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 referred to as perimenopause. 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 big drop in estrogen levels that causes most
of the symptoms of menopause.
When does menopause occur?
Although 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
have an earlier menopause, while 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. Premature menopause may happen when there is ovarian failure
before the age of 40. It 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 the removal of one or both ovaries,
or radiation of the pelvis, including the ovaries, in premenopausal women. This results
in an abrupt 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. 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 or flushes are, by far, the most common symptom of menopause. About 75%
of all women have these 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
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 is the drying and thinning of the tissues of the vagina and urethra.
This can lead to pain during sex, as well as vaginitis, cystitis, and urinary tract
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.
Intermittent dizziness, an abnormal sensation, such as numbness, prickling, tingling,
and/or heightened sensitivity, cardiac palpitations, and fast heart rhythm may occur
as symptoms of menopause.
Changing hormones can cause some women to have an increase in facial hair or a thinning
of the hair on the scalp.
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.
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 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 time
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 healthcare providers.
Practical suggestions for coping with hot flashes include:
Dress in layers, so that you can remove clothing when a hot flash starts.
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 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
Several therapies that help to manage menopause symptoms including:
Hormone therapy (HT)
Hormone therapy (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
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)
Estrogen therapy (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.
This type of treatment often involves the use of other types of medicines to relieve
some of the symptoms associated with menopause.
Estrogen alternatives are the so-called "synthetic estrogens," like ospemifene, improve
symptoms of vaginal atrophy without affecting endometrial cancer risk.
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 healthcare provider.