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Menopause

Menopause is a process of permanent cessation of menstruation at an end of reproductive life that is cause by loss of ovarian follicular activity. It is when the last and final menstruation occurs. Clinical diagnosis can be confirmed after following stoppage of menstruation (amenorrhea) for 12 consecutive months with no other pathology. This is the time a woman is declared to reach menopause only retrospectively. Premenopause refers to the period prior to menopause, postmenopause to the period after menopause and perimenopause to the period around menopause (40–55 years).

Climacteric is the period of time during which a woman passes from the reproductive to the nonreproductive stage. This phase covers 5–10 years on either side of menopause.

Perimenopause is the part of the climacteric when the menstrual cycle is likely to be irregular.

Postmenopause is the phase of life that comes after the menopause.

Age at which menopause occurs is genetically predetermined. The age of menopause is not related to age of menarche or age at last pregnancy. It is also not related to number of pregnancy, lactation, use of oral pill, socioeconomic condition, race, height or weight. Thinner women have early menopause. However, cigarette smoking and severe malnutrition may cause early menopause. Age of menopause ranges around 45–55 years, average about fifty years.

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Few years prior to menopause, along with depletion of the ovarian follicles, the follicles become resistant to pituitary gonadotropins. As a result, effective folliculogenesis is impaired with diminished estradiol production. There will be a significant reduce with the level of serum estradiol from 50–300 pg/mL before menopause to 10–20 pg/mL after menopause. This decreases the negative feedback effect on hypothalamopituitary axis resulting in increase in FSH. The increase in FSH is also due to diminished inhibin. Inhibin, a peptide, is secreted by the granulosa cells of the ovarian follicle. The increase of LH occurs subsequently.

Disturbed folliculogenesis during this period may result in anovulation, oligo-ovulation, premature corpus luteum or corpus luteal insufficiency. The sustained level of estrogens may even cause endometrial hyperplasia and clinical manifestation of menstrual abnormalities prior to menopause. The mean cycle length is significantly shorter. This is due to shortening of the follicular phase of the cycle.

Luteal phase length remaining constant. Ultimately, no more follicles are available and even some exist, they are resistant to gonadotropins Estradiol production drops down to the optimal level of 20 pg/mL → no endometrial growth → absence of menstruation.

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Following menopause, the predominant estrogen is estrone and to a lesser extent estradiol. Serum level of estrone (30–70 pg/mL) is higher than that of estradiol (10–20 pg/mL). The major source of estrone is peripheral conversion (aromatization) of androgens from adrenals (mainly) and ovaries. The aromatization occurs at the level of muscle and adipose tissue. The trace amount of estradiol is derived from peripheral conversion of estrone and androgens. Compared to estradiol, estrone is biologically less (about one-tenth) potent.

When the sources fail to provide the precursors of estrogen for around 5–10 years after menopause, there will be a significant reduce in estrogen and trophic hormones. Then it can be confirmed that the woman is in a state of true menopause.

Birth control and breastfeeding

The first ovulation after childbirth comes in a different period in very woman. There is no general rule when will ovulation happen but it is a well known fact that breastfeeding plays an important role in this process. If the mother is breastfeeding her baby, the first menstrual cycle should occur in around six months. Otherwise, ovulation usually occurs between four and six weeks after childbirth. But, the fact is that the menstrual cycle occurs just two weeks after ovulation so chances are that you can be fertile right after childbirth without being aware of that fact.

Those who believe that breastfeeding is a safe method of preventing pregnancy are not playing safe. It is a well known fact that during breastfeeding, the mother’s brain secretes a hormone called prolactin which is responsible for milk production. The bigger the amount of this hormone in the system the later you can expect ovulation. However, even a small break between breastfeeding that last more than 5 hours may be just enough to reduce the level of prolactin and the ovulation process can begin. This is why even mothers who are breastfeeding should start thinking about birth control.

In these cases, birth control pills are not recommended because the estrogen that they contain can stop the production of milk. Furthermore, these hormones can be transferred to the child through the milk. The high amount of estrogen that is usually found in these pills can cause negative effects in the child’s development. After childbirth, natural birth control methods are not that effective. The menstrual cycle after childbirth should stabilize after a while.

Between the 6th and 8th week after childbirth you can use an intrauterine device. This is the period when the uterus gets back to its natural form. Besides that you should wait for the vaginal discharge to stop in order to avoid infections. The biggest advantage of using intrauterine devices is the fact that the woman shouldn’t worry about pregnancy in the next 5 years. Of course, side effects are always present and things such as injuries during insertion, losing the IUDs and changing its position are possible. Some women can also experience bleeding. There are certain IUDs that can decrease the intensity and duration of bleeding during the menstrual cycle.

So-called mini pills and three-month injections don’t contain estrogen (they only contain gestagen) and they are another good birth control option during breastfeeding period. These pills don’t stop milk production and flow which makes them perfect for breastfeeding mums. The hormones can reach the baby’s body through the milk but experts claim that the hormones used in these pills are harmless. The only disadvantage of these pills is that they need to be consumed every day at the same time. The three-month injections are better because they are used once in three months. But, they contain more gestagen.

Finally, you can always try the traditional barrier methods like using condoms or a diaphragm. These methods are perfectly safe for breastfeeding mothers.

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Sex after Menopause

A lot of people are wondering if menopause is the last stage in a woman’s active sexual life. The answer is clear – certainly not.

Many people, including both men and women, are convinced that over time, when a woman enters menopause (the period when het fertile age is finished) her ability to enjoy sex is finished too. This of course is completely wrong. Furthermore, there are cases when women in this period of life enjoy sex even more because they are feeling more relaxed knowing that they should not worry about getting pregnant and because of the constant fear that someone might interrupt their sex act. Their children are probably grown and they’ve left the house a long time ago. Although there are some specific changes in the body of a woman in this period that may caused lower sex drive, those changes are not the only reason for low libido. This sex drive can be reduced because of some medications, diseases, and the level of stress that usually comes during this period and possibly because of the lowered self-confidence.

During menopause the body produces lower amounts of estrogen, female hormone and some people believe that this is the main reason for the decreased sex drive. However, many studies have shown that this is not the case. The main factors that cause decreased sex drive are actually linked with the attitude of some women toward their sexuality and their general health. The decline estrogen levels is certainly not the key factor for reduced sex drive and during these studies researchers have found out a really interesting fact – only women who expected that menopause will cause decreased sex drive after menopause feel that decreased sex drive. This means that this problem is linked with psychology too. If a woman has a positive attitude toward sexuality she certainly won’t notice the reduced production of estrogen in her body.

Many women during menopause start taking testosterone. This steroid hormone from the androgen group can be purchased only with prescription. With the help of testosterone women are able to ease some of the menopause symptoms like well known heat waves and night sweating. However, this is not the only benefit of using testosterone. Thanks to testosterone, women can increase their energy levels, improve their overall condition and most importantly increase their sex drive. But besides the positive effects taking testosterone brings some risks too. Probably the biggest danger is developing of breast cancer and although these cases are rare you should be careful with the dosage and follow the instructions.

Having all these things in mind, it’s not wrong to say that there is no general rule when it comes to menopause and sex drive. There is no proven link between menopause and decreased libido and most likely this is a consequence of some other factors and not the changes that occur in the body during menopause. Finally, there is no reason why women should not enjoy sex when they are mature.

How Do Birth Control Pills Affect The Body?

The first birth control pills were produced around 50 years ago and they were received very well by the public, especially among couples that were afraid of unwanted pregnancy. However these pills can affect on almost everything on your body, from the muscles and the brain to the sex drive.

These birth control pills work in a way that deceives the body with the help of artificial female hormones like estrogen and progesterone. They prevent the appearance of ovulation or in other words they stop the release of eggs. The process sounds very simple but the truth is that all those hormones are making a lot more than prevention of pregnancy.

Recent studies have shown that birth control pills can affect appearance, but not that much as previously because the new types of pills are having low levels of hormones and they are significantly improved. This is a short list of things that are usually affected by birth control pills.

Bones

Some studies suggest that taking birth control pills can lower the density of the spine, especially if those pills have low levels of estrogen in them. Natural estrogen stimulates the growth of bone tissue and pills maintain the normal level of estrogen. What is still uncertain is what happens when someone decides to stop taking those pills. However there is no proof that birth control pills cause any diseases related to the bones such as osteoporosis.

Cancer 

The link between breast cancer and birth control pills is still unclear. Few studies have shown different results and some suggest that there is a link while others suggest that there is absolutely no link between breast cancer and these pills. When it comes to cancer you should always be aware of family history of the disease, to consult a gynecologist or other doctors that can help you prevent it. What is interesting is that some scientist claim that women who take birth control pills lower their chances of getting uterine and ovarian cancer.

Sex Drive

It is well known that birth control pills reduce the level of testosterone in the body. Luckily, some women have high level of testosterone and taking pills does not affect their sexual desire. If you think that your sex drive is lowered because of the pills, consult a gynecologist who will look for another way to protect you against pregnancy.

Increased Weight

In the past there were cases where birth control pills made women gain weight while taking them. The main cause for this was the high level of estrogen which prevented the kidneys to excrete water from the body and what is interesting is that they have also stimulated a growth of the breasts. Modern birth control pills have low level of hormones (including estrogen) and don’t cause weight gain. Besides that they are even more effective when it comes to prevention of pregnancy compared to the pills from the past.

Skin

These pills can help you with acne and pimples because of the artificial estrogen that they contain. The estrogen reduces the level of testosterone which is responsible for the production of sebum that clogs pores and causes the formation of pimples.