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Menopause...A Turning Point By- Ragini Chaturvedi Ragini Chaturvedi has been living in New Jersey , USA for the last 3 years. Before that she was in New Delhi and Bombay. Ragini has a 12 years of experience in Print Media in the capacity of transcriber, translator, copy-editor and editor with various reputed publishing houses.

Menopause is one of the major turning points in a woman's life. Approaching menopause involves a process of change - and every woman experiences this transition in unique and individual ways.

Many women discover that menopause gives them a new lease on life - physically, emotionally, sexually, and spiritually. They are enthusiastic about becoming free of their concerns about pregnancy and premenstrual syndrome (PMS).

Menopause is not a point in time but is a process happening over many years. Many different types of changes occur associated with decreasing estrogen levels. These changes begin most often in a woman's 40s and sometimes in her 30s.

Many women are caught by surprise: how soon in life these menopause-related symptoms can begin, and also the many related symptoms. Other terms often used to discuss menopause include Pre-menopause, which includes all the reproductive years prior to menopause.

Peri-menopause includes the time of these early symptoms of menopause when the endocronological, biological, and clinical features of approaching menopause commence and stretch to a few years immediately after menopause. Post-menopause covers the time following menopause.

Most women have minimal impact on their life due to minor symptoms but some suffer severally. Fortunately the symptoms do not usually last forever but diminish or disappear over time. Many find they can be reduced with certain lifestyle changes such as exercise and diet modifications. Most or all decrease or disappear with treatment.

Hormone therapy after menopause can be a blessing or a curse - it helps keep bones strong and may prevent heart disease, but may also increase a woman's risk of breast cancer and may have side effects that lead to an overall lower quality of life. A study by Stanford researchers now shows that women, who have symptoms of menopause such as hot flashes, are more likely to see improved quality of life from hormone therapy. In other words, they may be happier.

When women go through menopause their ovaries stop producing estrogen. This loss of hormone can result in side effects that range from annoying to life-altering, such as hot flashes, mood swings, vaginal dryness, lowered libido and trouble sleeping. Many women opt to replace lost estrogen through hormone replacement therapy - as much to reduce these symptoms as for achieving health benefits. However, contradictory reports about long-term effects have left women in a quandary about whether replacement therapy is right for them.

In addition to producing some potentially uncomfortable symptoms, menopause can have more serious, long-term effects on a woman's overall health and potential years of life. For example, the drop in estrogen that occurs at menopause is thought to cause adverse changes in levels of cholesterol and other blood lipids (fats), and in levels of fibrinogen (a substance that affects blood clotting). These changes may increase the risk of heart disease (the leading cause of death among American women) and stroke. More than 370,000 women in this country die each year from heart disease, and about 93,000 die from stroke.

A study called HERS was conducted by the Journal of the American Medical Association. Results from the study, the Heart and Estrogen/Progesterone Replacement Study (HERS), were released in the Feb. 6 issue of the same Journal.

The HERS study was intended to resolve questions both about heart disease and quality of life in women taking hormone therapy, which contains both estrogen and progesterone. The study included 2,763 postmenopausal women who received either hormone therapy or placebo.

Dr. Hlatky and his group monitored four aspects of quality of life over the course of three years: physical activity, energy levels, mental health and depressive symptoms.

"We studied quality of life because it is really important to people," said Mark Hlatky, MD, professor of health policy and research and of cardiovascular medicine at the Stanford University School of Medicine. "In fact, people are willing to risk shortening their life in order to improve quality of life," he added.

It has been well documented for several decades that Hormone Replacement Therapy (HRT) is the most effective remedy for the hot flashes and sleep disturbances that often accompany menopause. Hormone replacement therapy has also consistently been shown to decrease vaginal discomfort by increasing the thickness, elasticity, and lubricating ability of vaginal tissue. Urinary tract tissue also becomes thicker and more elastic, reducing the incidence of stress incontinence and urinary tract infections.

It turns out that estrogen has different effects in different women. Those women who had symptoms of estrogen loss such as hot flashes had improved mental health and less depression when they replaced their lost estrogen. Those women who did not have symptoms had worse physical function and lower energy levels when taking hormone therapy. Previously, doctors prescribing hormone therapy had not anticipated an ill effect on women's health and energy - in short, their overall quality of life.

These results make sense, Hlatky said. Hormone therapy can reduce menopausal symptoms, but can also have side effects such as breast tenderness and abnormal bleeding. "In women with symptoms from menopause the balance is tipped toward improvement," Hlatky said. "In women without symptoms from menopause the balance is tipped toward lower quality of life. The most likely explanation is that when you don't have any symptoms, it's hard to make you feel better."

In the heart disease portion of the research, which was published last year, the HERS study found no difference on the risk of having a heart attack or dying of heart disease between women who were taking hormone therapy and those who were taking a placebo.
"That finding was a surprise to many people, because the conventional wisdom was that post-menopausal hormone therapy reduces heart disease risk," Hlatky said. "HERS and other well controlled studies found hormone therapy does not lower the risk in women who have already developed coronary disease. The jury is still out on the question of whether hormone therapy can prevent coronary disease from developing in the first place."

Although HRT was used initially to reduce the discomfort from short-term menopausal symptoms, studies have provided evidence that it may prevent or reduce some of the negative long-term health effects of menopause. Scientists continue to gather information to define the potential benefits from HRT and to identify the women for whom it may be most useful. Further research is also needed to determine when HRT should be started and how long it should be continued to achieve the greatest benefits.

Hormone replacement therapy plays a significant role in building and maintaining bone, thus helping to prevent osteoporosis. HRT is also sometimes used to treat bone loss that has already begun. HRT can prevent the decline of bone density and may reduce the incidence of fractures. It has been shown, however, that bone loss resumes upon discontinuation of HRT.

Hlatky points out that women in this trial do not necessarily reflect women in the general population. Study participants were an average age of 67 and had gone through menopause an average of 18 years before the trial began which is older than many women considering hormone replacement for the first time. Furthermore, all the women in this trial had symptoms of coronary artery disease. "Our findings may not apply to younger women closer to menopause," Hlatky said.

Some aspects of this trial can help younger women make decisions about hormone replacement, Hlatky added. In particular, he points out that women who have symptoms are more likely to see a quality-of-life benefit from hormone therapy. He noted that each woman must discuss her risk of osteoporosis, heart disease, breast cancer and quality-of-life issues with her doctor before deciding.

"This study gives just one more piece of information," Hlatky said. "Women need to include this as one of many factors that they talk about with their doctor."

Some studies suggest that taking estrogen may reduce the risk of developing Alzheimer's disease. However, scientists caution that additional research is needed to explore this possibility.

The Future of HRT

Many women decide against using HRT because they are concerned about the risk of developing cancer. Often, they prefer to take other steps (such as exercise and a well-balanced diet along with calcium supplementation) to reduce their risk of osteoporosis and heart disease.

In an effort to find definitive answers, the Women's Health Initiative (WHI) and other carefully designed studies are evaluating the effects of long-term use of HRT in postmenopausal women. Sponsored by the National Institutes of Health, the WHI is a 15-year nationwide clinical trial that is investigating heart disease, osteoporosis, and breast and colon cancers in 63,000 women ages 50 to 79. Long-term, well-designed studies such as the WHI should be able to answer many of the lingering questions about the true effects of HRT.

Weighing benefits and risks is part of all medical decisions. Some women and their doctors feel that HRT's potential beneficial effects on cardiovascular disease, osteoporosis, and general quality of life outweigh the risk of developing cancer. Others are concerned about the possible negative effects of long-term HRT use. Many women choose to reduce the risks of osteoporosis and heart disease by exercising regularly, avoiding tobacco products, eating a balanced diet, and/or taking dietary supplements or other medications.

Ultimately, physicians emphasize that each woman's decision about whether to take HRT and, if so, for how long, must be an individual one made in cooperation with her physician. This decision should be based on the woman's individual risk profile--her personal and family medical history, not only of cancer, but also of heart disease, stroke, and osteoporosis.

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