Menopause

What is Menopause

Menopause is the time in life when your monthly period stops. In other words, it is the permanently end of your menstrual cycles. It is diagnosed, when you have not had a period for one year. Menopause happens because the function of your ovaries stops. As a result, no hormones (estrogen and progesterone) are produced by your ovaries, which control your period and the release of eggs.

menopause in women

Menopause is a natural biological process. It usually begins between the ages of 40 and 55, but can develop before or after this age range. There is no reliable lab test to predict when a woman will experience menopause.

Furthermore, menopause is not a health problem. However, hormonal changes and other factors can cause uncomfortable symptoms, such as hot flashes and weight gain.

Stages of Menopause

Did you know that, natural menopause is not just one phase, it is actually divided into three stages:

  • perimenopause
  • menopause
  • postmenopause

Stage 1- Perimenopause : This phase usually begins several years before menopause, when your ovaries slowly make less estrogen. In the last 1 to 2 years of this stage, the estrogen levels fall faster. Moreover, perimenopause can start up to 10 years before you enter menopause. It often begins in your 40s, but some women enter perimenopause in their 30s.

During perimenopause, your period may become more unpredictable. It may even stop for several months and resume. It’s important to note that you can become pregnant during perimenopause by taking medicines directed by your doctor.

Stage 2- Menopause: The definition of menopause is not having your period for 12 months. At this stage, your ovaries have stopped releasing eggs and reproductive hormones (estrogen and progesterone). Menopause is diagnosed when a woman has gone without a menstrual period for 12 consecutive months.

Stage 3- Postmenopause refers to the years after menopause has occurred. In other words,  postmenopause refers to women who have already reached menopause.

As you enter postmenopause, it’s a good time to reevaluate your health situation and talk to your doctor about long-term health goals. Because, your lower level of estrogen due to postmenopause, puts you at increased risk of heart disease, osteoporosis and other conditions of the heart and bones.

Menopause Causes

A woman is born with all of her eggs, which are stored in her ovaries. Her ovaries also make the reproductive hormones estrogen and progesterone, which control her period (menstruation) and the release of eggs (ovulation). Menopause happens when the ovaries no longer release an egg every month and menstruation stops.

Age is the most common factor that cause menopause. As you approach your late 30s, your ovaries starts loosing their ability to produce hormones (estrogen and progesterone). Hence, your fertility declines.

In your 40s, your monthly periods may become longer or shorter, heavier or lighter, and less frequent. By the age of 52, the function of your ovaries stops. As a result, no hormones are produced and no egg is released by your ovaries, and you have no more periods.

However, some women can go through menopause in early age. It can be the result of surgery, like if their ovaries are removed in a hysterectomy, or damage to their ovaries from chemotherapy for cancer.

What are the symptoms of menopause?

Menopause is the time in a woman’s life at which she can no longer reproduce. Symptoms of menopause vary from woman to woman. However,common symptoms of menopause include:

  • Sleep Disturbances: You may have insomnia— trouble falling asleep or staying asleep.
  • Vaginal changes: The lining of your vagina may become thinner, drier, or less stretchy. This can cause dryness or discomfort during sex.
  • Weaker bones: Your bones will probably weaken during menopause. If it’s really bad, it can lead to osteoporosis after menopause.
  • Mood changes: Hormone changes can make you feel anxious, irritable, and tired. Your sex drive might change, too.
  • Night sweats: Hot flashes that wake you up in the middle of the night.
  • Hot Flashes: A hot flash is a sudden, sometimes intense feeling of heat that rushes to your face and upper body.
Hot Flashes Image
Hot Flashes
  • Urinary tract infections (UTIs): You may have to pee more often or get more frequent urinary tract or bladder infections.
  • Weight gain: Hormonal changes that occur during menopause often contribute to weight gain. Many studies have confirmed that women in menopause are likely to gain weight and have larger midsections than women who have not gone through menopause.
  • Depression
  • Anxiety
  • Memory problems
  • Reduced sex drive
  • Dry skin, mouth, and eyes
  • Sore or tender breasts
  • Headaches
  • Racing heart
  • Reduced muscle mass
  • Hair thinning or loss
  • Increased hair growth on other areas of the body, such as the face, neck, chest, and upper back

Please note, women affected with symptoms of racing heart, urinary changes, headaches, or other new medical problems should see a doctor to make sure there is no other cause for these symptoms

How is menopause diagnosed?

A blood test known as PicoAMH Elisa diagnostic was approved by the U.S. Food and Drug Administration (FDA). This test is used to determine whether a woman has entered menopause or is getting close to entering menopause. The test measures the amount of anti-Müllerian hormone (AMH) in the blood.

AMH is a hormone produced by a woman’s ovaries that has a role in egg release (ovulation). AMH levels fall as menopause approaches and is one of several indicators.

Furthermore, this test may be helpful to women who show symptoms of perimenopause, which can also have bad health impacts. Early menopause (before the age 45) is associated with a higher risk of osteoporosisheart disease, vaginal changes and loss of libido, and mood changes.

Kindly note, your doctor can also order another blood test that will measure the level of certain hormones in the blood, usually follicle stimulating hormone (FSH). FSH is a hormone produced by the pituitary gland. However, this test can be misleading during the beginning of menopause, because, your hormone levels are fluctuating up and down daily. 

Therefore, most doctors will diagnose menopause based on your symptoms, medical history, and menstrual information.

Menopause Treatments

Many women do not need treatment for their menopause symptoms. You may find that your symptoms go away by themselves. However, you may need treatment if your symptoms are severe or affecting your quality of life. Treatments may include:

  • Hormone therapy (HT): This therapy helps to control your symptoms of menopause (such as hot flashes and vaginal dryness). In Hormone therapy, the balance of your body’s hormone levels is maintained by providing supplemental hormones (estrogen and progesterone).

    However, using HT may increase the risk of developing certain diseases and health conditions. A person should not use hormone therapy if they have risk factors for the following health problems, or if they have a personal or family history of these issues:
    • heart disease
    • blood clots
    • gallbladder disease
    • liver disease
    • stroke
    • breast cancer

Furthermore, hormone therapy is available in various forms, including, oral (pill), skin patch and spray. But, it is important to discuss the benefits and risks of hormone therapy with your doctor before using it.

  • Vaginal estrogen: To relieve vaginal dryness, estrogen can be applied directly to the vagina using a vaginal cream or tablet. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissues. It can help relieve vaginal dryness.
  • Low dose of antidepressants:  A low dose of certain antidepressants may be useful for management of hot flashes in menopause.
  • Medications for osteoporosis: Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis (a bone disease).
    Several medications are available that help to reduce bone loss and risk of fractures. Your doctor may prescribe vitamin D supplements to help strengthen bones.
  • Low dose of birth control pills: Oral contraceptive pills are another form of hormone therapy often prescribed for women in perimenopause, to treat irregular vaginal bleeding, relieve hot flashes, vaginal dryness and mood changes.

    Oral contraceptive are not recommended for women who have already reached menopause.

Kindly note, before deciding any form of treatment, talk with your doctor about the risks and benefits involved with each option of treatment. Review your options yearly, as your needs and treatment options may change.

Natural Treatments for Menopause Symptoms:

  • Soy: Soy has isoflavones, which are phytoestrogens (plant estrogens). Some studies have observed that soy may be effective in reducing menopausal symptoms. However, other studies have found no benefit. Only food forms of soy, like tofu and soy milk, are recommended. Soy in tablet or powder form is not advised.

    Moreover, many experts recommend that women who have a history of breast cancer avoid phytoestrogens.
  • Vitamin E: Topical vitamin E oil applied to the vagina helps to improve lubrication and may also reduce hot flashes.
  • Calcium and Vitamin D: Take calcium and vitamin D supplements to help reduce your risk for osteoporosis (a bone disease). Talk to your doctor about supplements that can help you for your individual health needs.
  • Flaxseed: Flaxseed has omega-3 fatty acids and lignans, which act as phytoestrogens. Results from studies have been mixed, but it may help to reduce menopause symptoms in some women.

    Avoid whole flaxseed because it is difficult to digest.
  • Exercises: It is important to exercise for 20 to 30 minutes a day.
exercise in menopause image

Exercise can help:

    • increase energy
    • promote a better night’s sleep
    • improve mood
    • promote your general well-being

Lifestyle tips for Menopaue

Tips for managing the symptoms of menopause include:

  • Practicing relaxation and deep breathing exercises.
  • Having a healthful diet that includes plenty of fresh fruits, vegetables, and whole grains.
  • Quitting smoking.
  • Limiting the intake of alcohol.
  • Good sleeping habits and getting plenty of rest.
  • It is important to do regular exercise for managing the symptoms of menopause.
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What is an Endocrinologist

An endocrinologist is a specially trained doctors who is qualified to diagnose diseases that affect the glands. The conditions that are treated by an endocrinologist are as following:

  • Thyroid diseases
  • Diabetes
  • Hypertension
  • Menopause
  • Over or under production of hormones
  • Lack of growth
  • Metabolic disorders
  • Lipid disorders
  • Cancers of the endocrine glands
  • Osteoporosis

The common diseases and disorders that endocrinologists deal with include diabetes and thyroid disorders.

Endocrinologist Image

An Endocrinologist is a True Specialist

An endocrinologist is a specialist who has thoroughly studied hormonal conditions and knows the best possible treatments, even when conventional treatments do not work well. Unlike a family doctor or general practitioner, an endocrinologist studies hormones and hormonal diseases in depth. Hence, this specialist will be able to provide the best possible treatment. 

What to expect at your first appointment with an endocrinologist

Your endocrinologist is likely to ask you a number of questions. So being prepared before you see him will be of great help to you, as this may save time to go over any particularly important points you feel the need to spend more time on.

Appointment with Endocrinologist Image

He will ask in detail about the symptoms you are experiencing, specifically related to the deficiency or excess of a hormone you may have.

Your doctor may ask:

  • What are your symptoms, and when did you first notice them?
  • How have your symptoms changed over time?
  • Has your appearance changed, including your weight or the amount of your body hair?
  • Have any of your family members been diagnosed with thyroid disease, hormonal or autoimmune conditions?
  • Are you currently being treated or have you recently been treated for any other medical conditions?
  • Have you recently had a baby?
  • Have you lost interest in sex? If you’re a woman, has your menstrual cycle changed?
  • Have you had any recent head injuries or have you had neurosurgery?

Further, your examination will depend on the type of problem you have. Your endocrinologist will look for signs of a disease as well as complications of the disease and treatments.

An Endocrinologist Works with Your Primary Care Doctor

Visiting an endocrinologist does not mean you will never see your primary care doctor again. Going to an endocrinologist when struggling with a hormonal condition gives you another set of eyes to ensure your health is as good as it can be.

Remember, your goal when facing a hormonal disease diagnosis should be to take care of your disease as best as possible. This is often done with the support of an endocrinologist. 

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Goiter

A Goiter is an abnormal enlargement of thyroid gland which is a butterfly-shaped organ located at the base of your neck. It indicates a condition, in which, thyroid grows abnormally. Goiter commonly develops as a result of iodine deficiency or due to thyroid problem. In other words, if your thyroid gland is producing too much hormones ie. (hyperthyroidism) or too little (hypothyroidism), you can develop a goiter. Women are more likely to develop a goiter than men.

Goiter Image
Enlarged Thyroid Image

It is important to know that, having a goiter doesn’t always mean that your thyroid gland is malfunctioning. However, an enlarged thyroid gland can produce a normal amount of hormones. Goiters are generally pain less but some times you may feel difficulty in swallowing food and breathing.

Symptoms

Very primary symptom of goiter is a noticeable swelling in front of the neck. Not all the goiter cause symptoms but in some cases people experience symptoms given below:

  • Tightness in throat
  • Difficulty in swallowing
  • Lump in neck
  • Coughing
  • Voice hoarseness
  • In severe cases, difficulty breathing

What causes goiter?

There are different conditions that causes Goiter.

Iodine Deficiency: The primary activity of the thyroid gland is to concentrate iodine from the blood to make thyroid hormone. The gland cannot make enough thyroid hormone if it does not have enough iodine.

Therefore, due to iodine deficiency the individual will become hypothyroid. Consequently, the pituitary gland in the brain senses the thyroid hormone level is too low and sends a signal Thyroid Stimulating Hormone (TSH) to the thyroid. This hormone (TSH) stimulates the thyroid to produce more thyroid hormone and to grow in size. Hence, this abnormal growth in size of thyroid is termed a “goiter.”

Hashimoto’s disease : The main cause of goiter in developed countries is autoimmune disease. Hashimoto’s disease is an autoimmune disorder. It damages your thyroid, causing low production of hormones ie. (Hypothyroidism).

As a result, sensing a low hormone level, your pituitary gland produces more Thyroid Stimulating Hormone (TSH) . This hormone stimulates the thyroid to produce more thyroid hormone and to grow in size. This abnormal growth in size of thyroid is termed a “goiter.”

Hormonal Changes: Women leading to menopause can develop a goiter as there are so many hormonal changes occurs at that time. Women above age of 40 have more chances to develop it. Pregnancy also makes so many hormonal changes in women, so this can also lead to develop a goiter.

Family History: Hereditary factors may cause goiter. If one of the parent is suffering from it, then you may have chances to develop it as well.

How is goiter diagnosed?

  • Physical Examination: Your doctor may be able to tell if the thyroid gland has grown by feeling the neck area for nodules and signs of tenderness.
  • Ultrasound of the thyroid: It is a procedure which sends high frequency sound waves through thyroid to find out the gland’s size and nodules. It can be used to visualize the thyroid gland.
  • Hormone test: A blood test which measures the hormone levels of the body to check the proper working of thyroid.
  • CT scan: CT scan or MRI is used to measure the size of goiter.
  • Biopsy: In this procedure a small specimen is taken from thyroid tissue with a needle and send it to laboratory for further examination.

Treatment

Your doctor will decide on a course of treatment based on the size and condition of your goiter, and symptoms associated with it.

  • Medications: If you have hypothyroidism, then thyroid hormone replacement with levothyroxine will resolve the symptoms of it. This also slow down the release of thyroid stimulating hormone from your pituitary gland, often decreasing the size of the goiter.
  • Radioactive iodine treatment: This treatment is used in cases of an overactive thyroid gland. It involves taking radioactive iodine orally. Furthermore, iodine goes to thyroid gland through your bloodstream and kills thyroid cells. The treatment results in a diminished size of the goiter. However, After this treatment, the patient usually has to take thyroid hormone replacement therapy for the rest of his or her life.
  • Surgery: It is performed to remove all or part of your thyroid gland. It may also be needed if the goiter is large and causes problems with breathing and swallowing. Surgery is also sometimes used to remove nodules. It must be done if cancer is present. You may also need to take levothyroxine after surgery, depending on the amount of thyroid removed.

Diet and Yoga

Diet: If your goiter is caused by your diet then you may need to increase or decrease your iodine intake at home.

Kindly discuss your diet plan with your doctor. He/She will tell you how much iodine is required per day for keeping your thyroid healthy.

Yoga: Yoga brings many benefits to your overall health. It can help treat your thyroid gland naturally. Several studies have shown the positive effect of yoga for improving thyroid function.

However, it is important to know that Yoga can not cure but can help maintain and improve your thyroid function. Kindly note, Yoga is a complementary therapy and should not be used as a replacement for your existing medical treatment. Therefore, before you start practicing yoga for thyroid problems, make sure to consult with your doctor. 

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