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By Arthur A. Fischl, M.D.
Medical director

A recent article in Medical World News raised a question of considerable popularity these days. The lay literature is replete with the pros and cons of medication for the prevention of menopausal symptoms.

WHAT IS CHANCE?

Menopause is a normal physiological state occurring in women after the age of 45-50. After the child-bearing period is over, the necessary organs begin to atrophy because they no longer perform their functions. This disuse atrophy is a slow process and usually produces minimal symptoms. If the process of atrophy is produced surgically or by means of radiation to the ovaries, sudden cessation of various functions especially if in the child-bearing age, produces symptoms very suddenly.

SYMPTOMS

These disturbing manifestations, if produced rapidly, are flushes, sweats, some symptoms of dizziness and other evidences of vaso-motor changes. If the menopause occurs as the result of normal aging, its production of symptoms is very gradual and minimally disturbing. The number of patients requiring therapy for naturally occurring menopause is very small. Most such patients can be assured that these symptoms are of no consequence and that they are produced naturally.
When patients are so reassured, they accept their symptoms philosophically and are less likely to become disturbed. Should they not be told of the natural history of the menopausal syndrome, their mental reaction to the flushes and sweats is likely to be severe, and the vaso-motor episodes will increase in intensity.

SLEEP FLUSHES

Unfortunately most of the flushes occur at night during sleep. The warmth of the blanket increases the flushes and sweat, and sleep becomes disturbed. Should these nocturnal symptoms become upsetting, a mild sedative, or better still medication giving a small amount of ovarian substance called estrogen will tide the patient over until the symptoms abate. Estrogen is sometimes given by injection, but this rarely necessary; 95 per cent of the patients responds to oral medication. A patient can usually tell when she is entering the menopausal state by the changes in her menstrual cycle. The flow becomes more scant, she may begin to miss periods, and the symptoms mentioned before may develop.

CANCER SCARE

There has been some concern that taking medication such as estrogens may produce cancer, but there is very little evidence to support this, so that fear should not disturb the menopausal patient. Usually the physician tapers off the drug as symptoms abate.

AT WHAT AGE DOES THE MENOPAUSE OCCUR?

The majority of women go through the menopause between the ages of 40 and 50, although there are many cases in which it starts in the late thirties or does not begin until after 50.

WHAT IS THE NORMAL WAY FOR THE MENOPAUSE TO COME ABOUT?

There is a variety of normal menopausal patterns. In some women menstrual periods stop abruptly and never recur, but for the most women menstruation ends more slowly. One woman may find that the time between her regular periods is getting longer. Or she may find that her periods occur regularly but that the flow is lessened. Or that her periods last for a shorter time that they used to. Or a combination of these patterns.

WILL I HAVE HOT FLUSHES?

You may, but they are not nearly as common as people think. A hot flush is a feeling of warmth that suddenly spreads over the skin of the face, neck, and chest. It is often accompanied by intense perspiration. Hot flushes last only a minute or so. While this symptom may be uncomfortable, it is not one that needs to cause undue concern.

WHAT ABOUT OTHER SYMPTOMS?

Although the menopause is a completely normal process, it is often accompanied by symptoms which can be annoying. It helps to know how you might feel, but remember, you won’t have all of these symptoms and those you may have won’t last forever. Some women have headaches; difficulty in sleeping; fatigue; a tendency to be somewhat depressed; a feeling of irritability. None of these symptoms should alarm you, and it is reassuring to know that your doctor can prescribe preparations to relieve you if your discomfort becomes severe.

WHAT SYMPTOMS MAY BE ABNORMAL?

If you should have bleeding between periods, a flow which

gets heavier each month, or lengthened periods, or shortened intervals between f your physician immediately. They are not necessarily a sign that something is away to find out for sure. Some women mistakenly believe that any irregularity ities are actually the first symptoms of illness, including cancer. Detected it

HOW OFTEN SHOULD I BE EXAMINED BY MY DOCTOR?

A physical examination, at least once a year especially after age 35, is important. It should include a pelvic and breast examination, and a cancer smear (“Pap”) test. And, of course, you should consult your physician whenever any abnormal or unusual symptom appears.

WILL I GET “MIDLE-AGE SPREAD”?

No, you don’t have to lose your figure. Around this age, many women become less active and really require fewer calories than they used to. If you exercise moderately (walking is an easy type of exercise, and a good one), and follow a sensible diet, you don’t need to put on weight.

WHAT WILL HAPPEN TO MY SEX LIFE?

Many women fear that the menopause signals the end of their sex life. This is completely untrue. If you and your husband have had a satisfactory sex life prior to the menopause, there’s no reason why it should not continue. Actually, some women discover that their sex life becomes more enjoyable after menopause because they are completely free of the fear of unwanted pregnancies.

CAN I STILL BECOME PREGNANT IF MY PERIODS BECOME IRREGULAR?

Yes, as long as the ovary produces a single ovum (egg), there is a possibility that you may become pregnant.

WHAT ABOUT EMOTIONAL FACTORS?

Many women will be surprised to learn how large a part their emotions play in contributing to their discomfort. We have all had many ordinary experiences that illustrate how disturbed emotions can express themselves in the form of bodily symptoms. Remember when you’ve been frightened—and broken out tiny pimples called “goose flesh”? Or been embarrassed—and become red in the face? Or been excited –and had your hands perspire? Some of our most frequently used expressions have the same basis and reflect the same idea. You’ve often heard people say, “This burns me up,” or “That makes my blood run cold.” Doctors know that there is no organ or group of organs that cannot be influenced by state of the emotions. So, if your suffering is severe and other causes have been ruled out, your physician may want to investigate these emotional factors or send you to a specialist trained to look for them.

BE CONFIDENT

To sum up, menopause is not an illness, nor does it cause any illness. It is a perfectly natural process, and for most women it is a painless experience with only a minimum of discomfort. The more you understand of the process, the more you realize how many myths have been built up about it. Your doctor, through his advice and regular medical examinations, can be of great help to you, too. This is a good time to look forward, not backward. Always remember that life can be as rich and happy at 50 and after as at 25 or 30 . . . often far more so. It’s largely up to you.

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