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.

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 "synthetic estrogens" such as ospemifene. They 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.