Menopause

Menopause is the natural end to menstruation. The average age of menopause in the US is 52 years old. However, it can start around age 40 and as late as around age 60. If menopause occurs prior to age 40, it is thought to be abnormal and is called premature menopause.

Menopause is the result of the depletion of egg cells from the ovaries and the reduction of female hormones. Menopause is considered complete when you have been without a menstrual period for a full year. Rather than a single point in time, menopause is a process or transitional period when women move away from the phase of life where reproduction is possible. Menopause is a normal part of life. It marks the end of a long, slow process that begins when ovaries begin to produce less estrogen and progesterone. These female hormones are both important for normal menstrual cycles and successful pregnancy. An oophorectomy (removal of the ovaries) in women of reproductive age causes surgical menopause. In addition to its role in reproduction, estrogen is an important hormone for maintaining bone health. It may also play important roles in heart health, skin elasticity, and brain function.

Perimenopause:

• May begin 2-8 years before the last menstrual period

• Lasts about one year after the last menstrual period

• Signs and symptoms may appear during this phase

Menopause:

• Complete cessation of menstrual periods

• You have had no menstrual periods for one year, undergo surgical menopause, or have a blood test confirmation of menopause

• Childbearing is no longer naturally possible

Postmenopause:

• Begins after your last menstrual period

• You no longer menstruate

• The risk of certain health problems increases. These health problems include heart disease and osteoporosis.

Each woman experiences menopause differently. Some women have many symptoms and others have a few. Changing levels of estrogen and progesterone can cause this variety of symptoms.

Symptoms include:

• Shorter or longer cycles

• Heavier or lighter bleeding

• Spotting in between periods

• Reduced fertility

• Reported in up to 75% of American women

• Sudden onset of a feeling of heat

• Flushed face and neck

• Last 30 seconds-5 minutes

• Occur at any time

• Usually stop within a few years after menopause

• Skin in genital area becomes drier and thinner

• Sexual intercourse may become painful

• Vaginal dryness and burning

• Urinary tract problems may occur such as infection and incontinence

• Attitude toward sex may change

• Diminished interest in sex

• Arousal and comfort may be difficult

• Freedom from concerns about pregnancy (but should use birth control until one year after last period)

• Risk of sexually transmitted diseases remains

• Normal sleep patterns may be interrupted

• Early morning waking

• Irritability

• Depression

• Anxiety

• Stress and change in family dynamics may contribute to mood problems

• Thickening at the waist

• Loss of muscle mass

• Increase in fat

• Loss of elasticity in the skin

• Headaches

• Joint and muscle stiffness or pain

• Difficulty concentrating

• Thinning of scalp hair, more prominent facial hair

Diagnosis

Natural menopause is usually diagnosed when a woman has not had a menstrual period for 12 consecutive months. Your doctor will ask about your symptoms, family and medical history, and perform a physical exam. You may have blood tests, a pelvic exam, and a Pap smear. Most women in their late 40s and early 50s will have menopausal symptoms. Your doctor will consider if testing for other possible causes of these symptoms is needed.

In most cases, hormone tests are not needed. However, your doctor may give you a follicle-stimulating hormone (FSH) test, which measures the level of FSH in your blood. This is done to confirm that you are in menopause. Women most likely to have this test are those who have had a hysterectomy with preservation of ovaries. Without the cessation of menstruation as a guide, the FSH level may be used to diagnose menopause.

FSH is produced by your pituitary gland and stimulates your ovaries to produce estrogen. As your estrogen levels decline, your pituitary gland produces more FSH, which enters your blood in an attempt to stimulate more estrogen. When blood levels of FSH consistently rise to certain levels, it is likely that you have reached menopause. More than one FSH test may be needed to confirm menopause. You should not be taking birth control pills when you have an FSH test because birth control pills contain hormones that will affect the test results.

Treatments

Menopause is a natural part of life and does not necessarily require treatment. Decide how to best proceed by talking with your doctor. A treatment plan must be considered on an individual basis. First, consider how the symptoms are affecting your daily life. Then, talk with your doctor about your family and medical history. Remember to talk about the risks of heart disease, osteoporosis, and breast cancer. Remember any decision is not final. You can, and should, review it with your doctor every year during your annual checkup. You can see a gynecologist, a general practitioner, or an internist. It is also important to review current screening tests you may need based on your age, family and medical history.

Treatments for menopause aim to:

• Reduce unpleasant physical and psychological symptoms of menopause

• Reduce your risk of osteoporosis, heart disease, and stroke

How Can I Treat the Symptoms?

There are a bunch of ways.

Lifestyle changes: A healthy diet and regular exercise program will help manage your symptoms and boost your health. This is a great time to finally kick any old, unhealthy habits like smoking or drinking too much alcohol. To help with hot flashes, dress lightly and in layers. Avoid triggers like caffeine and spicy foods. And if you stay sexually active, that may help preserve your vaginal lining.

Prescription medication for hot flashes: If you still have your uterus, your doctor might prescribe treatment with estrogen and progesterone. This is called combination hormone therapy (HT) or hormone replacement therapy (HRT). It helps with hot flashes and night sweats, and it may help prevent osteoporosis. If you don’t have a uterus, you might get estrogen alone.

Hormone therapy isn’t for everyone. Don’t take it if you've ever had breast cancer, uterine or "endometrial" cancer, blood clots, liver disease, or a stroke. Also don't take it if you might be pregnant or you have undiagnosed vaginal bleeding. If you can't or don't want to take hormones, other medications can ease symptoms. They include antidepressants, antiseizure drugs, or blood pressure medications to help with hot flashes and mood swings. Prescription and OTC medication for vaginal dryness and sleep problems. You can try topical estrogen, lubricants, and non-estrogen prescriptions for dryness and painful sex. OTC or prescription sleep aids can help if you have trouble falling asleep.

Non-hormonal Options: There are also many non-hormonal options for treating menopause symptoms. Some work better than others. You can learn more about some of these options here. Acupuncture, meditation, and relaxation techniques are harmless ways to ease the stress of menopause, and some people believe they help. Many women also try herbal or natural remedies. Talk to a doctor before trying any of these.

To learn even more about Menopause, click here