Introduction to Menopause

What is menopause?

When a person permanently stops having menstrual periods, this is called menopause. This means they can no longer get pregnant. Many healthcare providers use the term menopause to refer to the period of time when hormone levels start to change. Menopause is complete when menstrual periods have stopped for 1 full year.

The transition phase before menopause is called perimenopause. During this time, the supply of mature eggs in the ovaries is reduced. Ovulation becomes irregular. The making of estrogen and progesterone declines. It is the big drop in estrogen levels that causes most of the symptoms of menopause.

When does menopause occur?

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

Menopause can also happen in these cases:

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

• Surgical menopause. This may happen if one or both ovaries are removed. It may happen after radiation of the pelvis that includes the ovaries. This leads to sudden menopause. This can cause more severe symptoms than menopause that happens over time.

What are the symptoms of menopause?

These are the most common symptoms of menopause. Each person may experience symptoms differently. Some have fewer and less severe symptoms. Other people have more frequent and stressful ones. The signs and symptoms of menopause may include:

Symptom	Description
Hot flashes	Hot flashes or flushes are the most common symptom of menopause. These are sudden, brief increases in body temperature. This can happen many times a day. Often hot flashes start before a person’s last period. For most people, hot flashes occur for 2 years or less. A small number of people have hot flashes for more than 2 years. These flashes seem to be linked to decreasing levels of estrogen. Hot flashes vary in how often and severe they are for each person. A hot flash may cause a faster heart rate. This causes sudden sweating as the body tries to reduce its temperature. A hot flash may occur with heart palpitations and dizziness. Hot flashes that happen at night are called night sweats. A person may wake up drenched in sweat. They may have to change their 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. It can lead to vaginitis, cystitis, and urinary tract infections.
Relaxation of the pelvic muscles	This can lead to urinary incontinence. It increases the risk of the uterus, bladder, urethra, or rectum bulging into the vagina.
Cardiac effects	These can include dizziness that comes and goes, numbness, prickling, tingling, heart palpitations, and fast heartbeat.
Hair growth	Changing hormones can cause more facial hair. It can cause a thinning of the hair on the scalp.
Mental health	Psychological and emotional symptoms of fatigue, mood swings, insomnia, and nervousness may be linked to both the lack of estrogen, the stress of aging, and a person's changing life roles.

What can I do about hot flashes? 

Hot flashes occur from a drop in estrogen levels. In response to this, your glands release higher amounts of other hormones that affect the brain's thermostat. This causes your body temperature to rise and fall. Hormone therapy has been shown to relieve some of the discomfort of hot flashes. But the decision to use these hormones should be made only after you and your healthcare provider have talked about the risks and benefits for you.

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. One was the estrogen-plus-progestin study of women with a uterus. The other was an 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. 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. This was more common in people who started hormone therapy more than 10 years after menopause.  

The WHI advises that people follow the FDA advice on hormone therapy. It states that hormone therapy should not be taken to prevent heart disease.

These products are approved for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. Hormone therapy may help prevent postmenopausal osteoporosis. But it should only be considered for people at high 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 should discuss the benefits and risks with their healthcare providers.

Tips 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 make hot flashes worse.

• 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 set off your hot flashes.

Treatments for menopause

Therapies that help to manage menopause symptoms include:

Treatment	Description
Hormone therapy (HT)	HT is done by taking the female hormones estrogen and progesterone during perimenopause and menopause. HT is most often prescribed in pill form. But estrogen can be given by using skin patches and vaginal creams. Talk with your healthcare provider about the risks and benefits of HT for you.
Estrogen therapy (ET)	ET is done by taking estrogen alone. ET is often prescribed for people who have had a hysterectomy. Estrogen is prescribed as pills, skin patches, and vaginal creams. Talk with your healthcare provider about the risks and benefits of ET for you.
Nonhormonal treatment	This type of treatment is done with other types of medicines to relieve some of the symptoms of menopause.
Estrogen alternatives	Estrogen alternatives are synthetic estrogens. One example is ospemifene. They improve symptoms of vaginal atrophy without affecting endometrial cancer risk.
Alternative therapies	Homeopathy and herbal treatments are often called bioidentical hormones. They may offer some relief from some symptoms of menopause. But there are concerns about potency, safety, purity, and effectiveness.

Talk about the risks and benefits of each treatment choice with your healthcare provider.