Introduction to Menopause

What is menopause?

When a woman permanently stops having menstrual periods, she has reached the stage of life called menopause. Often called the change of life, this stage signals the end of a woman’s ability to have children. Many health care providers actually use the term menopause to refer to the period of time when a woman’s hormone levels begin to change. Menopause is said to be complete when menstrual periods have ceased for one continuous year.

The transition phase before menopause is medically referred to as perimenopause or climacteric. During this transition time before menopause, the supply of mature eggs in a woman’s ovaries diminishes and ovulation becomes irregular. At the same time, the production of estrogen and progesterone decreases. It is the enormous drop in estrogen levels that causes most of the symptoms commonly associated with menopause.

When does menopause occur?

While the average age of menopause is 51, menopause can actually happen any time from the 30s to the mid-50s or later. Women who smoke and are underweight tend to experience an earlier menopause, while women who are overweight often experience a later menopause. Generally, a woman tends to experience menopause at about the same age as her mother did.

Menopause can also happen for reasons other than natural reasons. These include the following:

• Premature menopause. Premature menopause may happen when there is ovarian failure before the age of 40, and may be associated with smoking, radiation exposure, chemotherapeutic drugs, or surgery that impairs the ovarian blood supply. Premature ovarian failure is also called primary ovarian insufficiency.

• Surgical menopause. Surgical menopause may follow a removal of an ovary or both ovaries, or radiation of the pelvis, including the ovaries, in premenopausal women. This results in an abrupt menopause. These women often experience more severe menopausal symptoms than if they were to experience menopause naturally.

What are the symptoms of menopause?

The following are the most common symptoms of menopause. However, each woman may experience symptoms differently. Some have few and less severe symptoms, while others have more frequent and stressful ones. The signs and symptoms of menopause may include:

Hot flashes	Hot flashes or flushes are, by far, the most common symptom of menopause, with about 75% of all women experiencing sudden, brief, periodic increases in their body temperature. Usually hot flashes start before a woman’s last period. For 80% of women, hot flashes occur for 2 years or less. A small percentage of women experience hot flashes for more than 2 years. These flashes seem to be directly related to decreasing levels of estrogen. Hot flashes vary in frequency and intensity for each woman. In addition to the increase in the temperature of the skin, a hot flash may cause an increase in a woman’s heart rate. This causes sudden perspiration as the body tries to reduce its temperature. This symptom may also be accompanied by heart palpitations and dizziness. Hot flashes that happen at night are called night sweats. A woman may wake up drenched in sweat and have to change her night clothes and sheets.
Vaginal atrophy	Vaginal atrophy involves the drying and thinning of the tissues of the vagina and urethra. This can lead to dyspareunia (pain during sexual intercourse), as well as vaginitis, cystitis, and urinary tract infections.
Relaxation of the pelvic muscles	Relaxation of the pelvic muscles can lead to urinary incontinence and also increase the risk of the uterus, bladder, urethra, or rectum protruding into the vagina.
Cardiac effects	Intermittent dizziness, paresthesias (an abnormal sensation, such as numbness, prickling, tingling, and/or heightened sensitivity), cardiac palpitations, and tachycardia may occur as symptoms of menopause.
Hair growth	Changing hormones can cause some women to experience an increase in facial hair and/or a thinning of the hair on the scalp.
Mental health	While it is commonly thought that mental health may be negatively affected by menopause, several studies have indicated that menopausal women suffer no more anxiety, depression, anger, nervousness, or feelings of stress than women of the same age who are still menstruating. Psychological and emotional symptoms of fatigue, irritability, insomnia, and nervousness may be related to both the lack of estrogen, the stress of aging, and a woman’s changing roles.

Q: “I am 49 years old and have started exhibiting signs of menopause, with the most bothersome being hot flashes. I wondered if there is anything I can do to cope with these?”

A: Hot flashes appear as a result of decreasing estrogen levels. In response to this, your glands release higher amounts of other hormones that affect the brain’s thermostat, causing your body temperature to fluctuate. Hormone therapy has been shown to relieve some of the discomfort of hot flashes for many women. However, the decision to start using these hormones should be made only after you and your health care provider have evaluated your risk versus benefit ratio.

To learn more about women’s health, and specifically hormone therapy, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the Women’s Health Initiative (WHI) in 1991. The hormone trial had 2 studies: the estrogen-plus-progestin study of women with a uterus and the estrogen-alone study of women without a uterus. Both studies ended early when the research showed that hormone therapy did not help prevent heart disease and it increased risk for some medical problems. Follow-up studies found an increased risk of heart disease in women who took estrogen-plus-progestin therapy, especially those who started hormone therapy more than 10 years after menopause.  

The WHI recommends that women follow the FDA advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It states that hormone therapy should not be taken to prevent heart disease.

These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. Although hormone therapy may be effective for the prevention of postmenopausal osteoporosis, it should only be considered for women at significant risk of osteoporosis who cannot take nonestrogen medicines. The FDA recommends that hormone therapy be used at the lowest doses for the shortest duration needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their health care providers.

Practical suggestions for coping with hot flashes include:

• Dress in layers, so that you can remove clothing when a hot flash begins.

• Avoid foods and beverages that may cause hot flashes, like spicy foods, alcohol, coffee, tea, and other hot beverages.

• Drink a glass of cold water or fruit juice when a hot flash begins.

• Reduce your stress level. This may aggravate hot flashes.

• Keep a thermos of ice water or an ice pack next to your bed during the night.

• Use cotton sheets, lingerie, and clothing that allow your skin to breathe.

• Keep a diary or record of your symptoms to determine what might trigger your hot flashes.

Treatment for menopause

Specific treatment for menopausal symptoms will be determined by your health care provider based on:

• Your age, overall health, and medical history

• Current symptoms

• Your tolerance for specific medicines, procedures, or therapies

• Your opinion or preference

Several therapies that help to manage the symptoms often associated with menopause include the following:

Hormone therapy (HT)	Hormone therapy (HT) involves the administration of a combination of the female hormones estrogen and progesterone during perimenopause and menopause. HT is most commonly prescribed in pill form. However, estrogen can also be given by using transdermal skin patches and vaginal creams. The decision to start using these hormones should be made only after you and your health care provider have evaluated your risks and benefits.
Estrogen therapy (ET)	Estrogen therapy (ET) involves the administration of estrogen alone, which is no longer being produced by the body. ET is often prescribed for women who have had a hysterectomy. Estrogen is prescribed as pills, transdermal skin patches (where the estrogen is absorbed through the skin), and vaginal creams. The decision to start using this hormone should be made only after you and your health care provider have evaluated your risks and benefits.
Non-hormonal treatment	This type of treatment often involves the use of other types of medicines to relieve some of the symptoms associated with menopause.
Estrogen alternatives	Estrogen alternatives are the so-called “synthetic estrogens,” like ospemifene, which improves symptoms of vaginal atrophy without affecting endometrial cancer risk.
Alternative therapies	Homeopathy and herbal treatments, often called bioidentical hormones, may offer some relief from some symptoms of menopause. However, there are concerns about potency, safety, purity, and effectiveness.

When approaching menopause, every woman should discuss each option — the potential risks and benefits — with her health care provider. Visit Online Resources of Women’s Health for more information.