Oak Street Medical Blog

Most women know that menopause is marked by their last menstrual period and signifies the end of their fertility. What about fertility from the time the menstrual cycles begin to change to the time of menopause? This is called the menopause transition and fertility during this time is significantly reduced.

The menopause transition, sometimes called the peri-menopause, starts when menstrual cycles begin to change and ends with the final menstrual period (recognized only after 12 consecutive months of no menses). Ninety percent of women experience four to eight years of menstrual changes before their natural menopause.

Age can't predict menopause onset
In the United States, natural menopause occurs at an average age of 51.4 years but is considered normal any time between the ages of 40 to 60. Because women vary widely in the timing of their menopause transition, age alone is an inaccurate predictor of a woman's reproductive age.

If a woman is destined to have her last menstrual period at age 42, she will likely experience difficulty trying to conceive by the age of 34 to 37. The decrease in fertility depends on the quality of her eggs and to some extent, the declining number of eggs.

How egg loss happens
During a woman's fetal development she will have 1 to 2 million oocytes (eggs) in her ovaries. Follicular loss begins in utero and by the time she is born, she will have approximately 600,000. While that is still a huge number, many women wonder how we lose so many eggs so quickly.

Most follicular loss occurs through a process called apoptosis or atresia and not by ovulation. As a woman goes through her monthly menstrual cycle, she will recruit or "awaken" a number of follicles all vying to become the follicle of the month. Most of these awakened follicles will die off, leaving only one that continues to grow and ovulate. At age 17, a woman may awaken as many as 20 to 40 eggs each month. By age 30, that number can drop to 10 or 15 and by age 40 she will likely recruit only two to four follicles.

This oocyte die-off is continuous and occurs even if a woman is on birth control medication. For most women, the process begins to accelerate around the age of 37 until menopause.

For more information
If a woman has not completed her family and is interested in knowing her ovarian "reproductive age" there is testing available. Contact me, Jeannie Merrick, R.N., W.H.C.N.P., at Oak Street Medical for an appointment.

Every day in the United States, 30 women are diagnosed and 11 women die from cervical cancer, the second leading cancer in women worldwide. January is National Cervical Cancer Awareness Month and health advocates, including me, are urging women to protect themselves – and their mothers, daughters, sisters and friends – from this preventable disease.

What is cancer of the cervix?
A woman’s cervix is the opening of the uterus at the top of the vagina and it is made up of healthy cells that grow, divide and replace themselves, as needed. Cancer of these cells causes them to divide more rapidly, growing into deeper cell layers or spreading to other organs. 

What causes cervical cancer?
The main cause of cervical cancer is persistent infections from what is known as “high-risk” types of the human papillomavirus (HPV).  HPV is a very common sexually transmitted infection that three out of every four adults will have at some time in their lives. Most of these infections go away without treatment. Infections that do not go away on their own can lead to cervical cancer.

Who is at risk for cervical cancer?
The biggest risk factor for cervical cancer is infection with high-risk HPV. Your risk of becoming infected with HPV increases if you have or had multiple sexual partners; you have or had a partner who has had multiple sexual partners; and if your first sexual contact was early – younger than 18 years of age. Other risk factors include:

• Smoking

• Problems with the immune system

• Having another sexually transmitted infection, such as chlamydia

What is the Pap test?
The Pap is a simple test that takes a few cells from the cervical canal and is highly effective at detecting abnormal cells that can lead to cervical cancer. There is a small false negative rate – meaning the test returns normal but there is actually disease present – but this rate is diminished when Pap smears are done annually for several years. It usually takes several years for abnormal cervical cells to progress into cancer and the Pap test can detect pre-cancerous cells and early treatment can begin before the disease becomes cancer.

Are there symptoms of cervical cancer?
There are a few early signs of cervical cancer, including abnormal bleeding, spotting or watery discharge from the vagina. Bleeding may occur after sex and some women notice heavier than normal menstrual bleeding. Signs of advanced cancer can include pelvic pain, trouble urinating and swollen legs.

What can I do to prevent cervical cancer?
There are several ways to lower your risk of developing cervical cancer.

Girls and young women can talk to their healthcare provider about the HPV vaccine, which protects against the two types of HPV that cause the majority of cervical cancers. The vaccines are recommended for girls as early as 11 years old (before they become sexually active) and are approved for girls and young women up to age 26.

On October 25, 2011, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of HPV vaccine in males aged 11 or 12 years. ACIP also recommended vaccination with HPV for males aged 13 through 26 years who have not been vaccinated previously.

One of the best ways to reduce your risk is to use condoms with any new partner.

In addition, all women ages 21 and older should get a Pap test, which detects abnormal cells that can lead to cervical cancer. If you are 30 and older, you should get the PAP test and the HPV test together as part of routine cervical cancer screening.

If you would like to schedule an appointment, please contact us at 541-431-0000.