<h2>What is type 2 diabetes?</h2>
  <p>Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by elevated blood glucose levels. In T2DM, the body either produces insufficient insulin or its cells become resistant to insulin’s effects. Insulin is the hormone that enables glucose to enter cells for energy. When insulin function is impaired, glucose accumulates in the bloodstream, leading to hyperglycemia.</p>
  <p>Type 2 diabetes was once called adult-onset diabetes but now occurs at younger ages due to rising obesity rates. Genetics, lifestyle, and environmental factors all contribute to its development.</p>

  <h2>Causes and risk factors</h2>
  <ul>
    <li>Genetic predisposition and family history</li>
    <li>Overweight and obesity, especially abdominal fat</li>
    <li>Insulin resistance in muscle, fat, and liver cells</li>
    <li>Physical inactivity and sedentary lifestyle</li>
    <li>Diets high in refined sugars, unhealthy fats, and processed foods</li>
    <li>Low levels of “good” HDL cholesterol and high triglycerides</li>
    <li>Age (risk rises after age 45)</li>
    <li>Ethnicity (higher risk in African Americans, Hispanics, Native Americans, Asian Americans, Pacific Islanders)</li>
    <li>History of gestational diabetes</li>
    <li>Medical conditions such as polycystic ovary syndrome (PCOS) and metabolic syndrome</li>
    <li>Certain medications (e.g., corticosteroids, some antipsychotics)</li>
  </ul>

  <h2>Symptoms</h2>
  <p>Type 2 diabetes can develop gradually. Common signs include:</p>
  <ul>
    <li>Increased thirst and frequent urination</li>
    <li>Unexplained weight loss despite increased appetite</li>
    <li>Persistent fatigue</li>
    <li>Blurred vision</li>
    <li>Slow wound healing and frequent infections</li>
    <li>Tingling or numbness in the hands and feet</li>
    <li>Darkened skin patches (acanthosis nigricans) in body folds</li>
  </ul>

  <h2>Diagnosis</h2>
  <p>Diagnosis typically involves one or more of the following blood tests:</p>
  <ul>
    <li>Fasting plasma glucose &ge; 126 mg/dL on two occasions</li>
    <li>Oral glucose tolerance test with 2-hour glucose &ge; 200 mg/dL</li>
    <li>Random plasma glucose &ge; 200 mg/dL in a person with classic symptoms</li>
    <li>Hemoglobin A1C &ge; 6.5%</li>
  </ul>
  <p>Additional tests may include lipid panels, liver and kidney function, and screening for complications.</p>

  <h2>Treatment</h2>
  <p>Management combines lifestyle changes, monitoring, and medications:</p>
  <ul>
    <li>Healthy eating: Emphasize whole grains, vegetables, lean proteins, and healthy fats</li>
    <li>Regular physical activity: Aim for at least 150 minutes of moderate exercise per week</li>
    <li>Weight management: Even modest weight loss can improve insulin sensitivity</li>
    <li>Blood sugar monitoring: Self-monitoring or continuous glucose monitoring as advised</li>
    <li>Oral and injectable medications:
      <ul>
        <li>Metformin to reduce liver glucose production</li>
        <li>Sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists</li>
        <li>Insulin therapy when other agents are insufficient</li>
      </ul>
    </li>
    <li>Control of blood pressure and lipids to reduce cardiovascular risk</li>
    <li>Education and support: Diabetes self-management training and regular follow-up</li>
  </ul>

  <h2>Complications</h2>
  <ul>
    <li>Heart disease, heart attack, and stroke</li>
    <li>Kidney damage (nephropathy) leading to renal failure</li>
    <li>Nerve damage (neuropathy) causing pain, numbness</li>
    <li>Eye damage (retinopathy) and vision loss</li>
    <li>Foot ulcers and risk of amputation</li>
    <li>Skin infections and slow wound healing</li>
    <li>Gum disease</li>
    <li>Increased susceptibility to infections</li>
  </ul>

  <h2>Resources</h2>
  <ul>
    <li>American Diabetes Association: <a href="https://diabetes.org/about-diabetes/type-2">Understanding Type 2 Diabetes</a></li>
    <li>National Institute of Diabetes and Digestive and Kidney Diseases: <a href="https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes">Type 2 Diabetes Overview</a></li>
    <li>Centers for Disease Control and Prevention: <a href="https://www.cdc.gov/diabetes/basics/type2.html">Type 2 Diabetes Basics</a></li>
    <li>NCBI Bookshelf: <a href="https://www.ncbi.nlm.nih.gov/books/NBK513253/">Type 2 Diabetes</a></li>
  </ul>

Type 2 Diabetes

<h2>Weight Loss</h2>
  <p>Over 75% of Americans are overweight or obese. An estimated 160 million people are dieting, spending more than $70 billion annually on weight-loss programs, medications, supplements, and other strategies. Sustainable weight loss relies on healthy lifestyle changes—balanced eating, regular activity, and stress management—rather than quick fixes or fad diets.</p>

  <h2>What is a healthy weight?</h2>
  <p>Body Mass Index (BMI) and waist circumference help screen for health risks. A BMI of 25–29.9 indicates overweight; over 30 indicates obesity. Weight loss is recommended for anyone with BMI over 30, or BMI 25–29.9 plus conditions such as type 2 diabetes, hypertension, or heart disease. A full health assessment should guide individual goals.</p>

  <h2>What causes weight gain?</h2>
  <h3>Energy balance</h3>
  <p>Consuming more calories than you burn leads to weight gain.</p>

  <h3>Environment</h3>
  <ul>
    <li>Lack of safe places to exercise (parks, sidewalks, gyms)</li>
    <li>Large portion sizes</li>
    <li>Limited access to affordable fresh produce</li>
  </ul>

  <h3>Genetics</h3>
  <p>Genes may predispose some people to obesity, though lifestyle factors usually play a key role.</p>

  <h3>Medications and health conditions</h3>
  <ul>
    <li>Hormone imbalances (hypothyroidism, PCOS, Cushing’s syndrome)</li>
    <li>Certain antidepressants, anticonvulsants, and corticosteroids</li>
  </ul>

  <h3>Stress and sleep</h3>
  <p>Poor sleep and high stress can disrupt appetite hormones, leading to increased calorie intake.</p>

  <h2>How to start losing weight</h2>
  <ul>
    <li>Work with a dietitian or healthcare provider for personalized guidance</li>
    <li>Adopt regular physical activity (aim for ≥150 minutes of moderate exercise weekly)</li>
    <li>Consider medication if lifestyle changes alone aren’t enough—options include liraglutide, semaglutide, tirzepatide, orlistat, and bupropion/naltrexone</li>
  </ul>

  <h2>What’s a healthy diet for weight loss?</h2>
  <p>There is no one “best” diet, but most effective plans share these features:</p>
  <ul>
    <li>Plant-based emphasis</li>
    <li>Whole, minimally processed foods</li>
    <li>Healthy fats in moderation (olive oil, avocado, nuts, seeds)</li>
    <li>Limited added sugars and refined carbs</li>
    <li>Balanced meals: protein, complex carbs, vegetables, and healthy fats</li>
  </ul>
  <p>Protein sources:</p>
  <ul>
    <li>Legumes and beans</li>
    <li>Nuts and seeds</li>
    <li>Fish and lean poultry</li>
    <li>Low-fat dairy</li>
  </ul>
  <p>Vegetables: Aim for about 2½ cups daily (leafy greens, bell peppers, tomatoes, squash). Note that starchy vegetables (potatoes, corn) count toward your carbohydrate portion.</p>

  <h2>Key points</h2>
  <ul>
    <li>Set realistic, gradual goals (1–2 pounds per week)</li>
    <li>Track progress and celebrate milestones</li>
    <li>Combine diet, exercise, and stress management</li>
    <li>Seek professional support for best outcomes</li>
  </ul>

  <h2>Resources</h2>
  <ul>
    <li><a href="https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity">NIDDK: Understanding Overweight & Obesity</a></li>
    <li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321865/">Effects of whole grains on appetite and energy intake</a></li>
  </ul>

Weight Loss

<h2>What is asthma?</h2>
  <p>Asthma is a chronic respiratory disease that affects the airways in the lungs. It occurs in people of all ages and often starts during childhood. In asthma the muscles around your airways become tight, causing the bronchial tubes to narrow. You can also have increased mucus production which clogs the airways even more. This can lead to shortness of breath, wheezing, coughing, and chest tightness. If not treated, asthma can be life-threatening. Severe asthma can also lead to the development of chronic obstructive pulmonary disease (COPD).</p>
  <p>More than 27 million Americans have asthma (about 1 in 12 people), including approximately 4.5 million children under the age of 18. Asthma symptoms can vary in severity and be triggered by allergens (pollen, dust mites, pet dander), respiratory infections, exercise, cold air, air pollution, smoke, and certain medications.</p>
  <p>While there is no cure for asthma, it can be managed with medications and lifestyle changes. Treatment typically involves daily controller medications to prevent symptoms, as well as rescue inhalers or nebulizers to deliver medication directly to your lungs during flare-ups. Avoiding known triggers also helps reduce symptoms.</p>

  <h2>What causes asthma?</h2>
  <p>The exact cause of asthma is not known, but it likely results from a combination of genetic and environmental factors:</p>
  <ul>
    <li>Genetic factors: Family history of asthma or allergic conditions (hay fever, eczema) increases risk.</li>
    <li>Environmental allergens: Pollen, dust mites, mold, pet dander, and cockroach droppings can trigger or worsen asthma.</li>
    <li>Respiratory infections: Early childhood viral infections can inflame airways and increase reactivity.</li>
    <li>Occupational/environmental irritants: Secondhand smoke, chemical fumes, poor air quality, and strong odors.</li>
    <li>Early childhood exposures: Tobacco smoke and pollutants during development increase later asthma risk.</li>
    <li>Obesity: May contribute via inflammation and altered lung mechanics.</li>
    <li>Stress: Emotional stress can trigger or worsen symptoms in some individuals.</li>
  </ul>

  <h2>What are the symptoms of asthma?</h2>
  <ul>
    <li>Shortness of breath: Difficulty breathing, ranging from mild to severe, at rest or during activity.</li>
    <li>Wheezing: High-pitched whistling sound on exhale (and sometimes inhale).</li>
    <li>Coughing: Persistent cough, often worse at night or early morning; may be dry or productive.</li>
    <li>Chest tightness: Sensation of pressure or constriction in the chest.</li>
    <li>Difficulty sleeping: Symptoms like coughing and wheezing can disrupt sleep.</li>
    <li>Fatigue: Increased effort to breathe can cause low energy levels.</li>
  </ul>
  <p>Some people experience asthma in specific contexts:</p>
  <ul>
    <li>Exercise-induced asthma: Triggered by physical activity, especially in cold, dry air.</li>
    <li>Occupational asthma: Caused by workplace irritants like chemical gases, fumes, or dust.</li>
    <li>Allergy-induced asthma: Triggered by airborne allergens such as pollen, mold, or pet dander.</li>
  </ul>

  <h2>How is asthma diagnosed?</h2>
  <ul>
    <li>Medical history: Review of symptoms, triggers, personal and family history of allergies or respiratory conditions.</li>
    <li>Physical exam: Listening to lungs for wheezing and ruling out other causes.</li>
    <li>Lung function tests (PFTs): Spirometry measures how much and how quickly you can exhale air.</li>
    <li>Peak flow monitoring: Handheld device tracks exhalation speed over time.</li>
    <li>Allergy testing: Skin prick or blood tests identify specific allergic triggers.</li>
    <li>Additional tests: Chest X-ray, CT scan, or evaluation for conditions like GERD or vocal cord dysfunction to exclude other causes.</li>
  </ul>
  <p>Based on these assessments, your healthcare provider will confirm an asthma diagnosis and develop a management plan.</p>

  <h2>How is asthma treated?</h2>
  <p>Treatment aims to control symptoms, prevent attacks, and maintain lung function:</p>

  <h3>Medications</h3>
  <ul>
    <li>Quick-relief (rescue) medications: Short-acting beta-agonists (e.g., albuterol) relax airway muscles during an attack.</li>
    <li>Controller medications: Daily inhaled corticosteroids (e.g., fluticasone, budesonide) and long-acting beta-agonists reduce inflammation and prevent symptoms.</li>
    <li>Leukotriene modifiers: Oral medications (e.g., montelukast) that reduce airway inflammation.</li>
    <li>Biologic therapies: Injected or infused treatments (e.g., mepolizumab, omalizumab) for severe asthma not controlled by other medications.</li>
    <li>Oral corticosteroids: Short-term use to quickly reduce inflammation during severe exacerbations.</li>
    <li>Allergy immunotherapy: Allergy shots to decrease sensitivity to specific triggers over time.</li>
  </ul>

  <h3>Lifestyle and management strategies</h3>
  <ul>
    <li>Avoiding triggers: Identify and minimize exposure to allergens and irritants.</li>
    <li>Healthy habits: Maintain a healthy weight, quit smoking, manage stress, and exercise regularly.</li>
    <li>Asthma action plan: Written plan from your provider outlining daily management and steps for flare-ups.</li>
    <li>Regular monitoring: Track symptoms, peak flow readings, and medication use; attend follow-up visits.</li>
    <li>Emergency preparedness: Know when to seek immediate care for severe attacks requiring rescue medications or hospitalization.</li>
  </ul>
  <p>With proper treatment and self-management, most people with asthma can live active, symptom-free lives.</p>

  <h2>Sources</h2>
  <ul>
    <li><a href="https://www.nhlbi.nih.gov/health/asthma">What is Asthma? National Heart, Lung, and Blood Institute.</a> Accessed Apr. 5, 2024.</li>
    <li><a href="https://www.cdc.gov/asthma/default.htm">Asthma. Centers for Disease Control and Prevention.</a> Accessed Apr. 5, 2024.</li>
    <li><a href="https://allergyasthmanetwork.org/what-is-asthma/">What is Asthma? Allergy and Asthma Network.</a> Accessed Apr. 5, 2024.</li>
    <li><a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/what-is-asthma">What is Asthma? American Lung Association.</a> Accessed Apr. 5, 2024.</li>
    <li><a href="https://acaai.org/asthma/asthma-101">Asthma 101. American College of Asthma, Allergy and Immunology.</a> Accessed Apr. 5, 2024.</li>
  </ul>

Asthma

<h2>What are allergies?</h2>
<p>Allergies occur when the immune system overreacts to normally harmless substances (allergens), producing IgE antibodies that trigger release of histamine and other chemicals. More than 50 million Americans are affected each year, making allergies the sixth most common chronic illness in the U.S. Symptoms range from sneezing and itching to life-threatening anaphylaxis.</p>

<h2>What causes allergies?</h2>
<p>Allergens that commonly trigger reactions include:</p>
<ul>
  <li>Pollen (trees, grasses, ragweed)</li>
  <li>Dust mites (household dust)</li>
  <li>Animal dander (skin flakes, saliva, urine)</li>
  <li>Mold spores (indoors and outdoors)</li>
  <li>Insect stings (bees, wasps, fire ants)</li>
  <li>Foods (peanuts, tree nuts, milk, eggs, soy, wheat, fish, shellfish)</li>
  <li>Medications (penicillin, NSAIDs)</li>
  <li>Latex (gloves, balloons)</li>
</ul>
<p>Genetic predisposition and environmental exposures (early life, diet, pollution) also influence who develops allergies.</p>

<h2>What are the symptoms of allergies?</h2>
<p>Symptoms vary by type of allergy and organ system involved:</p>
<ul>
  <li><strong>Rhinitis (hay fever):</strong> sneezing, runny/stuffy nose, itchy eyes, conjunctivitis</li>
  <li><strong>Food allergy:</strong> oral tingling, hives, facial swelling, vomiting, anaphylaxis</li>
  <li><strong>Insect sting allergy:</strong> local swelling, hives, wheezing, anaphylaxis</li>
  <li><strong>Drug allergy:</strong> rash, itching, breathing difficulty, anaphylaxis</li>
  <li><strong>Atopic dermatitis (eczema):</strong> dry, itchy, red, flaky skin</li>
</ul>
<p>Anaphylaxis is a medical emergency featuring low blood pressure, severe breathing difficulty, rapid pulse, nausea, lightheadedness, and possible loss of consciousness.</p>

<h2>How are allergies diagnosed?</h2>
<ul>
  <li><strong>Medical history and exam:</strong> symptom patterns, family history, physical signs</li>
  <li><strong>Skin prick tests:</strong> small amounts of allergen are introduced to the skin to observe wheal-and-flare reactions</li>
  <li><strong>Blood tests:</strong> specific IgE measurement (RAST or ImmunoCAP)</li>
  <li><strong>Patch tests:</strong> allergens applied under patches for contact dermatitis evaluation</li>
  <li><strong>Elimination diets:</strong> removing and reintroducing foods under supervision</li>
  <li><strong>Allergy challenge tests:</strong> controlled exposure to confirm severe reactions</li>
</ul>

<h2>How are allergies treated?</h2>
<ul>
  <li><strong>Avoidance:</strong> steer clear of known triggers (e.g., pollen, foods, latex)</li>
  <li><strong>Antihistamines:</strong> relieve sneezing, itching, runny nose</li>
  <li><strong>Decongestants:</strong> reduce nasal stuffiness (short-term use only)</li>
  <li><strong>Nasal corticosteroids:</strong> anti-inflammatory sprays for rhinitis</li>
  <li><strong>Leukotriene modifiers:</strong> block inflammatory mediators in asthma and rhinitis</li>
  <li><strong>Immunotherapy:</strong> allergy shots or sublingual tablets to desensitize over time</li>
  <li><strong>Epinephrine:</strong> auto-injector (EpiPen) for anaphylaxis emergencies</li>
  <li><strong>Adjuncts:</strong> saline nasal irrigation, barrier devices, latex-free products</li>

Allergies

<h2>What is heart failure?</h2>
  <p>Heart failure, often referred to as congestive heart failure, is a condition where the heart muscle does not pump blood to the rest of the body as well as it should. Blood moves through the heart and body more slowly, and pressure in the heart increases. As a result, the heart cannot supply enough oxygen-rich blood and nutrients to meet the body’s needs.</p>
  <p>Heart failure can develop because of medical conditions that damage the heart or make it work harder, such as coronary artery disease, high blood pressure, faulty heart valves, irregular heartbeat, cardiomyopathy, inflammation, and congenital heart defects. Lifestyle factors like obesity, a high-fat diet, and a sedentary lifestyle also increase the risk.</p>
  <p>Symptoms include shortness of breath, fatigue, swollen legs, and rapid heartbeat. Treatment involves medications, lifestyle changes, and sometimes surgery to manage symptoms and prevent progression.</p>

  <h2>What are the types of heart failure?</h2>
  <ul>
    <li>Left-sided heart failure: fluid backs up into the lungs, causing shortness of breath.</li>
    <li>Right-sided heart failure: fluid backs up into the abdomen, legs, and feet, causing swelling.</li>
    <li>Heart failure with reduced ejection fraction (HFrEF): also called systolic heart failure, where the left ventricle cannot squeeze effectively.</li>
    <li>Heart failure with preserved ejection fraction (HFpEF): also called diastolic heart failure, where the left ventricle cannot relax or fill fully.</li>
  </ul>

  <h2>What causes heart failure?</h2>
  <p>Heart failure is caused by conditions that damage the heart muscle or increase its workload. Common causes and risk factors include:</p>
  <ul>
    <li>Coronary artery disease: narrowed arteries reduce blood flow to the heart.</li>
    <li>High blood pressure: forces the heart to work harder over time.</li>
    <li>Heart attack: sudden blockage damages heart muscle.</li>
    <li>Cardiomyopathy: diseases of the heart muscle from genetics, infection, alcohol, or drugs.</li>
    <li>Faulty heart valves: increase workload due to improper opening or closing.</li>
    <li>Arrhythmias: abnormal rhythms make the heart pump less efficiently.</li>
    <li>Infections: myocarditis, rheumatic fever, endocarditis can damage the heart.</li>
    <li>Chronic diseases: diabetes, severe anemia, thyroid disorders, pulmonary hypertension, emphysema, lupus.</li>
    <li>Lifestyle factors: obesity, high-fat diet, physical inactivity.</li>
  </ul>

  <h2>What are the symptoms of heart failure?</h2>
  <p>Symptoms vary by type, severity, and whether the condition is acute or chronic:</p>
  <ul>
    <li>Shortness of breath (dyspnea) during activity, rest, or when lying flat</li>
    <li>Persistent cough or wheezing producing white or pink mucus</li>
    <li>Edema: swelling in feet, ankles, legs, or abdomen</li>
    <li>Fatigue and difficulty performing daily activities</li>
    <li>Loss of appetite and nausea due to fluid buildup around the liver and intestines</li>
    <li>Impaired thinking or confusion from reduced brain blood flow</li>
    <li>Rapid or irregular heartbeat compensating for poor pumping</li>
    <li>Weight gain from fluid retention or weight loss from poor nutrient absorption</li>
  </ul>

  <h2>How is heart failure diagnosed?</h2>
  <ul>
    <li>Medical history and physical exam: review symptoms, risk factors, and check for fluid buildup</li>
    <li>Blood tests: measure natriuretic peptides (BNP, NT-proBNP) and assess kidney, liver, and thyroid function</li>
    <li>Chest X-ray: shows heart size and fluid in lungs</li>
    <li>Electrocardiogram (ECG/EKG): records heart’s electrical activity and detects damage or arrhythmias</li>
    <li>Echocardiogram: ultrasound measures ejection fraction and visualizes heart structure and function</li>
    <li>Stress test: evaluates heart performance during exercise</li>
    <li>Cardiac MRI or CT scan: detailed imaging of heart anatomy and function</li>
    <li>Cardiac catheterization: measures pressures inside the heart and checks for arterial blockages</li>
  </ul>

  <h2>How is heart failure treated?</h2>
  <h3>Lifestyle changes</h3>
  <ul>
    <li>Low-salt diet to reduce fluid retention</li>
    <li>Regular exercise as tolerated, in consultation with a healthcare provider</li>
    <li>Weight management to reduce cardiac workload</li>
    <li>Smoking cessation and limiting alcohol intake</li>
  </ul>

  <h3>Medications</h3>
  <ul>
    <li>ACE inhibitors and ARBs: relax blood vessels and lower blood pressure</li>
    <li>ARNI (sacubitril/valsartan): enhances vasodilation and fluid removal</li>
    <li>Beta-blockers: reduce heart rate and workload</li>
    <li>Diuretics: remove excess fluid to ease symptoms</li>
    <li>Aldosterone blockers: reduce fluid retention and prevent heart scarring</li>
    <li>Digoxin: strengthens heart contractions</li>
    <li>SGLT2 inhibitors: improve outcomes and reduce hospitalizations</li>
    <li>Vasodilators: widen blood vessels to decrease cardiac workload</li>
  </ul>

  <h3>Devices and procedures</h3>
  <ul>
    <li>Implantable cardioverter defibrillators (ICDs) to prevent sudden arrhythmic death</li>
    <li>Cardiac resynchronization therapy (CRT) pacemakers to improve ventricular coordination</li>
    <li>Ventricular assist devices (VADs) to mechanically pump blood</li>
    <li>Coronary artery bypass grafting (CABG) to restore blood flow past blockages</li>
    <li>Heart transplant for end-stage, refractory heart failure</li>
  </ul>

  <h2>Ongoing care</h2>
  <p>Regular follow-up with a healthcare team—including cardiologists, primary care physicians, and heart failure specialists—is essential to monitor disease progression, adjust treatments, and support self-care.</p>

  <h2>Sources</h2>
  <ul>
    <li>What is Heart Failure? American Heart Association. Accessed Apr. 25, 2024.</li>
    <li>Heart failure. National Heart, Lung, and Blood Institute. Accessed Apr. 25, 2024.</li>
    <li>Heart failure (HF). Merck Manual Professional Version. Accessed Apr. 25, 2024.</li>
    <li>Heidenreich PA, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022; doi:10.1161/CIR.0000000000001063.</li>
  </ul>

Heart Failure

<h2>What is menopause?</h2>
  <p>Menopause is a natural biological process that marks the end of a woman’s reproductive years. It occurs when the ovaries gradually produce less estrogen and progesterone, the hormones regulating menstruation. Menopause is diagnosed after a woman has gone 12 consecutive months without a menstrual period. In the United States, the average age of natural menopause is around 51 years. When menopause occurs before age 45, it is called early menopause; before age 40, it is considered premature menopause.</p>
  <p>The transition leading up to menopause, called perimenopause, may last several years and is characterized by menstrual irregularities and symptoms such as hot flashes. Common symptoms of menopause include hot flashes, night sweats, mood changes, sleep disturbances, vaginal dryness, and increased risk of osteoporosis. Menopause can also be induced surgically or by certain medical treatments.</p>
  
  <h2>What causes menopause?</h2>
  <p>Menopause results primarily from the natural decline in ovarian hormone production. Other causes include:</p>
  <ul>
    <li>Oophorectomy: Surgical removal of the ovaries causes immediate menopause and often severe symptoms due to abrupt hormonal changes.</li>
    <li>Chemotherapy and radiation therapy: Treatments for cancer can induce menopause during or shortly after therapy.</li>
    <li>Primary ovarian insufficiency (POI): In about 1% of women, ovarian function fails before age 40, often for unknown or genetic reasons.</li>
    <li>Hysterectomy: Removal of the uterus alone does not immediately cause menopause; however, removal of both uterus and ovaries does.</li>
  </ul>
  
  <h2>What are the signs and symptoms of menopause?</h2>
  <ul>
    <li>Hot flashes: Sudden warmth, often over the face, neck, and chest, followed by sweating and chills.</li>
    <li>Night sweats: Hot flashes during sleep, leading to disrupted rest.</li>
    <li>Irregular periods: During perimenopause, cycles may become shorter, longer, heavier, or lighter.</li>
    <li>Mood changes: Increased irritability, anxiety, or risk of depression.</li>
    <li>Vaginal dryness: Reduced lubrication and thinning of vaginal tissues, which can cause discomfort during intercourse.</li>
    <li>Sleep problems: Insomnia or poor sleep quality, often related to night sweats.</li>
    <li>Thinning hair and dry skin: Changes in hormone levels can affect skin and hair health.</li>
    <li>Bladder control issues: Loss of tissue elasticity can lead to incontinence or urgency.</li>
    <li>Weight gain and slowed metabolism: Hormonal shifts can make weight management more difficult.</li>
    <li>Osteoporosis: Lower estrogen levels contribute to bone density loss.</li>
    <li>Cholesterol changes: Menopause may increase LDL (“bad”) cholesterol, raising cardiovascular risk.</li>
  </ul>
  <p>If any vaginal bleeding occurs after menopause, seek medical attention immediately.</p>
  
  <h2>How is menopause diagnosed?</h2>
  <p>Diagnosis is based on menstrual history and symptoms. A woman who has not menstruated for 12 months is considered menopausal, unless menopause was induced surgically or by treatments. Blood tests may include:</p>
  <ul>
    <li>Follicle-stimulating hormone (FSH): Levels rise as ovarian function declines.</li>
    <li>Estrogen: Levels fall during the transition.</li>
    <li>Thyroid-stimulating hormone (TSH): Measured if thyroid disorders are suspected.</li>
  </ul>
  
  <h2>How is menopause treated?</h2>
  <p>Treatment aims to relieve symptoms and reduce long-term risks:</p>
  <ul>
    <li>Hormone replacement therapy (HRT): Effective for hot flashes, night sweats, and osteoporosis prevention; carries some risks and requires individualized assessment.</li>
    <li>Vaginal estrogen: Administered as a cream, tablet, or ring to alleviate dryness and urinary symptoms.</li>
    <li>Low-dose antidepressants: Certain SSRIs can reduce hot flashes.</li>
    <li>Gabapentin: Originally for seizures, can also help with vasomotor symptoms.</li>
    <li>Clonidine: A blood pressure medication that may ease hot flashes.</li>
    <li>Osteoporosis treatments: Calcium, vitamin D, and medications to strengthen bone.</li>
    <li>Lifestyle changes: Stress reduction (yoga, meditation), healthy diet, regular exercise, smoking cessation, and layered clothing for hot flashes.</li>
  </ul>
  
  <h2>What is postmenopause?</h2>
  <p>Postmenopause begins 12 months after the final menstrual period. While many symptoms improve, some women continue experiencing hot flashes and other effects for years. Lower estrogen levels increase the risk of osteoporosis and cardiovascular disease.</p>
  
  <h2>How long does menopause typically last?</h2>
  <p>Perimenopause can begin up to 10 years before the final period, often in the 40s. Once 12 consecutive months without menstruation have passed, a woman is postmenopausal. Surgical removal of ovaries causes immediate menopause.</p>
  
  <h2>Sources</h2>
  <ul>
    <li>Menopause basics. Office on Women’s Health. Accessed Apr. 11, 2024.</li>
    <li>Menopausal symptoms: In depth. National Center for Complementary and Integrative Health. Accessed Apr. 11, 2024.</li>
    <li>Menopause. National Institutes of Health. Accessed Apr. 11, 2024.</li>
    <li>What is Menopause? National Institute on Aging. Accessed Apr. 11, 2024.</li>
  </ul>

Menopause

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