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Showing posts with label Menopause Clinic. Show all posts
Showing posts with label Menopause Clinic. Show all posts
Tuesday, September 30, 2008
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Depression-Menopause



Description

Feeling down or depressed once in awhile is normal for most people. However, if these feelings become very intense and persist for a very long period of time, and obstruct normal daily activities, clinical depression has set in and must be treated.

Depression is not a temporary setback in emotions or a result of emotional weakness. It is a real mental illness that cannot be overcome by sheer will. It brings many difficulties occupationally, socially, and physically. Unlike sadness or sorrow, depression does not resolve with a change in circumstance (good news, for instance), and unlike the gradual recovery from mourning a loved one's death, it does not get better.

If depression is not treated, it can persist for several years, hampering relationships, reducing productivity at work, undermining confidence and self-esteem, and, ultimately, even leading to suicide. A depression sufferer is not able to solve his/her problem on his/her own. It is a mental illness that requires professional treatment. With proper treatment, depression is relatively easy to treat and has a success rate as high as 80%.



Dynamics

Depression is a common disorder occurring in 15% of men and 25% of women during their lifetimes. Presumably, women have a higher tendency to suffer depression than men because of the extra societal pressures put upon them and the hormonal roller coaster they go through during pregnancy and delivery. Generally, the first episode of depression happens in the mid-twenties, and then again during menopause for women, and after retirement in men. Although depression is a relatively easy disease to treat, without prompt and proper care, it can become chronic or recurrent.


Types

Depression, just like other diseases, can appear in many different forms. It is divided into three major groupings: major depression, dysthymia, and manic-depressive. In all three types of depression, the number, severity, and duration of the symptoms will vary depending on the individual.

Major Depression
The most serious of the three types, major depression, affects the body physically, emotionally, mentally, and behaviorally. Thus, work performance suffers and even daily activities, such as sleeping and eating, can be affected.

Dysthymia
Dysthymia is a relatively mild form of depression in which unhappiness lingers for a long period of time bringing sub-par performance in daily activities. Sometimes, patients with dysthymia also exhibit symptoms of major depression.

Manic-depressive
Manic-depressive depression does not occur as frequently as the other forms of depression. Here, the patient is seen to alternate from a state of depression and mania, forming a periodic cycle. Mania can be described as a condition of being restless, occupied in thought, and unnecessarily busy in behavior. In contrast, depression is a submergence of feeling, a settling of thought and behavior, which together with its antithesis, mania, comprise manic-depressive. The depressive cycle of manic-depressive depression often appears in the form of major depression, as discussed above.


Causes

There are many different causes of depression.

Physiological
Physiologically, neurotransmitters, the substance that links nerve cells to other nerve cells, may be the source of the problem. It is believed that the brain's activity, namely our thoughts and emotions, arise out of the change in the properties of these neurotransmitters. In the case of depression, it is believed that a decline in the activities of the neurotransmitters, norepinephrine and serotonin, are involved in the disorder.

Heredity
Heredity can play a factor in depression. If a close relative (parents, siblings, or children) suffers from depression, the chances of falling into major depression are 2-3 times greater. Although heredity is an influential factor in causing depression, it does not necessitate it.

Environmental, Psychological, and Societal
There are environmental, psychological, and societal factors that can also drive a person into depression. A person with low self-esteem, a strong superego, weak social interaction, and a very dependent personality will be more susceptible to these external pressures, whether it may be due to divorce, failure, or family discord.


Symptoms

The most notable symptoms of depression are gloominess, loss of interest and pleasures, fatigue, and loss of vigor. In addition, there are other symptoms, such as loss of concentration and attentiveness, loss of self-respect and self-confidence, guilt, lack of self-worth, hopelessness, thoughts of suicide, insomnia, and a loss of appetite. Sometimes, these symptoms may occur due to the accumulation of unexpressed anger, emotions, or personal preferences bottled up by peer-pressure, societal rules and customs, resulting in a redirected expression of these emotions in the form of various psychosomatic symptoms, such as loss of appetite and sexual desire, insomnia, etc. For teenagers, anger or other misgivings may be expressed with truancy, by smoking, drinking, getting into fights, or leaving home. Menopausal women may exhibit symptoms of "being on pins and needles" and become anxious and irritable.


Treatment

The treatment of depression can be divided as follows: medication, psychotherapy, and electroconvulsive therapy. Some people are cured by psychotherapy or taking medications. Most people, however, choose to take advantage of both, benefiting from the fast acting power of medications and the know-how of coping with daily problems acquired from psychotherapy. The important point here is that most people can be treated for depression with proper attention. In rare cases, electroconvulsive therapy is used to treat extreme depression.

Medication: Antidepressants
Traditionally, depression has been treated through the use of three types of antidepressants, namely tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAO inhibitors), and selective serotonin reuptake inhibitors (SSRIs). TCAs are encumbered by side effects such as dry mouth, constipation, drowsiness, and a decrease in sexual performance. MAO inhibitors have the inconvenience of having to avoid certain foods, such as cheese and wine. Recent additions to the antidepressant lineup do not have such side effects. These include the new class of antidepressants called SSRIs. Since antidepressants take 2 to 6 weeks to take effect, it is important that drug use be maintained for a reasonable amount of time before deciding to quit. If any difficulties arise, consult the prescribing doctor immediately. Alcohol and other medications can interfere with the potency of antidepressants and must be avoided.

Psychotherapy
Psychotherapy aids patients by identifying and resolving their problems through consultations with a psychiatrist, and helps patients get a better understanding of their mental illness. Behavioral therapy involves directing individuals to gain satisfaction and initiative by their own actions, and helping them to understand ways to avoid behaviors that may lead to depression. It also teaches them to adjust to their environment, becoming a master of their environment rather than a slave to it. Personal relations therapy and human-behavioral therapy are also helpful. Personal relations therapy rectifies the wrongs of personal behavior that contribute to depression, and human-behavioral therapy eliminates the patient's negative behavior and frame of mind that is associated with depression. Retrogressive psychotherapy focuses on the psychological problems of childhood as the center stage for resolving conflicts in the patient's current mental state.

Electroconvulsive Therapy
Electroconvulsive therapy is useful in treating very severe depression accompanied by suicidal tendencies, as well as those patients incapable of taking antidepressants. It is very effective in treating patients who have not completely recovered after using antidepressants.

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Late Childbearing



Description

Late marriages occur more frequently, and, consequently, the number of women having babies later is increasing. The World Health Organization defines late childbearing as giving birth at age 35 or older. Late childbearing is associated with increased risk of miscarriage, premature birth, Down syndrome, and low birth-weight infant.



Gestosis and hypertensive diseases

According to most reports, late child-bearers are 2-4 times more likely to have high blood pressure than young pregnant women.


Diabetes and gestational diabetes

The incidence rate for tumors, alcoholism, and non-insulin-dependent diabetes, or type 2 diabetes, increases with age, as do disorders of the cardiovascular system, nervous system, kidney, connective tissue, and lungs. If thrombus, pulmonary edema, or chronic high blood pressure, exists the risk of heart failure also increases.


Cesarean sections

The frequency of cesarean sections for premature separation of the placenta and placenta previa increases in pregnant women 35 and older. Plus, an increase in hypertensive diseases, diabetes, and premature labor in this age bracket necessitates more cesarean sections.


Maternal mortality rate

The maternal mortality rate is 4 times higher for women between 35 and 39 than it is for women 20-24. This difference is more striking for minorities.
# In the late-pregnancy age group, the early miscarriage rate, attributable to natural miscarriage or chromosome abnormalities, increases. Also the perinatal morbidity rate and mortality rate for preterm delivery, fetal growth delay, and fetal death within the uterus increase.


Miscarriage

Most investigations report that the risk of natural abortion increases with late childbearing. Pregnant women in their 40s have a natural miscarriage rate 2-4 times higher than that of pregnant women in their 20s.


Premature birth and fetal growth delay

There is a higher incidence in low birth-weight infants among late child-bearers because there is an increase in early delivery and fetal growth delay. The perinatal mortality rate increases for the same reason. Older pregnant women have an increased risk of giving birth to a large baby due to the prevalence of diabetes in this age group.


Congenital deformation

Down syndrome is the congenital deformation that is closely related to the women's age. It occurs most frequently in babies born to late child-bearers over 40. This is because the delay in fertilization causes the eggs to mature too much and non-disjunction takes place. With the exception of Down syndrome, there is no clear relationship between the age of pregnant women and rate of other chromosome abnormalities.


Age of pregnant woman

Frequency of occurrence of Down syndrome
< 25 years old 1/2,000
25 - 34 1/2,300
35 - 44 1/250
> 45 1/80
All ages 1/800



Benefits of late childbearing

Older pregnant women are mentally relaxed because they look forward to giving birth. Most have been married for a long time and are financially stable.


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Definition of Menopause



Description

Menopause, or climacterium, marks the completion of a woman's childbearing years and the cessation of menses (menstrual cycles), as the ovaries slow down and, eventually, stop functioning. Women typically reach this phase in their lives between ages 45 and 55. As a result of hormonal changes due to this process, women undergoing menopause may experience feelings of irritability, as well as "hot flashes" on the neck, chest, face and arms. There are other less obvious physiological indications that indicate that menopause has begun.



Causes

As a woman enters menopause, the number of eggs in the ovaries decrease, which lowers ovary function and leads to a dramatic reduction in estrogen secretion. At the same time, the pituitary gland increases the secretion of a follicle-stimulating hormone (FSH), which makes the eggs grow faster and the periods shorter. Sometimes ovulation does not occur.


Symptoms

In the years preceding menopause, the menstrual cycle is shortened by an increase in FSH, ovulation becomes irregular, and there is less estrogen in the blood. The decrease in estrogen causes various climacterium symptoms such as hot flashes, depression, dryness of the vagina, and a decline in sexual function.

Hot flashes
Hot flashes are the most common early symptom when blood levels of estrogen decrease. When less estrogen is secreted, the capillaries expand irregularly, causing hot sensations in the face, neck, and chest. It becomes hard to sleep because of night sweats caused by hot flashes. In severe cases, these symptoms occur 40 times a day. Approximately 67% of women experience these symptoms for a year, and 25% of women experience them for more than 5 years. Impatience, irritation, anxiety, and worry may also occur in conjunction with hot flashes.

Urinary system changes
The decrease in estrogen also affects skin and epithelial cells. With less estrogen being secreted, epithelial cells in the vagina and urinary system become thin and dry, losing elasticity. This causes the muscles in the perineum, urethra and bladder neck to weaken. As a result, many women find it hard to control urine, and lose a little when they cough, sneeze, laugh or exercise. Menopausal women may also have an urgent need to urinate even when the bladder is not full.

The uterus and vagina become atrophic with lack of estrogen during menopause, so sometimes there is a sagging or slacking sensation when lifting heavy objects.



If dryness of the vagina, or colpoxerosis, is severe, it can cause pain and small tears during intercourse. A drier, menopausal vagina is also more susceptible to yeast infections.

Emotional changes and sexual function
Many women in menopause complain about anxiety, depression, sensitivity, fatigue, forgetfulness, and insomnia. These symptoms are partially caused by decreases in estrogen, luteinizing hormone, and male hormone. A lack of female and male hormones decreases sexual desire (libido) and causes the painful intercourse (from dryness) that some women experience during menopause. These symptoms can be improved with hormone replacement therapy.

Skin changes
After menopause, skin loses elasticity and stretches, causing more wrinkles. Although the lack of estrogen is not the main cause, hormone treatment will help the skin maintain elasticity.

Breast changes
The lack of estrogen affects the breasts' size, quality, and supporting tissue. Breasts stretch, decrease in size, and become soft because there is less connective tissue.




Diagnosis

Menopause is diagnosed by history of an absence of menstrual periods for at least 6 months and by a hormone level (FSH > 35 IU/L).

Menstruation before menopause is nonovulational and signals the beginning of climacterium. One way of determining whether or not ovulation occurs is to measure basal body temperature. Normally the basal body temperature is low for the first half of the menstrual cycle and high during the latter half. When ovulation does not occur, there is no change in body temperature.

When menstruation becomes irregular, a woman may also be experiencing early symptoms of menopause. When ovulation stops, the secretion of progesterone stops and without progesterone, the little estrogen that is secreted facilitates growth of the endometrium (endometrial hyperplasia). This growth cannot be sustained, and as it breaks down little by little, irregular bleeding occurs. Eventually, menopause commences as ovary function comes to a halt and the secretion of estrogen stops.


Treatment

Menopause signals the beginning of potentially new health issues for women. Hormone replacement therapy can improve and prevent many menopause-related symptoms and problems, including osteoporosis, a degenerative bone disease. Bone density decreases at the rate of 1-2% per year after menopause. For some women, osteoporosis progresses more severely.

The reduction of estrogen after menopause can increase a woman's risk for high blood pressure, heart attacks, cerebral hemorrhages, and other cardiovascular diseases. After menopause, the level of low-density lipoprotein (LDL) or "bad cholesterol" increases and the level of high-density lipoprotein (HDL) or "good cholesterol" decreases. HDL removes cholesterol from the arteries, reducing the risk of vascular diseases. High LDL levels are related to the occurrence of arteriosclerosis. Hormone replacement therapy may prevent coronary artery disease in postmenopausal women.

Premature menopause is menopause that has occurred before age 35, and treatment is necessary to prevent side effects. If menstruation continues after age 55, a uterine myoma (a benign tumor) may be present and a woman should seek a medical examination.

If both ovaries have been surgically removed, then menopause is "surgically induced" and severe estrogen deficiency symptoms will occur. Hormone replacement therapy is needed in cases of surgically induced menopause.


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Urinary Incontinence and Menopause



Description

Urinary incontinence is the involuntary loss of urine, sufficient enough to cause a social or cleanliness problem.

By age 65, 1 in 10 women experiences urinary incontinence. It is most commonly seen in women who have had one or more vaginal deliveries, which cause a change in the anatomy of the uterus, vagina, and supporting structures of the bladder, urethra, and rectum. Changes may be temporary, mild, or very significant.

If you suffer from urinary incontinence, there are many new products and surgical methods available to treat this condition.



Causes

Urinary incontinence is often caused by a combination of the following:

* Pregnancy, particularly vaginal delivery.
* Weakened or damaged pelvic muscles that support the bladder.
* Lack of estrogen, e.g., menopause.
* Medical problems that affect the bladder function, e.g., diabetes mellitus.
* Urinary tract infections.
* Constipation causing straining.
* Repeated coughing, e.g., smoker's cough.
* Certain prescription and nonprescription medications.

Symptoms



Symptoms vary depending on the type of incontinence:

Stress incontinence is the loss of urine when there is a sudden increase in pressure in the abdomen caused by laughing, coughing, sneezing, exercising, or lifting something heavy.

Urge incontinence is the most common type of incontinence. It occurs when someone suddenly feels as though they need to use the toilet, but is unable to reach it in time. Urge incontinence has many causes.

Mixed incontinence is a combination of stress and urge incontinence.

Overflow incontinence occurs when the bladder cannot empty properly. A person makes frequent trips to the toilet, letting out small amounts of urine each time. Because the bladder never empties completely, it may feel full again very quickly. Some people may have periodic leaking without any sensation of fullness.

Functional incontinence is not caused by problems with the bladder. Accidents occur because it may be difficult for a person to get to the toilet due to illness, arthritis, or lack of available facilities.

Diagnosis

* Review of medical history.
* Physical exam, including pelvic examination.
* Laboratory tests, including urinalysis and urine culture to rule out a urinary tract infection; blood sugars to rule out diabetes mellitus.
* Urodynamic studies where the physician tests the function of bladder and urethra by measuring bladder pressure and urine flow.
* Cystoscopy, which involves the direct visualization of the urinary bladder and urethra from inside by inserting an endoscopic tube through the urethra. Please see cystoscopy for more information.
* Cystogram to show abnormal anatomy and functions that may be causing incontinence. For a cystography or voiding cystourethrography, the bladder is filled with iodine containing X-Ray dye, and an X-Ray is taken of the bladder and urethra when filled, during urination, and immediately after urination.


Treatment



Treatment depends on the type of incontinence and may require one or more of the following:

* Estrogen creams, if estrogen deficiency (from menopause) is suspected.
* Antibiotics to treat a urinary tract infection.
* Medication to help regulate the bladder and urethra.
* Surgery to support the bladder and correct the pelvic anatomy.
* Kegel exercises to strengthen the pelvic muscles.
* Bladder training to help a person control the urgent need to urinate.
* Vaginal pessaries to support a partially prolapsed bladder.



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Sex During Menopause



Description

A woman's normal sexual response can be divided into four stages: attraction, arousal, climax, and resolution. As women age, dysfunction in each of these stages becomes more and more likely.

For menopausal women the most common genital symptoms are urinary frequency, vaginal dryness and irritation. The most common sex-related symptoms during menopause are loss of libido and painful intercourse. Other menopausal-related symptoms include lack of orgasms and problems associated with the partner's sexual dysfunction.



The loss of female hormones during menopause can cause an increase in the frequency of vaginal atrophy, dryness, and inflammations. The atrophy of the vaginal mucosa can cause an avoidance of intercourse due to extreme vaginal pain.



Even under these circumstances, sexual encounters must be increased and enhanced with psychological stimulations to arouse sexual desires. Taking a warm bath before intercourse or using a topical lubricant can help. The most effective method of treatment, however, is estrogen supplements or applying estrogen-enhanced creams directly on the atrophied vagina.



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Practicing Longevity



Description

Human life expectancy has increased greatly over recent years. Currently, the average lifespan in the United States is 76.9 years -- 79.5 years for females and 74.1 years for males (National Vital Statistics Reports, 2000). With an extended lifespan, we aspire to optimize our health and wellness in order to reduce suffering from illnesses and live a fuller, richer life.



The ideal way to launch your quest for aging in wellness and healthy longevity is to receive an expert examination and receive a personal and tailored prescription for diet and exercise and, if needed, hormonal supplements, antioxidants, and supplements. After receiving a personal prescription, it is important to receive checkups 2-3 times a year to monitor your health conditions.


Longevity experts share and practice the following health guidelines.

1. Never overstrain. Exercise moderately everyday or as frequently as possible.
2. Do not eat fried foods. Eat low-fat grains that have not been whitened or bleached. Protein consumption should consist of fish and poultry.
3. Eat fresh fruits and vegetables that are in season, every day.
4. Do not smoke or drink alcohol, or limit alcohol consumption to red wine with a meal.
5. Meditate everyday for 10-30 minutes. Practice one's own stress-relieving methods often.
6. No matter what, keep a positive attitude toward life.
7. Take antioxidants and other health supplements daily.



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Suicide



Description

Most suicide victims were not receiving treatment at the time of their death. Suicidal thoughts usually suggest mental illness, especially depression. Suicide tends to occur during an intense episode of depression. Depression can be treated with proper medical attention, and professional help can prevent suicides.



Those at a high risk for suicide are:

* people with a past history of suicide attempts or thoughts, depression, or other mental illnesses, such as bipoloar disorder, schizophrenia, anxiety, etc.
* people with a history of alcohol or drug abuse.
* people with a serious physical illnesses, such as AIDS or cancer.
* people with a family history of depression, suicide, or mental illnesses.
* Men and people over 60. Though depression is two to four times more common in women than men, men are four to ten times more likely to complete suicide.



If someone talks about suicide, take the matter seriously and let family members or a mental health professional know immediately.


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Sex After 50 and Menopause

Description
In the process of aging, the number of cells in the organs of the body is diminished due to the loss of regenerative capability in the living organism. Aging, on the sexual level, is marked by a sudden reduction of male/female hormones at around the ages of 35-40. Then, at around age 60, the concentration of sexual hormones again drops drastically in the blood stream and continues at this level until 80.



The loss of sexual vigor with age does not include a loss in sexual interest. Human male hormones, unlike those of other animals, do not have absolute control over sexual activity, and its level at 80 is as much as 2/3 its level at age 20. Therefore, the idea that sex is only for the young is a misconception. The closeness, stimulation, and happiness that having sexual intercourse brings to a relationship does not decrease with age. Further, erectile dysfunction in men and frigidity in women are not necessarily physiological problems, but may be due to worries about sex or other mental insecurities. For example, a man may worry over whether he will be able to satisfy his partner; and likewise, a woman may be concerned about her dryness, which can pose a greater threat than any physical factor.



As males age, there are distinctive changes that happen related to their ability to function sexually:

* At an advanced age, an erection takes longer to attain. The length of time it stays in that state diminishes, also.
* At youth, the time needed for sexual arousal is only 5-10 seconds; whereas, at 60-70 years, it may take more than 3 times as long, if at all.
* At the point of erection, the penis makes an angle of 30-50 degrees to the flat of the stomach (abdominal wall) for youths; after 60, the angle will drop to 150 degrees or to the 7- 8 o'clock position from the stomach.
* For men in their 20s and 30s, maintaining an erection lasts on average of 40-50 minutes. As men age, lasting even 10 minutes can be difficult.
* At youth, sometimes there is a two-stage orgasm; with age, the urgency of sex disappears and even one orgasm may be difficult to achieve.
* The pressure with which the semen is ejaculated also varies with age, shooting from 50-100 cm during youth to just barely making it out with a dribble at old age.



The root of human sexual desire originates from the functionality of the testicles and ovaries; however, the brain plays a big part through memory, associations, emotion and experience. Therefore, the secret to a lifetime of healthy, pleasurable sex is not only to maintain a healthy body but a healthy mind, as well -- a mind that keeps sexual interests alive.

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Osteoporosis and Menopause

Description
* Osteoporosis is a disease of progressive bone loss associated with an increased risk of fractures. It literally means "porous bone." The disease often develops unnoticed over many years, with no symptoms or discomfort, until a fracture occurs. Osteoporosis often causes a loss of height and dowager's hump (a severely rounded upper back region). * Osteoporosis is a major public health threat for 28 million Americans, 80% of whom are women. In the U.S. today, 10 million individuals already have osteoporosis and 18 million more have low bone mass, placing them at increased risk for this disease. One out of every two women and one in eight men over 50 will have an osteoporosis-related fracture in their lifetime * More than 2 million American men suffer from osteoporosis, and millions more are at risk. Each year, 80,000 men suffer a hip fracture and one-third of these men die within a year. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, and approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites.



Causes



Doctors do not know the exact medical causes of osteoporosis, but they do know many of the major factors that can lead to the disease. * Aging. Everyone loses bone with age. After age 35, the body builds less new bone to replace losses of old bone. In general, the older you are, the lower your total bone mass and the greater your risk for osteoporosis. * Heredity. A family history of fractures; a small, slender body build; fair skin; and a Caucasian or Asian background can increase the risk for osteoporosis. Heredity also may help explain why some people develop osteoporosis early in life. * Nutrition and lifestyle. Poor nutrition, including a low calcium diet, low body weight and a sedentary lifestyle has been linked to osteoporosis, as have smoking and excessive alcohol use. * Medications and other illnesses. Osteoporosis has been linked to some medications, including steroids, and to other illnesses, including some thyroid problems.


Diagnosis

* The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination, skeletal X-rays, bone densitometry and specialized laboratory tests. If your doctor finds low bone mass, he or she may want to perform additional tests to rule out the possibility of other diseases that can cause bone loss, including osteomalacia (a vitamin D deficiency) or hyperparathyroidism (overactivity of the parathyroid glands). * Bone densitometry is a safe, painless x-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age 20 to 25, when it is at its highest. * It is often performed in women at the time of menopause. Several types of bone densitometry are used today to detect bone loss in different areas of the body. Dual beam X-ray absorptiometry (DXA) is one of the most accurate methods, but other techniques can also identify osteoporosis, including single photon absorptiometry (SPA), quantitative computed tomography (QCT), radiographic absorptometry and ultrasound. Your doctor can determine which method would be best suited for you.


Treatment



* Because lost bone cannot be replaced, treatment for osteoporosis focuses on the prevention of further bone loss. Treatment is often a team effort involving a family physician or internist, orthopedist, gynecologist, and endocrinologist. * While exercise and nutrition therapy are often key components of a treatment plan for osteoporosis, there are other treatments as well. * Estrogen replacement therapy (ERT) is often recommended for women at high risk for osteoporosis to prevent bone loss and reduce fracture risk. A measurement of bone density when menopause begins may help you decide whether ERT is for you. Hormones also prevent heart disease, improve cognitive functioning, and improve urinary function. It should be discussed with your doctor. * New anti-estrogens known as SERMs have been introduced. They increase bone mass, decrease the risk of spine fractures, and lower the risk of breast cancer. * Calcitonin is another medication used to decrease bone loss. A nasal spray form of this medication increases bone mass, limits spine fractures, and may offer some pain relief. Bisphosphonates, including Alendronate, markedly increase bone mass and prevent both spine and hip fractures. HRT, Alendronate, SERMs, and calcitonin all offer the osteoporosis patient an opportunity to not only increase bone mass, but also to significantly reduce fracture risk. Prevention is preferable to waiting until treatment is necessary.


Prevention

There is a lot you can do throughout your life to prevent osteoporosis, slow its progression, and protect yourself from fractures. Include adequate amounts of calcium and vitamin D in your diet. * Calcium. During the growing years, your body needs calcium to build strong bones and to create a supply of calcium reserves. Building bone mass when you are young is a good investment for your future. Inadequate calcium during growth can contribute to the development of osteoporosis later in life. Whatever your age or health status, you need calcium to keep your bones healthy. Calcium continues to be an essential nutrient after growth because the body loses calcium every day. Although calcium cannot prevent gradual bone loss after menopause, it plays an essential role in maintaining bone quality. Even if you have gone through menopause or already have osteoporosis, increasing your intake of calcium and vitamin D can decrease your risk of fracture. How much calcium you need will vary depending on your age and other factors. The National Academy of Sciences makes the following recommendations regarding daily intake of calcium:

Males and females 9 to 18 years: 1300 mg per day
Women and men 19 to 50 years: 1000 mg per day
Pregnant or nursing women up to age 18: 1300 mg per day
Pregnant or nursing women 19 to 50 years: 1000 mg per day
Women and men over 50: 1500 mg per day
Dairy products, including yogurt and cheese, are excellent sources of calcium. An eight-ounce glass of milk contains about 300 mg of calcium. Other calcium-rich foods include sardines with bones, and green leafy vegetables, including broccoli and collard greens. If your diet does not contain enough calcium, dietary supplements can help. Talk to your doctor before taking a calcium supplement.

* Vitamin D. Vitamin D helps your body absorb calcium. The recommendation for vitamin D is 400 IU daily for adults and 800 IU daily for the elderly. Supplemented dairy products are an excellent source of vitamin D. (A cup of milk contains 100 IU. A multivitamin contains 400 IU of vitamin D.) Vitamin supplements can be taken if your diet does not contain enough of this nutrient. Again, consult with your doctor before taking a vitamin supplement. Too much vitamin D can be toxic. * Exercise regularly. Like muscles, bones need exercise to stay strong. No matter what your age, exercise can help you minimize bone loss while providing many additional health benefits. Doctors believe that a program of moderate, regular exercise (3 to 4 times a week) is effective for the prevention and management of osteoporosis. Weight-bearing exercises such as walking, jogging, hiking, climbing stairs, dancing, treadmill exercises, and weight lifting are probably best. Falls account for 50% of fractures, therefore, even if you have low bone density you can prevent fractures if you avoid falls. Programs that emphasize balance training, especially, Tai Chi, should be emphasized. Consult your doctor before beginning any exercise program.

Are you at risk for osteopenia and osteoporosis?


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Menopause Symptoms



Description

Menopause, or climacterium, marks the completion of a woman's childbearing years and the cessation of menses (menstrual cycles), as the ovaries slow down and, eventually, stop functioning. Women typically reach this phase in their lives between ages 45 and 55.
As a result of hormonal changes due to this process, women undergoing menopause may experience feelings of irritability, as well as "hot flashes" on the neck, chest, face and arms. There are other less obvious physiological indications that indicate that menopause has begun.



Causes



As a woman enters menopause, the number of eggs in the ovaries decrease, which lowers ovary function and leads to a dramatic reduction in estrogen secretion. At the same time, the pituitary gland increases the secretion of a follicle-stimulating hormone (FSH), which makes the eggs grow faster and the periods shorter. Sometimes ovulation does not occur.


Symptoms

In the years preceding menopause, the menstrual cycle is shortened by an increase in FSH, ovulation becomes irregular, and there is less estrogen in the blood. The decrease in estrogen causes various climacterium symptoms such as hot flashes, depression, dryness of the vagina, and a decline in sexual function.

Hot flashes



Hot flashes are the most common early symptom when blood levels of estrogen decrease. When less estrogen is secreted, the capillaries expand irregularly, causing hot sensations in the face, neck, and chest. It becomes hard to sleep because of night sweats caused by hot flashes. In severe cases, these symptoms occur 40 times a day. Approximately 67% of women experience these symptoms for a year, and 25% of women experience them for more than 5 years. Impatience, irritation, anxiety, and worry may also occur in conjunction with hot flashes.

Urinary system changes
The decrease in estrogen also affects skin and epithelial cells. With less estrogen being secreted, epithelial cells in the vagina and urinary system become thin and dry, losing elasticity. This causes the muscles in the perineum, urethra and bladder neck to weaken. As a result, many women find it hard to control urine, and lose a little when they cough, sneeze, laugh or exercise. Menopausal women may also have an urgent need to urinate even when the bladder is not full.

The uterus and vagina become atrophic with lack of estrogen during menopause, so sometimes there is a sagging or slacking sensation when lifting heavy objects.

If dryness of the vagina, or colpoxerosis, is severe, it can cause pain and small tears during intercourse. A drier, menopausal vagina is also more susceptible to yeast infections.

Emotional changes and sexual function
Many women in menopause complain about anxiety, depression, sensitivity, fatigue, forgetfulness, and insomnia. These symptoms are partially caused by decreases in estrogen, luteinizing hormone, and male hormone. A lack of female and male hormones decreases sexual desire (libido) and causes the painful intercourse (from dryness) that some women experience during menopause. These symptoms can be improved with hormone replacement therapy.

Skin changes
After menopause, skin loses elasticity and stretches, causing more wrinkles. Although the lack of estrogen is not the main cause, hormone treatment will help the skin maintain elasticity.

Breast changes
The lack of estrogen affects the breasts' size, quality, and supporting tissue. Breasts stretch, decrease in size, and become soft because there is less connective tissue.




Diagnosis

Menopause is diagnosed by history of an absence of menstrual periods for at least 6 months and by a hormone level (FSH > 35 IU/L).

Menstruation before menopause is nonovulational and signals the beginning of climacterium. One way of determining whether or not ovulation occurs is to measure basal body temperature. Normally the basal body temperature is low for the first half of the menstrual cycle and high during the latter half. When ovulation does not occur, there is no change in body temperature.

When menstruation becomes irregular, a woman may also be experiencing early symptoms of menopause. When ovulation stops, the secretion of progesterone stops and without progesterone, the little estrogen that is secreted facilitates growth of the endometrium (endometrial hyperplasia). This growth cannot be sustained, and as it breaks down little by little, irregular bleeding occurs. Eventually, menopause commences as ovary function comes to a halt and the secretion of estrogen stops.


Treatment

Menopause signals the beginning of potentially new health issues for women. Hormone replacement therapy can improve and prevent many menopause-related symptoms and problems, including osteoporosis, a degenerative bone disease. Bone density decreases at the rate of 1-2% per year after menopause. For some women, osteoporosis progresses more severely.

The reduction of estrogen after menopause can increase a woman's risk for high blood pressure, heart attacks, cerebral hemorrhages, and other cardiovascular diseases. After menopause, the level of low-density lipoprotein (LDL) or "bad cholesterol" increases and the level of high-density lipoprotein (HDL) or "good cholesterol" decreases. HDL removes cholesterol from the arteries, reducing the risk of vascular diseases. High LDL levels are related to the occurrence of arteriosclerosis. Hormone replacement therapy may prevent coronary artery disease in postmenopausal women.

Premature menopause is menopause that has occurred before age 35, and treatment is necessary to prevent side effects. If menstruation continues after age 55, a uterine myoma (a benign tumor) may be present and a woman should seek a medical examination. If both ovaries have been surgically removed, then menopause is "surgically induced" and severe estrogen deficiency symptoms will occur. Hormone replacement therapy is needed in cases of surgically induced menopause.

The Natural Way- Common symptoms of menopause and the classification of each stage


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