From Encyclopedia of Sex and Sexuality
The time in a woman’s life when her menstrual periods stop. The woman no longer produces an egg each month and therefore no longer sheds the endometrium (uterine lining) through menstrual bleeding. The average age of last menstruation in American women is fifty-one. A woman, therefore, spends about one-third of her life after menopause.
The time when menopause occurs is also known as the "climacteric." It begins when the ovaries decrease their production of the female hormones, estrogen and progesterone. This may occur one to two years prior to the actual cessation of menstruation. The first signs of menopause are a change (sometimes an irregularity) in the menstrual cycle. A woman’s periods may become lighter, she may skip a period, the length of bleeding may be longer or shorter, and the flow may be lighter or heavier.
Another classic symptom of menopause is the hot flash. This is a sudden feeling of heat over the entire body, often accompanied by flushing or sweating. The hot flash may occur at any time of the day or night. When these occur at night, they commonly interrupt a woman’s sleep. The amount, frequency, and duration of hot flashes differ in each woman. Some women never experience hot flashes, but 25 percent of women, if untreated, have them beyond two years. A woman has no control over these symptoms, and they often occur at inopportune moments, causing embarrassment.
A decrease in the estrogen level may cause changes in the vagina and the bladder. The lining of the vagina becomes thin or atrophic without the influence of estrogen, causing vaginal dryness, which may, in turn, cause burning, irritation, decreased lubrication, and painful intercourse. The post-menopausal vagina, without hormone replacement therapy, does not always provide sufficient lubrication during lovemaking. This can cause physical discomfort and may lead to a loss of sexual interest. The bladder lining may also become atrophic (thinned out), causing symptoms such as frequency (urinating too often), urgency (difficulty “holding it in”), and burning with urination.
Many postmenopausal women also complain of psychological disturbances. Some of these include depression, anxiety, nervousness, and insomnia. Some women also report sexual dysfunction. This sexual dysfunction may be a result of the vaginal dryness described previously or it may be due to a loss of libido (sexual interest). The nervousness, anxiety, and insomnia are aggravated by hot flashes, especially when these occur at night. Many women find themselves more emotionally vulnerable and experience frequent crying episodes. The direct relationship of these psychological symptoms to estrogen deficiency is tenuous, however. They are more often a reflection of a woman’s situation at that time of her life.
Physical changes that occur with menopause have an important impact on future health. One of these is osteoporosis. Estrogen helps to maintain bone calcium, giving the bone strength. With the loss of estrogen, calcium is taken out of the bone and the bones become more susceptible to fractures. The wrist, hip, and spine are especially vulnerable. Hip fractures are life-threatening occurrences in older patients with serious complications of infection, blood clots, stroke, and pneumonia. A woman is protected from heart and vascular (blood vessel) disease by estrogen. Estrogen helps prevent the build-up of deposits of cholesterol. After menopause the estrogen level drops, decreasing this protective effect and a woman’s heart disease risk approaches that of a man.
Hot flashes, vaginal changes, osteoporosis, and heart disease risk can all be addressed by estrogen replacement therapy. Though certain women with specific health problems such as breast cancer, blood clots, abnormal genital bleeding, or clotting disorders should not receive hormones, hormone replacement therapy is very important in maintaining most women’s health.
Sexual relations may actually become more enjoyable after menopause. There is no longer fear of unexpected pregnancy; many couples are living alone, their children grown and gone, and there is more opportunity for privacy and intimacy. An older woman and her partner are more experienced in their abilities to please each other. Estrogen helps avoid vaginal dryness, and regular intercourse helps maintain vaginal lubrication and elasticity. Sometimes a woman’s sexual interest (libido) decreases after menopuse. Occasionally women may benefit from both male and female hormone replacement, when this loss of libido occurs.
A woman still needs regular gynecological check-ups after menopause. A yearly PAP test should be done, as well as a “hands on” yearly breast self-examination and mammogram after age forty. A woman also should do her own monthly breast examination. An annual cholesterol level and a screening test for colon cancer also should be done. If at any point a woman has unexplained vaginal bleeding after menopause, prompt evaluation is mandatory. She should not wait for her routine annual examination.
“Early menopause” is said to occur in women before age forty. This may be due to surgical removal of the ovaries, radiation treatment, chemotherapy, or rarely, from premature failure of the ovaries. The woman who undergoes early menopause is at a higher risk for development of osteoporosis and cardiovascular disease because she will be estrogen-deficient for a longer period of time. It is therefore very important to replace estrogen in cases of early menopause.
Postmenopausal women can lead an active and enjoyable life. Proper diet and exercise are very important. As a woman ages, her metabolism slows and she needs fewer calories, but she also needs sufficient calcium to help prevent osteoporosis. Regular exercise will help retard osteoporosis and give the mature woman a greater sense of well-being. The use of calcium and exercise to help prevent osteoporosis is much more effective if started years before menopause. The life expectancy of women has increased and, therefore, the number of women in the postmenopausal years is expanding. The physical changes a woman encounters as a result of menopause do not prevent her from enjoying satisfying, productive, and sexually active years, and can be a time of optimism, opportunity, and fulfillment.
 See also
- Aging and Sex
- Empty Nest Syndrom
- Hormone Replacement Therapy
- Hot Flashes
- PAP Test