What is Menopause?

Menopause is the stage in the female life cycle during which menstrual cycles stop. On average, menopause occurs at age 51, and generally takes from five to seven years from start to finish. For years, the menopausal stage was rarely talked about in public. Beginning in the 1960s, physicians began treating menopause aggressively as a medical problem, using estrogen hormones. Contemporary debate focuses on the wisdom of long-term estrogen use and the search for the best way to address problems linked to menopause.

A nineteenth-century term

Menopause has always been a part of natural life for women, and the history of medicine is littered with references to the period when women stop bearing children. The Greek philosopher Aristotle noted that women stop giving birth after the age of 50. But little was written about ways to ease women through the symptoms of menopause, which include hot flashes, night sweats, insomnia, and vaginal dryness.

Occasional historical references to what we now call menopause and therapy for the condition can be found, such as the reference to hot flashes and other menopausal symptoms in the 1628 book, The Anatomy of Melancholy by Robert Burton. A 1675 account described a cooling diet for menopause, and in 1701, physician Thomas Sydenham described the tendency of women ages 45-50 to develop "Hysterick Fits," and suggested blood letting as therapy.

But the term menopause was not used until 1816, when a medical syndrome called "la Menepause" was described in a French journal by C. P. L. de Gardanne. By 1839, the first book entirely about menopause was written by Frenchman C. F. Menville. The book explained symptoms of menopause as a response to the death of the womb.

Menopause was described clearly in 1899 in an article entitled "Epochal Insanities," under the heading "Climacteric Insanity." The article described symptoms of menopause and invited physicians to treat it as a syndrome in need of attention. Women in the late nineteenth century were often advised to rest as a way of combating menopausal symptoms. By the early twentieth century, menopause was seen as "the death of the woman in the woman." Contemporary research has shown that menopause is not linked to mental illness or the death of the womb. The average woman of 51 can expect several more decades of life, making menopause more a stage of life than a death sentence.

The many symptoms noted by early observers of menopause stem from profound hormonal changes which occur when women experience menopause. During menopause, hormonal activity changes as the body's needs are altered and production of natural estrogen and progesterone is reduced. The most obvious of these changes is the end of the monthly menstrual cycle, a process which occurs gradually. When this process ends, women can no longer bear children and ovulation no longer occurs.

Various studies suggest that while a majority of women experience some menopausal symptoms, fewer than half have severe problems with the process.

A new era

The 1923 isolation of estrogen, the female sex hormone manufactured in both sexes, lead to a new era for menopausal women. Estrogens were first tried as an aid to menopausal women in the 1930s, but negative side affects cut short the effort. By the 1960s, a palatable estrogen supplement was developed. The substance was heavily promoted as a medication to keep menopausal women "feminine forever" (also the title of a 1965 book by Robert A. Wilson promoting estrogen therapy). Estrogen was promoted as a cure for hot flashes, urogenital dryness, and even mental illness.

However, in 1975, studies emerged linking estrogen with an elevated risk of endometrial cancer, and use of estrogen supplements dropped. Use of estrogens dropped considerably until researchers explored using estrogen with progesterone as a combined therapy. This combination is thought to reduce the risk of endometrial cancer.

Since the early 1980s, the use of synthetic hormones for menopause has climbed dramatically. In 1980, 12 million prescriptions were written for estrogen supplements. By 1993, a total of 48 million prescriptions were written. As estrogen has become used more widely, various benefits and risks have become apparent. Risks of using hormone replacement therapy include the development of gallstones, the development of blood clots, and an elevated risk of breast cancer among women who use estrogen supplements for long periods of time. More careful, standardized research needs to be done, particularly to understand the association between duration of hormone replacement therapy, dose of hormone replacement therapy, type of hormone replacement therapy, and risk of breast cancer. Negative side effects of the estrogen-progesterone combination are commonly reported. These include headaches, depression, and bloating. One sign of the distaste with which many women view the estrogen-progesterone combination is that the average use of estrogen replacement prescriptions is nine months.

On the positive side, estrogen supplements have been shown to reduced the risk among women of heart disease, the leading cause of death among men and women and a far more likely cause of death than endometrial cancer. Research suggests that estrogen lowers total cholesterol and relaxes blood vessels, making the heart's job easier. Studies have also shown that estrogen supplements cut the risk of osteoporosis, a disease in which bones become brittle and easily broken. Several small studies suggest that estrogen may also increase short-term memory.

Better studies needed

Virtually millions of women must decide how best to approach the symptoms of menopause and life after menopause every year. There were 473 million women 50 or over in the world in 1990. But relatively little research has been conducted concerning the long-term health consequences of estrogen or estrogen and progesterone therapy in women or about other ways to address menopausal symptoms. There has never been a large-scale, long term study of estrogen and progesterone supplements which included scientifically selected individuals for control group and treatment groups. This means that the results of much current research is suspect.

The United States government is currently conducting a study with nine years of follow-up which will examine the effect of hormone replacement therapy on the prevention of heart disease and osteoporosis. The study is expected to enroll 63,000 women ages 50-79, and will include scientifically selected control and treatment groups.

Other research must also be conducted concerning alternative therapy for menopause and a variety of issues linked to health risk and the duration of hormone therapy use. In 1994, the World Health Organization scientific group announced a series of recommendations for research concerning physical and psychological aspects of menopause. Such research studies are ongoing.

Menopause remains a time of life shrouded in scientific mystery. This stems from the paucity of ambitious studies concerning health options for menopausal women. As more research is conducted, the increasing availability of information should ease the transition for women entering this stage of life.

Further Reading

Ehrenreich, Barbara and Deirdre English. For Her Own Good. New York: Doubleday, 1989.

Fackelmann, Kathleen. "Forever Smart. Does Estrogen Enhance Memory?" Science News. Vol. 147.74-75.

Greer, Germaine. The Change. New York: Alfred A. Knopf, 1992.

Sheehy, Gail. The Silent Passage: Menopause. New York: Random House, 1992.

Te Velde, Egbert R.; Van Leusden, Huub AIM. "Hormonal treatment for the Climacteric: Alleviation of Symptoms and Prevention of Postmenopausal Disease." The Lancet. vol. 343, March 12, 1994. 654-657.

"WHO Scientific Group Formulates New Research Agenda on Menopause." Public Health Reports. Vol. 109, No. 5. September-October 1994.715.

Patricia Braus

KEY TERMS

Endometrium--Inner membrane of the uterus.

Estrogen--Female sex hormones, responsible for development of sex characteristics and for preparation of environment for the early embryo.

Progesterone--Hormone which plays a critical role in preparing the body for a developing embryo.

Osteoporosis--A disease which occurs primarily in women in which the mass of the bones is reduced, making it easier for fractures to occur.

Record Number: A30431853

SOURCE:
Gale Encyclopedia of Science.  June 2001 pNA.

Full Text: COPYRIGHT 2001 Gale Group