Menopause is a natural stage that takes place after a person's final menstrual cycle. It signals the end of the body's ability to reproduce. Symptoms may include vaginal dryness, hot flashes, and emotional changes that last an average of 7.4 years after the last period.

Menopause is part of a woman's sexual maturation and is not a disease or condition, although people may experience many symptoms of menopause

Doctors define menopause as occurring 1 year after a person's last period. Every individual experiences menopause differently and the symptoms may vary in duration.

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Menopause can cause hot flashes. These last an average of 4.5 years after a person's final period.

Menopause symptoms last an average of 4.5 years, following a person's last period, and 7.4 years in total, according to a study published in JAMA.

The study suggests healthcare professionals advise people to expect a 7-year duration for their symptoms. It also notes that women who experience regular symptoms before the menopause or during the early stages may run a higher risk of a longer duration, with some women having symptoms for 11.8 years.

Approximately 8 in 10 women have symptoms before and after the ending of their periods. Doctors refer to the year between the last period and menopause as perimenopause.

The extended duration of these symptoms is the result of the body rebalancing and reducing levels of estrogen and progesterone as the ovaries slowly lose function.

When does menopause start?

Though menopause is defined as starting one year after the end of a person last period, they may begin experiencing symptoms earlier.

According to the North American Menopause Society, the average age for a woman to reach menopause in the United States is 51 years. However, this age range varies. Menopause may happen early when a woman is in her forties or later when she is in her late 50s.

The onset of menopause can also follow surgery that reduces ovarian function or hormones, such as a hysterectomy, where a surgeon removes the uterus, or surgery or other treatments for cancer. In these circumstances, symptoms may begin rapidly as an adverse effect of these procedures.

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Menopause can lead to low mood and a range of other effects.

The symptoms of menopause usually start when a woman's estrogen levels begin to drop. Typically, this happens in the 3–5 years before menopause starts. This is the perimenopause.

Irregular menstruation: As estrogen levels drop, the menstrual cycle may change. A woman may miss periods or experience more time between periods. The menstrual flow may also be heavier or lighter than before the hormonal changes.

Vaginal dryness: Decreases in estrogen levels can cause a reduction in vaginal lubrication. As lubrication decreases, the vaginal tissues also become thinner. This can lead to pain during intercourse and vaginal inflammation.

Decreased fertility: As estrogen levels drop in perimenopause, pregnancy might become more difficult. When a woman reaches menopause, her ovaries no longer release eggs, meaning that pregnancy is not possible.

Weight gain: A woman's metabolism tends to slow down during menopause, and she may suddenly gain body mass. This weight gain can happen without any changes to diet or exercise routine.

Hot flashes: Fluctuations in hormone levels might lead to hot flashes or an abrupt feeling of heat and flushing. These flashes may be mild, occurring primarily in the upper body, or they may radiate throughout the body. Hot flashes can last from a few seconds to many minutes.

Night sweats: Hot flashes that happen during sleep cause night sweats, and these may prompt such intense sweating that they wake a person up.

Sleep disturbances: Menopause often makes it hard to sleep. Many women find that sleep disturbances occur more often around the time of menopause. The disturbances may be related to night sweats.

Low mood: Some women may experience mood changes during menopause. These may be due to hormonal fluctuations, but life circumstances that tend to occur around the time of menopause can also contribute. Low mood may also be a result of fatigue from sleep disturbances or the psychological adjustment to the loss of fertility.

Attention problems: Many people find that they have difficulty concentrating and focusing during menopause and might experience lapses in memory. Scientists are not sure if this is due to falling estrogen levels or the natural aging process.

Thinning skin and hair: Extreme fluctuations in hormone levels might cause skin to become thinner. Some women may experience hair loss.

Urinary frequency and incontinence: Around menopause, women may experience an increase in the frequency of passing urine, due to a weakening of the muscles that control the pelvic floor.

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HRT can help reduce the symptoms of menopause.

Menopause itself does not require medical treatment, as it is not a medical condition, but many women seek relief from its uncomfortable symptoms.

Estrogen therapy is one of the most effective options for relieving menopause-related hot flashes. Doctors often prescribe the lowest dose of estrogen possible to relieve symptoms. Sometimes, progestin supplementation is also needed.

Aside from relieving hot flashes, hormone replacement therapy (HRT) can help prevent bone loss and osteoporosis.

Some studies suggest that low doses of estrogen may protect against heart disease if a person starts them within 5 years of menopause.

There are many other treatments available that alleviate symptoms and prevent issues related to aging.

Other options include:

  • Medications to treat hot flashes: Low-dose antidepressants and some anti-seizure medications may help decrease hot flashes. Antidepressant medications may also assist with the emotional changes that occur during menopause.
  • Vaginal estrogen: Estrogen is available for direct application to the vagina in the form of a cream, tablet, or inserted ring. This can help relieve dryness and discomfort during intercourse. It may also help with urinary issues that occur during this time.
  • Medications to prevent osteoporosis: Some doctors prescribe medications to prevent the loss of bone density that can occur during perimenopause and menopause.

When to see a doctor

At the onset of perimenopause, a person may wish to schedule regular doctor visits for preventive healthcare.

Around perimenopause, doctors may recommend certain health screenings that sometimes include a colonoscopy, mammogram, and blood tests.

An individual should not hesitate to seek a doctor's care and advice to deal with disruptive menopausal symptoms. If vaginal bleeding occurs after menopause, a person should also seek medical attention.

The risk of some conditions increases after menopause, including:

  • Cardiovascular disease: As estrogen levels decline, the risk of heart disease rises.
  • Osteoporosis: Osteoporosis is a condition that causes bones to weaken, increasing the risk of fractures. For the first years after menopause, women lose bone density very rapidly. This increases the risk of osteoporosis and breaks.
  • Certain cancers: The risk of breast and ovarian cancer rises after menopause. The reasons vary but may be due to hormonal changes related to menopause, HRT if a woman has used this for symptoms, or simply natural aging.

Most people continue to enjoy a healthy life throughout menopause, however. They can ensure this further by maintaining a balanced and nutritious diet, exercising, and checking in with a doctor regularly.

Q:

Is there a way to delay the onset of menopause?

A:

The most common method to delay the onset of menopause is estrogen or estrogen/progesterone therapy known as hormone replacement therapy (HRT).

HRT may help delay menopause and the symptoms of menopause. One study describes a newer strategy. During the young adult period, a medical center harvests and freezes ovarian tissue for future use. When menopause begins, the center then transplants the tissue back to the ovaries with the hypothesis that it will graft and continue to function for a longer time.

This technique is similar to a method used for fertility preservation in women who are facing chemotherapy that might destroy their ovaries.

Deborah Weatherspoon, PhD, RN, CRNA Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.