Menopause

The term “menopause” technically refers to the cessation of menstruation, while the broader range of menopause symptoms, often associated with the gradual ending of ovarian function, is called “climacterium.” Some accounts of the climacterium imply that all of the positive aspects of being a woman are now ended; many women perceive this to be the case.  (Sheldon J. Segal Ph. D., Luigi D. Mastroianni Jr., M, 2003).

Menopause normally occurs to women between the ages of forty and fifty-five, although technically menopause can also occur earlier if the ovaries begin to malfunction. This leads to declining levels of progesterone and estrogen, although there can be temporary increases of these hormones as the pituitary attempts to have the body compensate for the lower hormones produced by the ovaries. Gradually, though, the hormones achieve a stable, but very low level, menstrual cycles stop, and ova are no longer produced.

This gradual decline in hormones begins in the late twenties although the final cessation of menstruation does not generally occur until the forties or fifties. After menopause, estrogen levels are on the average about one-sixth of that of a premenopausal woman and production of progesterone also shows a substantial drop. Androgen levels, however, are relatively unaffected, although they show a gradual decline.  (Sheldon J. Segal Ph. D., Luigi D. Mastroianni Jr., M, 2003).

A wide range of physical and emotional changes have been associated with menopause. The group of menopausal women reports a relatively high number of physical symptoms such as hot flashes and cold sweats. However, menopausal women did not report a consistently higher incidence of psychological symptoms. Although for some symptoms the percentages listed for menopausal women are very high (e.g., 78 percent report depression), the percentages are essentially no higher than those listed at most other ages. In fact, adolescents reported the highest incidence of many psychological symptoms commonly attributed to women experiencing menopause.

After menopause, women exhibit a variety of body changes, but it is unclear if such symptoms are a result of having undergone menopause itself or if they reflect the effects of aging. Among these effects are: drying of skin tissues; weakening of muscles; decreased immunity to disease; bones becoming more brittle; shrinking of the breasts; and thinning of the vaginal walls.

Also, even though sexual functioning is affected (the vaginal walls become thinner and thus more prone to infections and vaginal lubrication necessary to sexual intercourse is reduced), many women report feeling continued or increased interest in sex. Finally, some women react to menopause with depression, though the risk of developing an affective disorder during menopause does not seem to be as high as many think.  (Sheldon J. Segal Ph. D., Luigi D. Mastroianni Jr., M, 2003).

The symptoms associated with the climacterium, as with the correlates of the menstrual cycle and pregnancy can be attributed to a variety of biological and psychological factors. Along with the hormonal changes of menopause and the general effects of aging, middle age is time when mothers find their direct maternal role is over, with the adulthood of their children being reached. It is also accompanied by fears of loss of beauty and concern over the deaths of parents and other loved ones. Marital difficulties may also emerge. All these factors may also be causal elements in the depression so often related to menopause, as well as some of the physiological symptoms.  (Molly Siple, Deborah Gordon, 2001).

One of the major theories of the underlying cause of postmenopausal and menopausal symptoms is that they are produced by the withdrawal of estrogen from the woman’s body. Many of the physiological symptoms discussed earlier can be seen as opposites of the general effects of estrogen upon the body. Also, some research suggests that postmenopausal symptoms can be relieved by the administration of estrogen. It does seem plausible that direct physiological symptoms could be aided with hormone therapy, but this will do little for psychological symptoms.

It is less clear that a depressed middle-aged woman should be given estrogen when the possibility of negative side effects has not been ruled out and when depression could well have psychological rather than biological reasons. These are complicated issues and there are no easy answers. The estrogen might well have the effect of making a woman look and feel younger, which might in turn relieve her depression, but are the risks worth this possibility? The medical profession is currently in controversy about the increased risks of cancer as a result of estrogen-replacement therapy. (Molly Siple, Deborah Gordon, 2001).

References

Molly Siple, Deborah Gordon (2001). Menopause the Natural Way; John Wiley & Sons

Sheldon J. Segal Ph. D., Luigi D. Mastroianni Jr., M. (2003). Hormone Use in Menopause & Male Andropause: A Choice for Women and Men; Oxford University Press