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‘Menopause’ has both specific and general meanings

Dear Doctors: Can you please talk about the change of life for women? I have two grown daughters, and one of them went through it at a very young age. Why would that be? This part of a woman’s life doesn’t get a lot of attention, but it seems like it’s important.

Dear Reader: When you refer to “the change of life,” you’re talking about menopause. Quite specifically, it’s the point at which a woman has gone a full year without having a menstrual cycle. These days, however, the word is used in a more general sense. It encompasses the many physical, mental and emotional changes that lead up to, and accompany, this major transition. This period of time, which is more accurately known as perimenopause, begins years before the actual moment of menopause. For many women, it occurs between ages 45 and 55, a time during which the ovaries slow their production of hormones, most notably estrogen.

The duration of perimenopause varies greatly, depending on the individual. It can last from just a few years to well over a decade. Symptoms of perimenopause can include changes to the menstrual cycle, the advent of hot flashes, difficulty sleeping, changes to mood, weight gain, vaginal dryness, lowered libido and changes to urinary continence. For many women, these symptoms lead to an altered quality of life, and they can make this transition a challenging time.

When someone experiences menopause at age 40 or younger, it is known as premature menopause. If it occurs between the ages of 40 and 45, it’s called early menopause. These terms don’t refer to the symptoms of perimenopause, but to the absence of a menstrual cycle for a full year. Women with a family history of early or premature menopause are more likely to experience it themselves. Additional factors include a history of smoking, which research has linked to earlier menopause. Health conditions such as autoimmune diseases, chronic fatigue syndrome and HIV/AIDS can play a role.

Women who are anorexic or bulimic may increase their chances of experiencing early or premature menopause. Certain genetic disorders can raise the risk of premature ovarian failure. And menopause can also be triggered by medical interventions, such as a hysterectomy, or by some cancer treatments.

Diagnosis begins with a medical exam, which will include a detailed medical history. Blood tests to rule out other possible causes and to measure levels of reproductive hormones will also be done. An accurate diagnosis is important, because women going through early or premature menopause will spend up to an extra decade or more living without the protective benefits of estrogen. This puts them at increased risk of a range of medical issues, including osteoporosis and heart disease.

A loss of estrogen has also been associated with a higher incidence of colon and ovarian cancers, tooth loss, gum disease and cataracts.

We agree with you on both of the points you made in your letter — that menopause isn’t adequately discussed and that
it’s important. Women deserve information and support as they go through this complex transition.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@ mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.

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