Menopause

What is menopause?

Menopause refers to the time in a woman's life when she stops having a menstrual period and is no longer fertile. The time leading up to menopause is called the menopausal transition, or perimenopause.

During perimenopause, a woman's ovaries start to produce less estrogen and progesterone. Changes in these hormones cause symptoms of menopause. Periods occur less often and eventually stop. Although this typically is a gradual process that happens over time, in some cases, a woman's periods will stop suddenly. Throughout perimenopause, ovulation—the release of eggs from the ovaries—also occurs less and less frequently.¹

Menopause is the point at which a woman has not had a period in 12 consecutive months. The time after menopause is called postmenopause, a phase that lasts for the rest of a woman’s life.

All women experience menopause, usually between ages 45 and 55.² The average age of menopause is 51, but it occurs earlier in some women. Women who smoke may go through menopause earlier than women who don't smoke.³

However, perimenopause can begin several years earlier when levels of estrogen and progesterone first begin to fluctuate.² Surgical or medical menopause is the term for a decrease in estrogen that is a result of surgery to remove the ovaries or uterus, or medical treatments such as chemotherapy or hormone therapy to treat breast cancer.²

Perimenopause begins with a change in a woman's menstrual cycle. During perimenopause, a woman's periods may be irregular in that they could last for a longer or shorter amount of time or be lighter or heavier. Although such changes are expected, women should consult a healthcare provider if they experience heavy bleeding, periods that occur very close together, spotting, or periods that last longer than a week.

A common symptom of menopause is the appearance of hot flashes (sometimes called a hot flush). Hot flashes occur because of changing estrogen levels in a woman's body.¹ A hot flash consists of a sudden feeling of heat and may include flushing of the face and neck, red blotches on the chest and arms, and sweating followed by shivering. A hot flash can last 30 seconds to 10 minutes.

During menopause, many women experience vaginal dryness, which can make sexual intercourse uncomfortable and can lead to vaginal or urinary tract infections. In addition, the bladder muscles may weaken, which could lead to urine leakage when sneezing, coughing, laughing, or running. This condition is called urinary incontinence.

Some women find that they're not as interested in sex, while others find that they enjoy sex more during the years around menopause. It's important to note that women can still become pregnant during perimenopause and should take appropriate contraceptive measures. Also, menopause does not change the risk of contracting a sexually transmitted disease.

In addition, getting a good night's sleep can sometimes be difficult for menopausal women. Whether sleep is disrupted due to night sweats or other reasons, long-term lack of sleep can lead to fatigue, lack of energy, and memory problems.²

Mood changes such as irritability or anxiety can occur when a woman is going through menopause. These symptoms could be due to shifts in hormones or lifestyle factors, such as caring for elderly parents, that are likely to occur during this time in a woman's life.

Other physical changes occur that can put menopausal women at risk for osteoporosis and heart disease. The loss of estrogen causes women to lose bone density, a condition called osteoporosis. This can cause the bones to become weak and prone to breakage.

Heart disease may develop after menopause due to the loss of estrogen or to other problems related to normal aging. Weight gain, high blood pressure, and diabetes all put stress on the heart and can increase the risk of a heart attack or stroke.¹

In the natural process of menopause, a woman's ovaries stop releasing eggs and making the hormones estrogen and progesterone. When this occurs, a woman stops having her period and is no longer fertile.

Menopause can also occur after surgical removal of a woman's ovaries or following chemotherapy or hormone therapy for the treatment of breast cancer.

Women typically notice the signs and symptoms of menopause without a formal diagnosis from their healthcare provider. A change in menstrual patterns and the appearance of hot flashes are usually the first signs.

Although blood tests are not required, healthcare providers can run blood or urine tests to determine levels of the hormones estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).^1,2 At menopause, the ovaries become less responsive to FSH and LH hormones, so the body makes more of these hormones to compensate. Estradiol and other hormones decrease around menopause as well. A healthcare provider can use the test results to tell if a woman is in menopause.

During and after menopause, a woman should get regular physical, pelvic, breast, colorectal, and skin exams to monitor her health.

Menopause is a normal part of aging and every woman goes through it. It can't be prevented and normally doesn't require treatment. However, some symptoms of menopause can be lessened or perhaps even eliminated with treatment. Likewise, the risk of disorders or diseases associated with menopause, such as osteoporosis and heart disease, may benefit from treatment.

Physicians used to routinely prescribe hormone replacement therapy (HRT) with estrogen and, sometimes, progesterone to treat the general symptoms of menopause. However, this is no longer routine after several large studies showed that HRT can raise the risk of breast cancer, heart attacks, strokes, and blood clots.¹

If you are having trouble with menopause symptoms, talk to your healthcare provider about the benefits and risks of what is now called menopausal hormone therapy (MHT).² According to the National Institute on Aging, only women at low risk for stroke, heart disease, blood clots, and breast cancer are considered candidates for MHT—and only those who have entered menopause recently. MHT can be given in the forms of pills, creams, or skin patches. Most medical professionals recommend an individualized MHT plan for each woman based on the age of menopause. It is important to know that MHT may cause side effects, such as bleeding, bloating, breast tenderness or enlargement, headaches, mood changes, and nausea.³

The loss of estrogen may also be associated with changes in cholesterol levels and increased risk of heart disease. If you have high blood pressure or diabetes or are overweight, your healthcare provider may prescribe dietary changes or drugs to reduce your risk of heart disease, heart attack, and stroke.

There are a variety of options available to help treat the symptoms of menopause. The National Institute on Aging provides detailed information on some treatments for menopause. In addition, the Department of Health and Human Service's Office on Women's Health also provides information about menopause treatments. The sections below provide some additional information.

• Treatment for osteoporosis and bone loss related to menopause
• Treatment of hot flashes and night sweats
• Treatment of irregular or missed periods
• Treatment of vaginal dryness
• Treatment of sleep problems

Treatment for Osteoporosis and Bone Loss Related to Menopause

Because bone loss increases in the first two years after menopause, healthcare providers may order a bone density test, such as a dual-energy X-ray absorptiometry (DEXA) scan. If you have osteoporosis or are at risk for it, your healthcare provider may prescribe bone-strengthening drugs or supplements to help prevent future bone loss and fractures.
Medications commonly prescribed to treat osteoporosis include:³

• Bisphosphonates
• Calcium + vitamin D
• Calcitonin
• Parathyroid hormone
• Raloxifene

There are also many things you can do as part of a healthy lifestyle to help prevent bone loss:³

• Eat a healthy, low-fat, low-cholesterol diet that features lots of vegetables, fruits, and whole-grain foods.
• Make sure to get at least 1,200 mg of calcium and 800–1,000 international units (IUs) of vitamin D each day.
• Avoid drinking more than one alcoholic drink per day.
• Don't smoke.
• Avoid consuming caffeine.
• Achieve and maintain a healthy weight.
• Exercise most days of the week, including exercise that elevates your heart rate, and weight-bearing exercises such as weight lifting or walking.

Treatment of Hot Flashes and Night Sweats

Several prescription drugs are available to relieve hot flashes and night sweats:

• Clonidine, a blood pressure drug
• Gabapentin, a seizure drug that has been shown to reduce hot flashes
• Menopausal hormone therapy (MHT)

There are also several practical things you can do on a daily basis to relieve these symptoms:

• Sleep in a cool room in light clothing.
• Keep a fan on in your bedroom at night.
• Sip a cold drink of water or juice.
• Avoid smoking, caffeine, and alcohol.
• When you feel a hot flash coming on, take several slow, deep breaths.

Treatment of Irregular or Missed Periods

While irregular or missed periods are normal during perimenopause or the menopausal transition, women with very heavy bleeding or periods close together may want to talk to a healthcare provider about regulating their periods with one of the following:

• Low-dose birth control pills to regulate menstrual bleeding
• MHT

Treatment of Vaginal Dryness

• A water-based lubricant (not petroleum jelly)
• MHT

Treatment of Sleep Problems

• Be physically active most days of the week during the day.
• Go to bed and get up at the same time each day.
• Set aside time to wind down and relax before bed, whether by reading or taking a warm bath.
• Avoid alcohol or eating a large meal right before bedtime.
• Avoid caffeine after the morning.
• Avoid drinking fluids before bed.