Menopause

In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:

• Irregular periods
• Vaginal dryness
• Hot flashes
• Chills
• Night sweats
• Sleep problems
• Mood changes
• Weight gain and slowed metabolism
• Thinning hair and dry skin
• Loss of breast fullness

Symptoms, including changes in menstruation, are different for every woman. Most likely, you'll experience some irregularity in your periods before they end.

Menopause requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. Treatments may include:

• Hormone therapy. Estrogen therapy is the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose and the shortest time frame needed to provide symptom relief for you. If you still have your uterus, you'll need progestin in addition to estrogen. Estrogen also helps prevent bone loss. Long-term use of hormone therapy may have some cardiovascular and breast cancer risks, but starting hormones around the time of menopause has shown benefits for some women. You and your doctor will discuss the benefits and risks of hormone therapy and whether it's a safe choice for you.
• Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissues. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
• Low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. A low-dose antidepressant for management of hot flashes may be useful for women who can't take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
• Gabapentin (Neurontin, Gralise, others). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can't use estrogen therapy and in those who also have nighttime hot flashes.
• Clonidine (Catapres, Kapvay, others). Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes.
• Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. Your doctor might prescribe vitamin D supplements to help strengthen bones.

A common virus called human papillomavirus (HPV) causes cervical dysplasia. HPV is a sexually transmitted virus, and there are hundreds of strains. Some are low-risk and cause genital warts. Others are high-risk and cause cell changes that can turn into cervical dysplasia and cancer.

According to the Journal of the American Medical Association (JAMA), an estimated 26.8 percent of U.S. women have tested positive for one or more strains of HPV.

Are there risk factors for cervical dysplasia?

There are several risk factors for cervical dysplasia, some of which relate directly to the risk of HPV:

• having an illness that suppresses the immune system
• being on immunosuppressant drugs
• having multiple sexual partners
• giving birth before the age of 16
• having sex before the age of 18
• smoking cigarettes

If you’re sexually active, a condom might reduce your risk of getting HPV. But the virus can still live on the skin surrounding the genitals not covered by the condom.

Treatment of cervical dysplasia

Treatment of cervical dysplasia depends on the severity of the condition. Mild dysplasia might not be treated immediately since it can resolve without treatment. Repeat Pap smears may be done every three to six months.

For CIN 2 or 3, treatment can include:

• cryosurgery, which freezes abnormal cells
• laser therapy
• loop electrosurgical excision procedure (LEEP), which uses electricity to remove affected tissue
• cone biopsy, in which a cone-shaped piece of the cervix is removed from the location of the abnormal tissue

Dysplasia is usually caught early because of regular Pap tests. Treatment typically cures cervical dysplasia, but it can return. If no treatment is given, the dysplasia may get worse, potentially turning into cancer.