Menopause
Introduction
Menopause is a point in time when a person has gone 12 consecutive months without a menstrual period. Menopause is a natural part of aging and marks the end of your reproductive years. On average, menopause happens at age 51.
Menopause is a point in time when you’ve gone 12 consecutive months without a menstrual cycle. The time leading up to menopause is called perimenopause. This is when a lot of women or people assigned female at birth (AFAB) start to transition to menopause. They may notice changes in their menstrual cycles or have symptoms like hot flashes.
Identification
You’ll know you’ve reached menopause when you’ve gone 12 consecutive months without a menstrual period. Contact your healthcare provider if you have any type of vaginal bleeding after menopause. Vaginal bleeding after menopause could be a sign of a more serious health issue.
Three Phases
Natural menopause is the permanent ending of menstruation that doesn’t happen because of any type of medical treatment. The process is gradual and happens in three stages:
Perimenopause or “menopause transition”: Perimenopause can begin eight to 10 years before menopause when your ovaries gradually produce less estrogen. It usually starts when you’re in your 40s. Perimenopause lasts up until menopause, the point when your ovaries stop releasing eggs. In the last one to two years of perimenopause, the drop in estrogen accelerates. At this stage, many people may experience menopause symptoms. But, you’re still having menstrual cycles during this time and can get pregnant.
Menopause: Menopause is the point when you no longer have menstrual periods. At this stage, your ovaries have stopped releasing eggs and stopped producing most of their estrogen. A healthcare provider diagnoses menopause when you’ve gone without a menstrual period for 12 consecutive months.
Postmenopause: This is the name given to the time after you haven’t had a period for an entire year (or the rest of your life after menopause). During this stage, menopausal symptoms, such as hot flashes, may get better. However, some people continue to experience menopausal symptoms for a decade or longer after the menopause transition. As a result of a lower estrogen level, people in the postmenopausal phase are at an increased risk for several health conditions, such as osteoporosis and heart disease.
Normal age for Menopause
The average age of menopause in the United States is approximately 51 years old. However, the transition to menopause usually begins in your mid-40s.
Menopause
When menopause happens on its own (natural menopause), it’s a normal part of aging. Menopause is defined as a complete year without menstrual bleeding, in the absence of any surgery or medical condition that may cause bleeding to stop such as hormonal birth control, radiation therapy or surgical removal of your ovaries.
As you age, your reproductive cycle begins to slow down and prepares to stop. This cycle has been continuously functioning since puberty. As menopause nears, your ovaries make less of a hormone called estrogen. When this decrease occurs, your menstrual cycle (period) starts to change. It can become irregular and then stop.
Physical changes can also happen as your body adapts to different levels of hormones. The symptoms you experience during each stage of menopause (perimenopause, menopause and postmenopause) are all part of your body’s adjustment to these changes.
Hormonal changes
The traditional changes we think of as “menopause” happen when your ovaries no longer produce high levels of hormones. Your ovaries are the reproductive glands that store and release eggs. They also produce the hormones estrogen and progesterone. Together, estrogen and progesterone control menstruation. Estrogen also influences how your body uses calcium and maintains cholesterol levels in your blood.
As menopause nears, your ovaries no longer release eggs, and you’ll have your last menstrual cycle.
Symptoms and Causes
You may be transitioning into menopause if you begin experiencing some or all of the following symptoms:
Hot flashes, also known as vasomotor symptoms (a sudden feeling of warmth that spreads over your body).
Night sweats and/or cold flashes.
Vaginal dryness that causes discomfort during sex.
Urinary urgency (a pressing need to pee more frequently).
Difficulty sleeping (insomnia).
Emotional changes (irritability, mood swings or mild depression).
Dry skin, dry eyes or dry mouth.
Breast tenderness.
Worsening of premenstrual syndrome (PMS).
Irregular periods or periods that are heavier or lighter than usual.
Some people might also experience:
Racing heart.
Headaches.
Joint and muscle aches and pains.
Changes in libido (sex drive).
Difficulty concentrating or memory lapses (often temporary).
Weight gain.
Hair loss or thinning.
Changes in your hormone levels cause these symptoms. Some people may have intense symptoms of menopause, while others have mild symptoms. Not everyone will have the same symptoms as they transition to menopause.
Contact a healthcare provider if you’re unsure if your symptoms are related to menopause or another health condition.
Diagnosis and Tests
There are several ways your healthcare provider can diagnose menopause. The first is discussing your menstrual cycle over the last year. Menopause is unique in that your provider diagnoses it after it occurs. If you’ve gone a full year (12 straight months) without a period, you’ve entered menopause and may be postmenopausal.
Management and Treatment
Menopause is a natural process that your body goes through. In some cases, you may not need any treatment for menopause. When discussing treatment for menopause with your provider, it’s about treating the symptoms of menopause that disrupt your life. There are many different types of treatments for the symptoms of menopause. The main types of treatment for menopause are:
1. Hormone therapy.
2. Nonhormonal treatments.
It’s important to talk to your healthcare provider while you’re going through menopause to craft a treatment plan that works for you. Every person is different and has unique needs.
Hormone Therapy
During menopause, your body goes through major hormonal changes — decreasing the amount of hormones it makes. Your ovaries produce estrogen and progesterone. When your ovaries no longer make enough estrogen and progesterone, hormone therapy can make up for lost hormones. Hormone therapy boosts your hormone levels and can help symptoms like hot flashes and vaginal dryness. It can also help prevent osteoporosis.
There are two main types of hormone therapy:
Estrogen therapy (ET): In this treatment, you take estrogen alone. Your provider prescribes it in a low dose. Estrogen comes in many forms, such as a patch, pill, cream, vaginal ring, gel or spray. Estrogen therapy isn’t a good treatment for you if you still have a uterus.
Estrogen Progesterone/Progestin Hormone Therapy (EPT): This treatment is also called combination therapy because it uses doses of estrogen and progesterone. Progesterone is available in its natural form, or also as a progestin (a synthetic form of progesterone). This type of hormone therapy is for people who still have their uterus.
Risks to hormone therapy
The health risks of hormone therapy include:
Endometrial cancer (only increased if you use estrogen therapy and still have your uterus).
Gallstones and gallbladder issues.
Blood clots.
Deep vein thrombosis.
Pulmonary embolism.
Stroke.
These risks are lower if you start hormone therapy within 10 years of menopause. After that point, your risk for cardiovascular diseases is higher.
A correlation exists between severe hot flashes and night sweats and your risk for cardiovascular disease. Healthcare providers may suggest starting hormone therapy if you have these severe symptoms since it’s an indicator for future cardiovascular risk.
Going on hormone therapy is an individualized decision. Discuss all past medical conditions and your family history with your healthcare provider to understand the risks versus benefits of hormone therapy.
Non-hormonal therapies
Though hormone therapy is a very effective method for relieving menopause symptoms, it’s not the perfect treatment for everyone. Nonhormonal treatments include changes to your diet and lifestyle. These treatments are often good options for people who have other medical conditions or have recently been treated for breast cancer. The main nonhormonal treatments that your provider may recommend include:
Changing your diet.
Avoiding triggers to hot flashes.
Exercising.
Joining support groups.
Prescription medications.
Diet
Sometimes changing your diet can help relieve menopause symptoms. Limiting the amount of caffeine you consume every day and cutting back on spicy foods can make your hot flashes less severe. You can also add foods that contain plant estrogen into your diet. Plant estrogen (isoflavones) isn’t a replacement for the estrogen your body makes before menopause. Foods to try include:
Soybeans.
Chickpeas.
Lentils.
Flaxseed.
Grains.
Beans.
Fruits.
Vegetables.
Avoiding triggers to hot flashes
Certain things in your daily life could be triggers for hot flashes. To help relieve your symptoms, try and identify these triggers and work around them. This could include keeping your bedroom cool at night, wearing layers of clothing or quitting smoking. Weight loss can also help with hot flashes.
Exercising
Working out can be difficult if you’re dealing with hot flashes, but exercising can help relieve several other symptoms of menopause. Exercise can help you sleep through the night and is recommended if you have insomnia. Calm, tranquil types of exercise like yoga can also help with your mood and relieve any fears or anxiety you may be feeling.
Joining support groups
Talking to other people who are also going through menopause can be a great relief for many. Joining a support group can not only give you an outlet for the many emotions running through your head, but also help you answer questions you may not even know you have.
Prescription medications
Prescription medications such as estrogen therapy (estrogen in a cream, gel or pill), birth control pills and antidepressants (SSRIs and SNRIs) can help manage symptoms of menopause like mood swings and hot flashes. Prescription vaginal creams can help relieve vaginal dryness. A seizure medication called gabapentin has been shown to relieve hot flashes. Speak with your healthcare provider to see if nonhormonal medications could work for managing your symptoms.
