Dr Luikenaar is a member of the North American Menopause Society. Menopause is the time that marks the end of your periods, diagnosed 12 months after your last period. The average age is 52 in the United States. Menopause is a natural biological process, a natural transition in your life that should be celebrated and appreciated. Unfortunately there are many physical andmental symptoms that affect your daily life. The time leading up to menopause is called “perimenopause” and can begin 4 to 6 years before menopause, usually in your forties. Your ovaries start producing less estrogen and run out of eggs and stop releasing eggs. A person is postmenopausal after they have not had a menstrual cycle for a year. Due to a lower estrogen level you are at a higher risk for osteoporosis and heart disease.
People transitioning into menopause can have the following symptoms that can last for up to 10 years, but most people experience symptoms of menopause for less than 5 years.Symptoms of Menopausal Syndrome are:
- Hot flashes, also known as vasomotor symptoms (a sudden feeling of feeling hot that spreads over your body, a red face, sweating and feeling cold after the heat).
- Night sweats and/or cold flashes.
- Vaginal dryness that can cause discomfort during sex or frequent UTIs.
- Urinary urgency (a pressing need to pee more frequently).
- Difficulty sleeping (insomnia).
- Emotional changes (irritability, mood swings, or mild depression).
- Dry skin, dry eyes, or dry mouth.
- Breast tenderness.
- Worsening of premenstrual syndrome (PMS).
- Irregular periods or periods that are heavier or lighter than usual.
Some people might also experience:
- Heart palpitations.
- Joint and muscle aches and pains.
- Changes in libido (sex drive).
- Difficulty concentrating or memory lapses (often temporary).
- Weight gain.
- Hair loss or thinning.
PCOS often leads to irregular periods and irregular ovulation. Your ultrasound can show “polycystic ovaries,” enlarged ovaries with immature follicles on the surface that look like a pearl string.
It can be difficult to get pregnant with PCOS, which is often when PCOS is diagnosed. Up to 15% of women, and a higher rate of people assigned female at birth, have PCOS.
Signs of PCOS are irregular periods, abnormal hair growth, acne, obesity, dark areas on your skin (neck, armpits, groin, breasts) called Acanthosis Nigricans, ovarian cysts, skin tags, male pattern balding, and infertility.
The exact cause of PCOS is unknown and is considered multifactorial. Genes play a role, as do higher levels of androgens and insulin resistance. Insulin resistance leads to higher insulin levels, which in turn leads to higher androgen production that affects ovulation. Insulin helps process glucose (carbohydrates), and having insulin resistance can result in higher glucose levels in the blood, potentially leading to diabetes. People with PCOS also experience chronic inflammation, indicated by elevated white blood cell count or C-reactive protein.
Other complications related to pregnancy include a higher risk of preeclampsia, gestational diabetes, preterm labor, and cesarean section.
PCOS is diagnosed through a combination of medical history, physical examination, lab tests, and pelvic ultrasound.
Treatment options for PCOS include hormonal interventions, medications that improve insulin sensitivity (such as Metformin), and medications that block androgens (such as Spironolactone). Lifestyle changes are also recommended.
To treat irregular periods and improve chances of pregnancy, medications like clomiphene and letrozole can be used to induce ovulation. In some cases, an injection of gonadotropins or in vitro fertilization (IVF) may be necessary.
PCOS is a chronic condition that can increase the risk of developing diabetes, hypertension, heart disease, endometrial cancer, sleep apnea, depression, and anxiety.