Besides discomfort or pain, another fairly common menstrual difficulty is amenorrhea (ay-meh-nuh-REE-uh), the absence of menstruation. Two types of amenorrhea exist: primary and secondary. Primary amenorrhea is the failure to begin to menstruate at puberty. It can be caused by problems with the reproductive organs, hormonal imbalances, poor health, or an imperforate hymen. Secondary amenorrhea involves the disruption of an established menstrual cycle, with the absence of menstruation for 3 months or more (Hormone Foundation, 2011). This is a normal condition during pregnancy and breast-feeding. It is also common in women who have just begun menstruating and in women approaching menopause. Women who discontinue birth control pills occasionally do not menstruate for several months, but this situation is usually temporary and resolves spontaneously.
Amenorrhea is more common among athletes than among the general population (Colino, 2006). Women who experience athletic amenorrhea also have decreased estrogen levels. This reduction in estrogen can place them at increased risk for developing serious health problems, such as decreased bone mineral density, with a resultant increased incidence of bone fractures and atrophy of the genital tissues. Athletic amenorrhea can be reversed by improving diet, gaining weight, or, in some cases, decreasing training intensity (Epp, 1997). Anabolic steroid use to attempt to enhance athletic performance will, among
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around 40 years of age, the ovaries begin to slow the production of estrogen. This period before complete cessation of menstruation is called perimenopause, and it can last for up to 10 years. Menstruation continues but cycles can become irregular, with erratic or heavy bleeding as menopause approaches (Bastian et al., 2003). Up to 90% of women experience a change in menstrual patterns and sexual response during perimenopause. Also, by age 40 a woman’s level of circulating testosterone is half what it was when she was 20 years old (S. Davis, 2000). Some women in perimenopause experience symptoms similar to those described in the following menopause section (Torpy, 2003). Low-dose birth control pills are sometimes prescribed to alleviate the perimenopausal symptoms and to prevent bone loss (Seibert et al., 2003).
Menopause, one of the events of the female climacteric, is the permanent cessation of menstruation. Menopause occurs as a result of certain physiological changes and takes place at a mean age of 51 but can occur in the 30s or as late as the 60s (Andrews, 2006). About 10% of women reach menopause by age 45 (Speroff & Fritz, 2005). Research indicates that women who experience earlier menopause smoke tobacco, began their periods by age 11, had shorter cycles, had fewer pregnancies, had used oral contraceptives, had a history of endometriosis, and had higher blood levels of perfluorocarbons (man-made chemicals used in many household products) (Knox et al., 2011; Palmer et al., 2003; Pokoradi et al., 2011).
The experience of menopause varies greatly from woman to woman. Some women experience few physical symptoms other than cessation of menstruation. For these women menopause is surprisingly uneventful:
After hearing comments for years about how menopause was so traumatic, I was ready for the worst. I was sure surprised when I realized I had hardly noticed it happening. (Authors’ files)
A recent research study found that women who reported fewer symptoms of menopause had more positive views of the effects of menopause on their health and attractiveness (Strauss, 2011). In addition, most women feel relieved that they no longer need to be concerned about pregnancy, contraception, and menstruation. They may experience an increased sense of freedom in sexual intimacy as a result (Andrews, 2006).
However, for many women, menopause brings a range of symptoms that can vary from mild to severe (Pinkerton & Zion, 2006). The most acute menopausal symptoms occur in the two years before and the two years following the last menstrual period. Hot flashes and night sweats are common difficulties. Hot flashes can range from a mild feeling of warmth to a feeling of intense heat and profuse perspiration, especially around the chest, neck, and face. A severe hot flash can soak clothing or sheets in perspiration. The flashes usually last for one to five minutes. Hot flashes can occur several times a day and during sleep. About 75% of women experience hot flashes, and women smokers experience hot flashes more frequently than nonsmokers (Staropoli et al., 1997). For unknown reasons, African American women experience more hot flashes and women of Asian descent have fewer hot flashes than other racial and ethnic groups (Avis et al., 2001). Researchers have studied the physiology of hot flashes for over 30 years and still do not know how hot flashes occur (Schatz & Robb-Nicholson, 2006).
Other menopausal symptoms can significantly affect a woman’s daily life and, indirectly, her sexuality. Research has found that sleep disturbance, night sweats, and symptoms of depression are associated with a decrease in sexual interest (Reed et al., 2007). Thinning of the vaginal walls and less lubrication as a result of the decline in estrogen can make intercourse uncomfortable or painful (Krychman, 2011). A woman may take longer to become sexually aroused. Sleep disturbance can easily contribute to fatigue, irritability, short-term memory loss, and difficulty concentrating during the day (Maki et al., 2008).