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| Information | For women, menopause, or the cessation of menses , is an obvious sign of aging. It is by no means the only change in the female reproductive system. There is a transition period called the climacteric that extends for many years before and after the last menstrual period. For a woman, aging changes involve hormone levels , physical changes in the woman's entire reproductive tract, and psychological changes. Changes occur in the intricate relationship between the ovarian hormones and those produced by the pituitary gland (in the brain). AGING CHANGES Menopause is a normal part of a woman's aging process. The ovaries stop releasing "eggs" (ova), and menstrual periods stop. Most women experience menopause around age 50, although it can occur before age 40 in about 8% of women. Prior to menopause, menstrual cycles often become irregular. The ovaries become less responsive to stimulation by follicle-stimulating hormone ( FSH ) and leuteinizing hormone ( LH ). To try to compensate for the decreased response, the body produces MORE of these ovary-stimulating hormones for a time. The level of these hormones will eventually decrease. The hormones produced by the ovaries include the different forms of estrogen (including estradiol), progesterone, and prolactin . These hormones also decrease. The ovaries continue to produce small amounts of testosterone and some estrogen. Because hormone levels fall, changes occur in the entire reproductive system. The vaginal walls become less elastic, thinner, and less ridged. The vagina becomes shorter. Secretions become scant and watery. The external genital tissue decreases (atrophy of the labia). In both men and women, reproductive system changes are closely related to changes in the urinary system. EFFECT OF CHANGES Prior to menopause, fertility varies depending on hormone levels. Menopause is said to have occurred when there has been one year without a menstrual period. With menopause, reproductive capacity is lost. The hormones produced by the ovaries and by the pituitary gland are decreased. Symptoms that accompany the climacteric vary in severity; many of the symptoms are triggered by the hormone changes. Only about 20 to 30% of all women have symptoms that are severe enough that they seek medical attention. Changes occur in the woman's breast tissue at the same time as other reproductive changes. A woman may experience changes in her "sex drive" (libido) and her sexual response may change, but aging does not prevent a woman from being able to have or enjoy sexual relationships. Most often, things such as availability of a partner, symptoms from vaginal dryness, and psychological and social factors affect a woman's sexual response more than direct aging changes. COMMON PROBLEMS The pubic muscles lose tone, and the vagina, uterus, or urinary bladder can "fall" out of position (vaginal prolapse, bladder prolapse, or uterine prolapse ). A prolapse of any of these structures increases the risk of problems such as stress incontinence (urine leakage). Most prolapses can be treated. Irritation of the external genitals can occur (pruritus vulvae). The vaginal walls become thinner and dryer and may become irritated ( atrophic vaginitis ). Sexual intercourse may become uncomfortable for some women ( dyspareunia ).The "normal" vaginal microorganisms change, and there is an increased risk of vaginal yeast infections . Similar changes to the bladder and urethra may increase symptoms such as frequency and urgency of urination, and there is an increased risk of urinary tract infection after menopause. Hot flushes, mood disturbances and sleep disturbances are common symptoms that occur during the climacteric. The causes of these changes are not well-understood, but they are also related to the decreasing amount of estrogen produced by the ovaries. Osteoporosis risk is greater in older women. This is, in part, caused by decreased estrogen level. PREVENTION and TREATMENT Adequate lubrication (with a water-soluble lubricant) can help prevent painful sexual intercourse . A topical estrogen (applied inside the vagina) is sometimes recommended to help maintain the structure of the vaginal tissues. Sexual changes are most frequently related to factors other than simple aging. Sex is more likely if a willing partner is available and if sexual activity has continued during middle age. Estrogen replacement (such as estrogen pills or patches) can prevent or reduce many of the symptoms associated with menopause, including vaginal atrophy and hot flushes. It also decreases the risk of complications such as osteoporosis. However, estrogen replacement may have side effects such as vaginal bleeding, and it has been associated with a somewhat increased risk of breast cancer, so each woman should discuss the pros and cons of estrogen replacement with her own health care provider. RELATED TOPICS. aging changes in hormone production aging changes in organs, tissues, and cells aging changes in the breast aging changes in the kidneys aging changes in the male reproductive system |
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