Menopause
Menopause
What is menopause?
Menopause is a point in time when you’ve gone 12 consecutive months without a menstrual period. It happens, on average, at age 52. It’s a natural process that occurs when your ovaries stop producing reproductive hormones. When menopause happens due to surgery or medical treatment, it’s called induced menopause.
Hormonal changes due to menopause can cause uncomfortable physical and emotional symptoms. There are treatments available to help with symptoms of menopause, like hormone therapy, medication or lifestyle adjustments.
What are the three stages of menopause?
Menopause is the permanent ending of menstruation. If it doesn’t happen because of any type of medical treatment or surgery, the process is gradual and happens in three stages:
- Perimenopause or “menopause transition:” Perimenopause can begin eight to 10 years before menopause when your ovaries gradually produce less and less estrogen. It usually starts when you’re in your 40s. You can be in perimenopause for several months or several years. Many people begin feeling symptoms like irregular periods, hot flashes and mood swings in perimenopause.
- Menopause: Menopause is the point when you no longer have menstrual periods. At this stage, your ovaries don’t release eggs, and your body doesn’t produce much estrogen. A healthcare provider diagnoses menopause when you’ve gone without a period for 12 consecutive months. Unlike the other stages, menopause itself is a defined moment, so you don’t stay in this stage.
- Postmenopause: This is the time after menopause. You stay in postmenopause for the rest of your life. While most symptoms of menopause ease up in postmenopause, you can continue to have mild menopausal symptoms for several years in postmenopause. People in the postmenopausal phase are at an increased risk for osteoporosis and heart disease due to low estrogen levels.
What is premature menopause?
Menopause, when it occurs between the ages of 45 and 55, is considered “natural” and is a normal part of aging. Menopause that occurs before the age of 45 is called early menopause. Menopause that occurs at 40 or younger is considered premature menopause. When there’s no medical or surgical cause for premature menopause, it’s called primary ovarian insufficiency.
What is the average age for menopause?
The average age of menopause in the United States is 52 years old. But the transition to menopause usually begins in your mid-40s.
How long does menopause last?
Menopause is a point in time, so you don’t stay in menopause. You reach it when you haven’t gotten a menstrual period for one year. Immediately after you reach menopause, you move into postmenopause. This stage lasts for the rest of your life.
Symptoms and Causes
There are several symptoms that may mean you’re transitioning into menopause.
What are the signs of menopause?
You may be transitioning into menopause if you begin experiencing some or all of the following symptoms:
- Irregular periods or periods that are heavier or lighter than usual
- Hot flashes, also known as vasomotor symptoms (a sudden feeling of warmth that spreads over your body)
- Night sweats and/or cold flashes
- Vaginal dryness that causes discomfort during sex
- Urinary urgency (a pressing need to pee more frequently)
- Difficulty sleeping (insomnia)
- Emotional changes (irritability, mood swings or depression)
- Dry skin, dry eyes or dry mouth
- Worsening premenstrual syndrome (PMS)
- Breast tenderness
Some people might also experience:
- Racing heart
- Headaches
- Joint and muscle aches and pains
- Changes in libido (sex drive)
- Difficulty concentrating or memory lapses (often temporary)
- Weight gain
- Hair loss or thinning
Changes in your hormone levels cause these symptoms. Some people have intense symptoms of menopause, while others have mild symptoms. Not everyone will have the same symptoms as they transition to menopause.
Contact a healthcare provider if you’re unsure if your symptoms are related to menopause or another health condition
How long do you have symptoms of menopause?
You can have symptoms of menopause for up to 10 years before it officially occurs. The average length of menopause symptoms is about seven years. Most women say their symptoms ease up or disappear completely once they reach postmenopause.
What makes menopause symptoms worse?
It depends on your symptoms. For example, if hot flashes and sweating are your main symptoms, you may want to avoid warm environments or stop eating spicy foods. If you have symptoms like anxiety or insomnia, you may find that relaxing activities like yoga or reading before bed help calm your mind and lead to a more peaceful sleep.
Some women find keeping a journal of symptoms helps them identify what causes their symptoms to worsen. Then, you can take steps to avoid certain activities that make your menopause symptoms worse.
How do I know if I’m in menopause?
There is no specific test for PCOS. To find out if you have PCOS, your provider:
- Will do a physical exam, which will include looking for the physical signs of PCOS.
- Will ask about your medical history and family health history.
- May do a pelvic exam to check for signs of extra male hormones and to see if your ovaries are enlarged or swollen.
- May order a pelvic ultrasound to look for cysts on your ovaries and check the thickness of your endometrium (the lining of your uterus, or womb).
- May order blood tests, including tests to check your hormone levels.
Why does menopause happen?
When menopause happens on its own (natural menopause), it’s a normal part of aging. Menopause is defined as a complete year without menstrual bleeding, in the absence of any surgery or medical condition that may cause bleeding to stop, like hormonal birth control, chemotherapy or radiation therapy. Surgical removal of your ovaries will result in menopause if your surgeon removes both ovaries.
As you age, your reproductive cycle begins to slow down and prepares to stop. This cycle has been continuously functioning since puberty. As menopause nears, your ovaries make less estrogen. When this decrease occurs, your menstrual cycle (period) starts to change. It can become irregular and then stop.
Physical changes can also happen as your body adapts to different hormone levels. The symptoms you experience during each stage of menopause are all part of your body’s adjustment to these changes
What hormonal changes happen during menopause?
The traditional changes we think of as “menopause” happen when your ovaries no longer produce high levels of hormones. Your ovaries produce the hormones estrogen and progesterone. Together, estrogen and progesterone control menstruation. Estrogen also influences how your body uses calcium and maintains cholesterol levels in your blood.
As menopause nears, your ovaries no longer release eggs, and you’ll have your last menstrual cycle.
Diagnosis and Tests
How is menopause diagnosed?
There are several ways your healthcare provider can diagnose menopause. The first is discussing your menstrual cycle over the last year. Menopause is unique in that your provider will diagnose it after it occurs. If you’ve gone a full year (12 straight months) without a period, you’ve entered menopause and are postmenopausal.
Blood tests that check certain hormone levels can suggest that you’ve reached menopause. Usually, though, blood work isn’t necessary. In some situations, blood tests can be misleading because so many hormonal fluctuations occur during the perimenopause stage. Your provider may want to check hormone levels if they suspect an underlying health condition may be causing your symptoms.
Management and Treatment
What are treatments for menopause?
Menopause is a natural process that your body goes through. In some cases, you may not need any treatment for it. When discussing treatment for menopause with your healthcare provider, it’s about treating the symptoms of menopause that disrupt your life. There are many different types of treatments for managing menopause symptoms. The main types are:
- Hormone therapy (HT). A term used for hormones offered to those going through menopause at natural ages (after age 45).
- Hormone replacement therapy (HRT). The word replacement is added when using hormones to treat menopause which occurs at a young age, especially before age 40.
- Nonhormonal treatments.
It’s important to talk to your provider while you’re going through menopause to craft a treatment plan that works for you. Every person is different and has unique needs. People experiencing menopause before age 40 should be offered hormone replacement therapy, except in rare circumstances (such as a personal history of breast cancer at a young age).
What is hormone therapy for menopause like?
During menopause, your body goes through major hormonal changes — decreasing the amount of hormones it makes. When your ovaries no longer make enough estrogen and progesterone, hormone therapy can make up for lost hormones. Hormone therapy boosts your hormone levels and can help with symptoms like hot flashes and vaginal dryness. It can also help prevent osteoporosis.
There are two main types of hormone therapy:
- Estrogen therapy (ET): In this treatment, you take estrogen alone. Your provider prescribes it in a low dose. Estrogen comes in many forms, such as a patch, pill, cream, vaginal ring, gel or spray. Estrogen therapy can’t be used alone (without a progestogen) if you still have a uterus.
- Estrogen progestogen therapy (EPT): This treatment is also called combination therapy because it uses doses of estrogen and a hormone similar to progesterone. Progesterone is available in its natural form or also as a progestin (a synthetic form of progesterone). Progestogen is a general name for treatments that can include both natural progesterone and synthetic progestins. This type of hormone therapy is for those who still have their uteruses.
There are risks to hormone therapy. Talk to your provider about the risks and benefits and whether hormone therapy is an option for you based on your health history, age and other factors.
What are nonhormonal treatments for menopause?
Though hormone therapy is an effective method for relieving menopause symptoms, it’s not the perfect treatment for everyone. Nonhormonal treatments include things like lifestyle changes and nonhormonal medications. These treatments are often good options for women who have medical reasons to avoid estrogen, including a personal history of blood clots or receiving breast cancer treatment. Some of the nonhormonal treatments that your provider may recommend include:
- Changing what you eat
- Avoiding triggers to hot flashes
- Getting regular physical activity or exercise
- Joining support groups
- Prescription medications
- Cognitive behavioral therapy (CBT)
- Hypnotherapy
Changing what you eat and drink
Sometimes, changing what you eat can help relieve menopause symptoms. Limiting the amount of caffeine you consume daily and cutting back on spicy foods can make your hot flashes less severe. You can also eat more foods that contain phytoestrogens (nutrients that have estrogen-like properties in the human body). Foods to try include:
- Soybeans
- Chickpeas
- Lentils
- Flaxseed
- Grains
- Beans
- Fruits
- Vegetables
Avoiding triggers for hot flashes
Certain things in your daily life may trigger hot flashes. To help relieve your symptoms, try to identify these triggers and work around them. This could include keeping your bedroom cool at night, wearing layers of clothing or quitting smoking. Maintaining a weight that’s healthy for you can also help with hot flashes.
Exercising
Exercise can be difficult if you’re dealing with hot flashes, but getting regular physical activity can help relieve several other symptoms of menopause. Any type of physical activity is good for you, even yard work or swimming laps in a pool. Calm, tranquil types of movement like yoga can also help with your mood and relieve anxiety.
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