Introduction to Menopause

Picture of a mother and her young son, smiling

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 is considered normal between 40 and 60 years old. 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:

  • Primary ovarian insufficiency. Primary ovarian insufficiency 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. 

  • 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

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 and dizziness.

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

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 infections.

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.

Hair growth

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

Mental health

Mood changes are common, especially for women who have a prior history of depression, PMS, or mood changes during their pregnancies.

What can I do about hot flashes? 

The North American Menopause Society (NAMS) published a guideline for menopause hormone therapy in 2017, which states that for most women who are within 10 years of their last menstrual period or less than 60 years old, hormone therapy is safe and effective option for treatment of hot flashes, prevention of osteoporosis, or vaginal dryness also known as the genitourinary syndrome of menopause. There are also non-hormonal options including prescriptions, cognitive behavioral therapy, or acupuncture.

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 can be administered via patches or pills.

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 rings..

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.

Genitourinary syndrome of menopause (GSM)

Genitourinary syndrome of menopause (GSM) affects 50 percent of all menopausal women. Treatment for mild symptoms include over the counter moisturizers and lubricants. For moderate to severe symptoms prescription vaginal estrogens that come as suppositories, rings, pills, or creams are effective. There are also non-estrogen treatment options such as intravaginal DHEA or Osphena. Vaginal laser treatment is another option for GSM.

When approaching menopause, every woman should discuss each option — the potential risks and benefits — with her healthcare provider. 

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