Menopause marks the time in a woman's life when her menstruation stops, and she is no longer fertile (able to become pregnant).
The menopause is a normal part of life; it is not a disease or a condition.
Even though it is the time of the woman's last period, symptoms may begin many years earlier. Also, some women may experience symptoms for months or years afterward.
In the United States, the average age for the menopause is 51.
Perimenopause is the 3-5-year period before the menopause when a woman's estrogen levels begin to drop.
Fast facts on menopause
Here are some key points about menopause. More detail and supporting information is in the main article.
- Menopause marks the end of a woman's fertility
- Symptoms of menopause include night sweats, hot flashes, mood fluctuations, and cognitive changes
- There are a number of medical treatments and home remedies that can help with symptoms
Symptoms of menopause
Women going through menopause may experience problems with focusing and learning.
Experts say that technically, menopause is confirmed when a woman has not had a menstrual period for 1 year. However, the symptoms and signs of menopause generally appear well before that 1-year period is over. They may include:
This is usually the first symptom; menstrual pattern changes. Some women may experience a period every 2-3 weeks, while others will not have one for months at a time.
During the perimenopausal stage of a woman's life, her estrogen levels will drop significantly, lowering her chances of becoming pregnant.
This may be accompanied by itching and/or discomfort. It tends to happen during the perimenopause. Some women may experience dyspareunia (pain during sex). The term "vaginal atrophy" refers to an inflammation of the vagina as a result of the thinning and shrinking of the tissues, as well as decreased lubrication, caused by a lack of estrogen.
A sudden feeling of heat in the upper body. It may start in the face, neck, or chest, it then spreads upwards or downwards (depending on where it started). The skin may redden and become patchy, and the woman typically starts to sweat. The heart rate may suddenly increase (tachycardia), or it might become irregular or stronger than usual (palpitations). Hot flashes generally occur during the first year after a woman's final period.
If the hot flashes happen in bed, they are called night sweats. Most women say their hot flashes do not last more than a few minutes.
Sleeping problems are generally caused by night sweats, but not always. Sleep disturbance may be caused by insomnia or anxiety. Difficulty falling asleep and staying asleep increase as women go through menopause.
Women tend to be more susceptible to urinary tract infections, such as cystitis. Urinary frequency may increase as well.
Moodiness often goes hand-in-hand with sleep disturbance. Experts say that most mood changes are triggered by poor sleep.
Problems focusing and learning
Some women may also have short-term memory problems, as well as finding it hard to concentrate on something for long.
Other symptoms of menopause can include:
- More fat building up in the abdomen
- Hair loss (thinning hair)
- Loss of breast size
If left untreated, all of the symptoms mentioned will usually taper off gradually over a period of 2-5 years. However, symptoms can persist for much longer. In some cases, vaginal dryness, itching, and discomfort can become chronic, and eventually get worse if left untreated.
Causes of menopause
Estrogen regulates menstruation, while progesterone is more involved with preparing the body for pregnancy.
When the ovaries start producing less of these two hormones, perimenopause will begin. In fact, by the time a woman is in her late 30s the ovaries start producing less progesterone and estrogen. A woman's fertility starts to decline a long time before she may notice any menopausal or perimenopausal symptoms.
As time passes and the ovaries produce less estrogen and progesterone, the ovaries eventually shut down completely, and the woman no longer has any more menstrual periods. The vast majority of females experience a gradual change in menstrual activity, while some go on normally until they stop suddenly.
Some women may experience premature menopause - their ovaries fail earlier than they are supposed to (before the age of 45). Although rare, ovarian failure can occur at any age. Premature menopause may be caused by a number of factors, including:
- Enzyme deficiencies
- Down's syndrome
- Turner's syndrome
- Addison's disease
- Removal of the ovaries (bilateral oophorectomy surgery)
- Radiotherapy to the pelvic area
- Hysterectomy surgery (the uterus - womb - is surgically removed)
How is menopause diagnosed?
A doctor should be able to diagnose menopause or perimenopause if he knows the age of the patient, has information about her menstrual patterns, and receives feedback from her about the symptoms.
Apart from a blood test, which can measure levels of FSH (follicle-stimulating hormone), there is no definitive test to diagnose menopause or perimenopause. FSH blood levels rise when a woman is going through menopause. However, as FSH levels tend to fluctuate a lot during the menopause and perimenopause, the test is not that helpful for a diagnosis.
Under certain circumstances, a doctor may order a blood test to determine the level of estradiol (estrogen). As hypothyroidism (underactive thyroid) can cause menopause-like symptoms, a blood test to determine the woman's level of thyroid-stimulating hormone might be recommended.
Treatments for menopause or perimenopause
Most women do not seek medical advice during menopause, and many women require no treatment. However, if symptoms are significantly affecting the woman's daily life, she should see a doctor.
The type of therapy depends on the symptoms, medical history, and preferences.
Available treatments include:
HRT (hormone replacement therapy)
Hormone therapy can be received by a simple patch on the skin that releases estrogen and progestin.
Also known as HT (hormone therapy), HRT is very effective for many of the symptoms that occur during the menopause.
HRT tops up the woman's levels of estrogen. However, as with many treatments, HRT has its risks and benefits:
Benefits of HRT
- Effectively treats many troublesome menopausal symptoms
- Helps prevent osteoporosis
- Lowers colorectal cancer risk
Risks of HRT
- Raises breast cancer risk
- Raises ovarian cancer risk
- Raises uterine cancer risk (cancer of the womb)
- Raises coronary heart disease risk
- Raises stroke risk
- HRT slightly accelerates loss of brain tissue in areas important for thinking and memory among women aged 65 and over
SSRIs (selective serotonin reuptake inhibitors) have been shown to decrease menopausal hot flashes. Drugs include venlafaxine (Effexor), fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalopram (Celexa), and sertraline (Zoloft).
Researchers from the Universite Laval's Faculty of Medicine found that Omega-3 may ease psychological distress and depressive symptoms often suffered by menopausal and perimenopausal women.
This medication is effective in treating hot flashes. It is sometimes used for treating seizures (epilepsy).
This can be taken either orally as a pill or placed on the skin as a patch. It is effective in treating hot flashes. The drug is commonly used for treating high blood pressure (hypertension). However, unpleasant side-effects are common.
Please read our article about osteoporosis which has a section on treatments.
Vaginal estrogen may be applied locally using a tablet, ring, or cream. This medication effectively treats vaginal dryness, discomfort during intercourse, as well as some urinary problems.
Exercise during menopause can have a range of benefits, including the prevention of weight gain, reducing cancer risk, strengthening bones, and boosting general mood.
Hypnosis may prove effective for the treatment of hot flashes
Research, published in the journal Menopause, found that hypnosis can reduce the symptoms of menopausal hot flashes by up to 74 percent. The investigators found that those in the hypnosis group had considerably fewer bouts of hot flashes and much milder symptoms, compared with the women in the control group.
After menopause, it is common for the following chronic (long-term) conditions to appear:
- Cardiovascular disease - a drop in estrogen levels has been associated with an increased risk of cardiovascular disease.
- Osteoporosis - a woman may lose bone density rapidly during the first few years after menopause. The lower a person's bone density, the higher the risk of developing osteoporosis.
- Urinary incontinence - menopause causes the tissues of the vagina and urethra to lose their elasticity, this can result in frequent, sudden, strong urges to urinate, followed by urge incontinence (involuntary loss of urine). Stress incontinence may also become a problem - urinating involuntarily after coughing, sneezing, laughing, or lifting something.
- Low libido - this may be linked to disturbed sleep, depression symptoms, and night sweats.
- Overweight/obesity - during the menopausal transition, women are more susceptible to weight gain.
- Breast cancer - women are at a higher risk of breast cancer after menopause. Regular exercise after menopause significantly reduces breast cancer risk.
Unless symptoms are severe, changes in lifestyle and diet might be all that is needed to deal with the symptoms:
Hot flashes and night sweats
- Plenty of exercise
- Avoid tight clothing
- Make sure the bedroom is not hot
- Try to reduce levels of stress
- Remember the following commonly trigger symptoms for susceptible people: spicy food, caffeine, smoking, and alcohol
- Exercise regularly. However, do not exercise too late during the day.
- Go to bed and get up at the same time each day - even during weekends.
- Cut out caffeine.
- Learn how to do deep breathing, guided imagery, and progressive muscle relaxation.
- Get plenty of rest
- Strenuous exercise can help - individuals should check with a doctor whether this is safe
Vaginal discomfort and dryness
- OTC water-based vaginal lubricants or moisturizers
- Stay sexually active
Pelvic floor muscle exercises - Kegel exercises. If individuals practice three or four times a day, they will most probably notice a difference after a few weeks.
Overweight/obesity and osteoporosis prevention
Eating a well-balanced diet that includes plenty of vegetables, fruits, whole grains, good quality fats, fiber, and unrefined carbohydrates is important. Try to consume 1,200-1,500 milligrams of calcium and plenty of vitamin D each day. Ensuring the right levels of sleep and exercise can also help.