Introduction to Menopause

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 healthcare providers actually use the term menopause to refer to the
period of time when a woman’s hormone levels start to change. Menopause is said to
be
complete when menstrual periods have ceased for one continuous year.

The transition phase before
menopause is often called perimenopause. During this time, the supply of mature eggs
in
a woman’s ovaries is reduced and ovulation becomes irregular. At the same time, the
production of estrogen and progesterone decreases. It is the big drop in estrogen
levels
that causes most of the symptoms of menopause.

Woman with water bottle walking outdoors.

When does menopause occur?

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

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

  • Premature menopause. This may happen when there is
    ovarian failure before the age of 40. It may be linked to smoking, radiation
    exposure, chemotherapy medicines, or surgery that impairs the ovarian blood
    supply. Premature ovarian failure is also called primary ovarian
    insufficiency.

  • Surgical menopause. This may follow the removal of one
    or both ovaries, or radiation of the pelvis, including the ovaries, in
    premenopausal women. This leads to sudden menopause. These women often have more
    severe menopausal symptoms than if they were to have menopause naturally.

What are the symptoms of
menopause?

These are the most common symptoms
of menopause. 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:

Symptom

Description

Hot flashes

Hot flashes or
flushes are, by far, the most common symptom of menopause. About 3 in 4
women have these sudden, brief, periodic increases in their body
temperature. Often hot flashes start before a woman’s last period. For 4
in 5 women, hot flashes occur for 2 years or less. A small percentage of
women have hot flashes for more than 2 years. These flashes seem to be
directly linked to decreasing levels of estrogen. Hot flashes vary in
frequency and intensity for each woman.

A hot flash may also
cause a faster heart rate. This causes sudden perspiration as the body
tries to reduce its temperature. This symptom may occur with heart
palpitations and dizziness.

Hot flashes that
happen at night are called night sweats. A woman may wake up drenched in
sweat. She may have to change her night clothes and sheets.

Vaginal atrophy

This is the drying
and thinning of the tissues of the vagina and urethra. This can lead to
pain during sex, vaginitis, cystitis, and urinary tract infections.

Relaxation of the pelvic muscles

This can lead to
urinary incontinence. It also increase the risk of the uterus, bladder,
urethra, or rectum protruding into the vagina.

Cardiac effects

These can include
dizziness that comes and goes, an abnormal feeling (such as numbness,
prickling, tingling, or greater sensitivity), heart palpitations, and
fast heart rhythm.

Hair growth

Changing hormones
can cause some women to have more facial hair or a thinning of the hair
on the scalp.

Mental health

Many people think
that menopause can negatively affect mental health. But several studies
have shown that menopausal women have 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,
grouchiness, insomnia, and nervousness may be linked to both the lack of
estrogen, the stress of aging, and a woman’s changing roles.

What can I do about hot flashes? 

Hot flashes occur from a decrease
in 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 healthcare 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 advises 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. Hormone therapy may be effective in preventing postmenopausal
osteoporosis. But it should only be considered for women at significant risk of
osteoporosis who can’t take nonestrogen medicines. The FDA advises that hormone therapy
be used at the lowest doses for the shortest time needed to reach treatment goals.
Postmenopausal women who use or are thinking of using hormone therapy should discuss
the
possible benefits and risks to them with their healthcare providers.

Practical suggestions for coping
with hot flashes include:

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

  • Don’t have foods or beverages
    that may cause hot flashes. These include spicy foods, alcohol, coffee, tea, and
    other hot beverages.

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

  • Reduce your stress level.
    Stress may worsen 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 find what might trigger your hot flashes.

Treatment for menopause

Therapies that help to manage
menopause symptoms include:

Treatment

Description

Hormone therapy (HT)

HT involves the
taking 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 skin patches and
vaginal creams.

The decision to
start using these hormones should be made only after you and your
healthcare provider discuss the risks and benefits.

Estrogen therapy (ET)

ET involves taking
estrogen alone, which is no longer being made by the body. ET is often
prescribed for women who have had a hysterectomy. Estrogen is prescribed
as pills, skin patches, and vaginal creams.

The decision to
start using this hormone should be made only after you and your
healthcare provider discuss the 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,
improve 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 nearing menopause, talk about
the risks and benefits of each treatment option with your healthcare provider.