS). According to research, PMS seems to result from hormone fluctuations. One treatment for PMS is the birth control pill, because it provides a steady, daily dose of hormones that does not fluctuate.

In addition to PMS, some women have discomfort or cramps as the uterus contracts during menstruation. This discomfort or pain, called dysmenorrhea, varies from woman to woman and from month to month. The discomfort and pain of PMS can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Talk to your doctor if you have symptoms of PMS or discomfort or cramps during menstruation.

By the time a woman reaches her mid- to late thirties, the number of follicles in her ovaries has gradually declined. At about the same time, the remaining follicles become less responsive to FSH and LH. As a result, the ovaries produce less and less estrogen and progesterone. In response, the pituitary gland secretes higher levels of FSH and LH to stimulate the ovaries.

Initially, a woman may not notice any difference in her menstrual cycles. But between 2 and 8 years before menopause, her menstrual flow will change. It may become heavier one month, lighter the next, and she may even miss periods altogether. This transition period is commonly referred to as perimenopause. As the levels of estrogen and progesterone produced by the ovaries drop, menstruation stops completely. This is known as menopause and occurs at an average age of 51.

Copyright © 1998 by American Medical Association

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