Health Advice Agnes Oblas

September is National Menopause Awareness Month

Simply stated, the definition of menopause is “cessation of menstruation.” However, everyone knows that rarely does menstruation simply just cease. In fact, the transition into the state of menopause generally begins years before a woman no longer has monthly cycles. The time period during this transitional phase when symptoms may occur is known as peri-menopause. A woman is not officially post-menopause until she has gone a full calendar year without any menstrual bleeding.

Women (and the men in their lives) need to be aware of a few important aspects of menopause and the peri-menopausal phase other than that it is representing one of life’s milestones. Primarily, men and women need to understand that the symptoms of menopause are varied, can vary from one woman to the next, and can vary in intensity within the same woman from time to time. About 70 percent of all women will experience some degree of symptoms with the remaining women sailing through this period of life with none. However, the most important aspect to emphasize is this: even though a woman is experiencing symptoms, her ability to conceive remains a possibility. Not until that full calendar year has elapsed will she be free to consider herself no longer capable of conception.

The most common signs of the peri-menopausal phase are well known and include hot flashes, mood swings or depression, lack of energy or extreme fatigue, insomnia, brain fogginess, and decreased libido (sex drive) and painful intercourse. Less obvious signs occur internally and involve the skeletal and cardiovascular systems.

Why do these signs and symptoms occur? The answer lies in the fact that the ovaries begin to wax and wane in their production of the female hormone estrogen causing blood levels to fluctuate and eventually drop to very low levels. The bones of the skeleton require estrogen for normal bone growth and strength. Although some bone loss begins in a woman’s early adult life, the loss accelerates during menopause. The fall in estrogen also accounts for a woman’s risk of developing heart disease catching up to equal the risk that men face. Both of these consequences accentuate the admonition, once again, for healthful lifestyle choices (hopefully, beginning early in life but OK to begin even at this time of life) including proper nutrition and adequate exercise.

Menopause can occasionally occur in women younger than 40 (called premature menopause or premature ovarian failure), or can be a side-effect secondary to a total hysterectomy.

When a woman suspects she is experiencing symptoms of menopause it is still recommended that she visit a health care professional as the symptoms may actually represent other medical conditions, most commonly an underactive thyroid and the treatment for that is substantially different.

Blood tests of hormone levels may be necessary or the diagnosis may be made clinically, meaning simply based on a woman’s description of her symptoms along with a change in her typical menstrual cycle. If a diagnosis is uncertain, two female hormone levels can be checked: estradiol, or estrogen, and follicle stimulating hormone (FSH). The first, obviously, would be below normal levels. The latter is a hormone released from the “master gland” pituitary located in the brain. As the ovaries begin to fail in their production of estrogen, the pituitary releases more FSH in an attempt to stimulate the ovaries to produce more (hence the name follicle stimulating hormone). So, during menopause, FSH levels will be higher than normal.

Treatment for menopause at one time was straightforward. Since the condition represents lack of female hormones, the practice was to simply replace them by taking pill forms of hormones (hormone replacement therapy, or HRT). Research has demonstrated, however, that the advantages gained with HRT plateau within five years, thereby, nullifying the need for lifelong replacement. In addition, the benefits of HRT are not fully realized if treatment is delayed by a year or two after symptoms begin. Each woman’s situation needs to be assessed individually.

Many women opt for alternatives to traditional HRT with the most popular being “bio-identical” hormones. The thing to remember is that while the latter may work just as well as traditional HRT, they are still hormones and, therefore, the potential for attendant risks still exist. Virtually all replacement hormones, bio-identical or synthetic, are first extracted from soybeans or wild yams in a laboratory. Those that are processed so that they exactly match the molecular structure of the hormones of the human body have come to be called bio-identical, to distinguish them from synthetic hormones, which have a molecular structure that is altered from the original and, therefore, not found in a woman’s body. An analogy would be if you baked a cake and then extracted only the wheat flour from it. There would be no more cake — it would just be wheat flour. Similarly, once a hormone is extracted from the soybean or wild yam, there is no more wild yam or soybean in it, so it really makes no difference where it originally came from.

Lastly, pelvic exams with Pap smears, breast exams and mammograms should continue past menopause. The frequency of these exams as well as when to discontinue them should be decided upon by a woman together with her health care provider based upon her personal medical history as well as her family medical history. The first bone mineral density test, or DEXA scan, should be done at the commencement of menopause as a baseline to help determine any need for treatment of osteoporosis (the condition of significant bone loss) or osteopenia (the early stages of bone loss).


• Agnes Oblas is an adult nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, or if there is a topic you would like her to address, call (602) 405-6320 or email Her website is

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