rmany_12238294Infertility is the failure of a couple to conceive after one year of having regular, unprotected sexual intercourse. In women over the age of 35, it is often prudent to begin an evaluation of the couple after only 6 months. Nearly one in five couples experience infertility and seek treatment. There is a natural decline in fertility that comes with aging; this decline occurs more quickly after age 30. Primary infertility describes a couple who has never conceived, while secondary infertility refers to a couple who has achieved a pregnancy in the past but is unable to do so again. There are some differences in  evaluation and treatment for couples with secondary infertility, since theoretically, a couple who previously achieved a pregnancy had all the basic components of their reproductive systems intact. This implies a much greater likelihood that one or both partners have recently developed a problem that is responsible for their current infertility.

Menopause is the medical term for the end of a woman’s menstrual periods. It is a natural part of aging, and occurs when the ovaries stop making hormones called estrogens. This causes estrogen levels to drop, and leads to the end of monthly menstrual periods. The average age of menopause is 51, but it can also occur when the ovaries are surgically removed or stop functioning earlier.

Declining estrogen levels are linked to some uncomfortable symptoms in many women. The most common and easy to recognize symptom is hot flashes – sudden intense waves of heat and sweating. Some women find that these hot flashes disrupt their sleep, while others report mood changes. Other symptoms may include irregular periods, vaginal or urinary tract infections, urinary incontinence (leakage of urine or inability to control urine flow), and inflammation of the vagina.

Because of the changes in the urinary tract and vagina, some women may have discomfort or pain during sexual intercourse. Many women also notice changes in their skin, digestive tract, and hair during menopause. About 75% of women report some troublesome symptoms during menopause. In the long term, some women experience problems related to the low levels of estrogen found after menopause.

These problems include osteoporosis and increased risk for heart disease. The period of time leading up to menopause is often characterized by irregular periods. In fact, changes such as shorter or longer periods, heavier or lighter menstrual bleeding, and varying lengths of time between periods may be a sign that menopause is near. Estrogen is also now known to be important in memory and the healthy functioning of nerve cells in the brain.

Some studies have shown that estrogen replacement therapy can preserve brain activity and even improve memory. Treatment of menopausal women with replacement hormones can slow the rate of bone thinning and may prevent bones from breaking. In addition, it is important that women take in enough calcium in their diet to strengthen the bones.

Calcium is naturally found in many foods, including dairy products, and may also be added to a food (for instance, some orange juices now have calcium added). Calcium tablets are another good way to add to calcium to your diet. The goal should be to reach a total daily intake of 1000 milligrams per day before menopause or 1500 milligrams per day after menopause.

Regular weight-bearing exercise, like walking, may also help prevent osteoporosis. Finally, the rate of heart disease rises considerably in women after menopause- an increase that can be prevented by estrogen replacement. Some experts believe that estrogen replacement therapy may be the single most important factor in preventing heart disease in women.


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