Menopause

Menopause at a glance

  • Menopause is signaled by absence of menses (menstrual period) for 12 months, indicating that a woman is no longer releasing eggs and her ovaries’ production of the hormones estrogen and progesterone is reduced.
  • Menopause, which renders a woman infertile, is a natural process that generally happens in a woman’s 40s or 50s, with the average age of menopause in the United States being 51, according to the American Society for Reproductive Medicine.
  • Most women will start having substantially decreased fertility in their late 30s or early 40s, and this decrease is dramatically lower in the mid-40s with the start of perimenopause, which can begin six to eight years before menopause.
  • Lifestyle changes can help women manage the symptoms of menopause, such as hot flashes and emotional upset.
  • Women who experience severe and debilitating symptoms are often treated with hormone replacement therapy.

What is menopause?

Women are said to enter menopause, a normal part of aging in females, when they have not had their monthly period for a year. Women who reach menopause cannot conceive a child naturally or through in vitro fertilization (IVF). Menopause generally occurs in a woman’s late 40s to early 50s, with 51 being the average age in the U.S.

Most of the time women experience natural menopause, when their eggs are depleted and the ovaries reduce production of estrogen and progesterone, the hormones that control menstrual cycles and other functions of a woman’s body. Women who enter menopause naturally go through gradual changes beginning with perimenopause.

Perimenopause, which occurs when the ovaries begin slowly producing less of the hormone estrogen, can begin eight to 10 years before full menopause, with an average duration of four years. Women still have periods during perimenopause and can still become pregnant. During the last year or two of perimenopause, many women begin to experience symptoms of menopause (see below) because the drop in estrogen production accelerates at this time.

After perimenopause and menopause, women are said to be in postmenopause. Most women notice a drop in symptoms at this time. Since estrogen levels are so low in postmenopause, many women are at higher risk of heart disease and osteoporosis.

This is the time when hormone replacement therapy or lifestyle changes may be recommended to reduce a woman’s risk of these conditions. Each woman’s situation is different, and a thorough discussion with her physician is in order before taking steps to prevent such conditions.

Menopause can begin sooner for some women due to their ovaries not functioning, because of medical treatments such as chemotherapy, or having an oophorectomy (removal of the ovaries). When menopause happens to a woman before age 40, it’s called premature menopause or primary ovarian insufficiency.

There’s usually no need to diagnose menopause due to obvious symptoms. Occasionally doctors may use urine or blood tests to check for hormone levels indicating whether a woman is close to menopause or already has gone through it.

Symptoms of menopause

Symptoms of menopause often begin in a woman’s 40s and can last for up to a decade. They are caused by hormonal changes.

A woman’s menstrual cycle is regulated by the ebb and flow of reproductive hormones that trigger the chain of events in menstruation. In menopause, this cycle of egg preparation no longer occurs, and the hormones that were involved are significantly decreased. However, the ovaries and the adrenal gland continue to produce androgen (male) hormones, such as testosterone.

The levels of all of these hormones vary among individuals, affecting the presence and severity of menopause symptoms a woman may experience. Symptoms of menopause and perimenopause include:

  • Difficulty sleeping.
  • Night sweats.
  • Hot flashes (sudden warmth spreading over the upper body).
  • Mood swings, depression, anxiety, irritability.
  • Irregular menstrual cycles.
  • Urination urges such as frequency.
  • Vaginal dryness.
  • Dry skin, eyes or mouth.

Women in perimenopause may also experience irregular periods or skipped periods. Symptoms of a racing heart, headaches, urinary changes or other symptoms are cause for seeking medical attention.

Individual women experience a variety of symptoms and in varying degrees. Symptoms can come and go at different times. It’s important for women to pay attention to how they react to symptoms and to see a doctor if they feel their symptoms are unusually severe.

Treatment of menopause

There is no “cure” for menopause, but there are some treatments for menopausal symptoms that may be particularly useful for women experiencing severe symptoms. Lifestyle changes can alleviate symptoms and so can hormone replacement therapy (HRT). A woman’s decision to try treatments depends on her health in general, the severity of her symptoms, and her personal preferences.

Hormone replacement therapy

Hormone replacement therapy replaces the hormone estrogen, and sometimes the progesterone hormone, that a woman produces less of in perimenopause or menopause. Hormone replacement can reduce symptoms, particularly hot flashes.

HRT should only be considered after thorough counseling with a physician who is familiar with the woman’s health history. There are several studies that question the benefits of HRT and others that suggest it may increase a woman’s risk of developing heart disease, breast cancer, blood clots and stroke. Women should speak with their physician about the potential risks and benefits of HRT.

Some guidelines for HRT include:

  • HRT can be used for women recently entering menopause.
  • HRT should not be used longer than necessary.
  • HRT is not appropriate for women who entered menopause many years prior.
  • Women at risk for stroke, heart disease, breast cancer or blood clots should not use HRT.
  • Vaginal estrogen can be applied topically (locally) to reduce vaginal dryness.

In addition to HRT, some medications can reduce hot flashes, moodiness and other symptoms. These include some antidepressants, the blood pressure medication clonidine and the seizure drug gabapentin.

Lifestyle changes

Women can alter their behavior in order to adapt to the symptoms of menopause. They can identify and avoid things that trigger their symptoms, such as spicy foods that cause hot flashes.

Lifestyle changes include:

  • Avoid alcohol, caffeine and spicy foods.
  • Eat a healthy diet.
  • Include calcium and vitamin D in diet.
  • Eat soy foods, which contain estrogen.
  • Exercise frequently.
  • Get stress reduction treatments, or do yoga or meditation.
  • Do Kegel exercises.
  • Manage weight.
  • Do deep breathing when hot flashes come on.
  • Keep having sex and use water-based lubricants or a vaginal moisturizer.