Hormonal Changes (continuation)
The hot flushes usually occur without warning and may be over in a flash or they may last for as long as a minute.
Although many women experience discomfort from these flushes and are embarrassed because they fear they are obvious to
those around them, the latter usually is not the case. Night sweats, another term for hot flushes that occur during sleep,
are sometimes severe enough to disrupt sleep and, consequently, may give rise to the increased irritability, fatigue or
feelings of depression often associated with menopause. It should be emphasized that mood changes are not menopausal
symptoms per se, but instead may be consequences of concurrent factors in the woman's life, such as feeling unneeded as
children move out on their own or as career and other roles change.
Vaginal dryness is another symptom directly related to the hormonal changes of menopause. This condition, which may lead
to itching, infection and discomfort during sexual intercourse, is relieved by the use of lubricating cream. Since many
women experience a strong resurgence of sexual desire at menopause, problems in this area should be frankly discussed with
your doctor so that they can be resolved promptly.
Hormone Replacement
Hormone replacement therapy to make up for the body's diminished estrogen production will relieve the severity and frequency
of hot flushes and the vaginal dryness. At one time, long-term estrogen replacement was widely recommended for all women.
In recent years, however, there has been a shift in attitudes as more became known about possible risks of long-term estrogen
therapy. Studies have linked estrogen replacement with an increased risk of gallbladder disease and cancer of the endometrium
(the lining of the uterus). In the menstruating woman, fluctuating levels of estrogen and progesterone stimulate the endometrium
to grow in readiness for a fertilized egg. If conception does not take place, the hormone levels drop and the lining is shed
in the form of a menstrual period. During uninterrupted estrogen therapy, the endometrial tissue proliferates, but it is not
shed. Some researchers feel this unopposed estrogen stimulation is a factor in the increased occurrence of endometrial cancer
seen in women on long-term estrogen replacement. These risks can be minimized, many experts feel, by using the smallest possible
dose of estrogen that effectively minimizes symptoms for as short a time as needed. Periodic endometrial biopsies also may be
advised. Of course, the worry is moot for women who have undergone surgical removal of the uterus (hysterectomy), since they no
longer have any risk of endometrial cancer.
