Everything you need to know about menopause
Symptoms may occur years before a woman's final period. Some women may experience symptoms for months or years afterward.
In the United States (U.S.), the average age for menopause is 51 years.
Despite being a natural process in the body of any woman, menopause can cause drastic changes that trigger severe symptoms.
This article will explain the symptoms and causes of menopause, as well as how to diagnose and treat any symptoms that arise.
- Menopause marks the end of a woman's fertility.
- Symptoms of menopause include night sweats, hot flashes, mood fluctuations, and cognitive changes.
- A reduction in estrogen levels can lead to the symptoms of menopause.
- There are a number of medical treatments and home remedies that can help with symptoms, including hormone replacement therapy (HRT) and self-management techniques.
- The average age of menopause in the United States (U.S.) is 51 years.
Signs and symptoms
Menopause is a natural change in the body. It causes symptoms such as hot flashes.
While menopause is not a disease or disorder, it does trigger some profound changes in a woman's body.
A diagnosis of menopause is confirmed when a woman has not had a menstrual period for one year. However, the symptoms of menopause generally appear before the end of that one-year period.
Changes to the menstrual pattern are the first noticeable symptoms of menopause. Some women may experience a period every 2 to 3 weeks. Others will not menstruate for months at a time.
Perimenopause is the 3-to-5-year period before menopause.
During the perimenopausal stage, a woman's estrogen levels will drop significantly. This reduces her chances of becoming pregnant.
Dryness, itching, and discomfort of the vagina tend to occur during perimenopause.
Vaginal atrophy is an inflammation of the vagina that happens as a result of the thinning and shrinking of the tissues, as well as decreased lubrication.
A hot flash is a sudden sensation of heat in the upper body. It may start in the face, neck, or chest, and progress upward or downward.
The skin may become red and patchy, and a woman will typically start to sweat. Her heart rate may suddenly increase, strengthen, or become irregular. Hot flashes generally occur during the first year after a woman's final period.
Hot flashes that occur during the sleep cycle are called night sweats. Most women say their hot flashes do not last more than a few minutes.
However, studies have confirmed that moderate-to-severe night sweats and hot flashes may pose a problem for around 10.2 years.
It can be difficult for women to fall asleep and stay asleep as they progress through menopause.
Menopause can disrupt a woman's urinary cycle.
Women can experience depression and low mood during menopause.
Hormonal changes can often trigger depressed feelings and mood swings. In many cases, these emotional symptoms also go hand-in-hand with sleep disturbance.
Women may also experience low libido, or sex drive, as a result of these emotional changes.
Problems focusing and learning
Menopause can affect cognitive functions, such as concentration.
Some women may also experience short-term memory problems and difficulty focusing for long periods.
Other symptoms of menopause include:
- a buildup of fat in the abdomen, sometimes leading to overweight and obesity
- hair loss and thinning hair
- breast shrinkage
Without treatment, symptoms usually taper off over a period of 2 to 5 years. However, symptoms can persist for longer. In some cases, vaginal dryness, itching, and discomfort can become chronic and eventually get worse without treatment.
Menopause can lead to the development of complications, including:
- Cardiovascular disease: A drop in estrogen levels has been associated with an increased risk of cardiovascular disease.
- Osteoporosis: A woman may lose bone density rapidly during the first few years after menopause. Low bone density leads to a higher risk of developing osteoporosis.
- Urinary incontinence: Menopause causes the tissues of the vagina and urethra to lose their elasticity. This can result in frequent, sudden, and overwhelming urges to urinate. These urges can be followed by involuntary loss of urine. Women may involuntarily urinate after coughing, sneezing, laughing, or lifting during menopause.
- Breast cancer: Women face a higher risk of breast cancer following menopause. Regular exercise can significantly reduce the risk.
Treatment for menopausal symptoms can range from hormone replacement therapy to self-management.
During menopause, women can pursue a number of treatments to maintain comfort.
Most women do not seek medical advice during this time, and many women require no treatment. However, a woman should visit a doctor if symptoms are affecting her quality of life.
Women should choose the type of therapy dependent on their menopausal symptoms, medical history, and personal preferences.
Hormone replacement therapy (HRT)
Women can keep the symptoms of menopause at bay by supplementing their estrogen and progestin levels.
Hormone replacement therapy can be received through a simple patch on the skin. This patch releases estrogen and progestin. HRT is highly effective for many of the symptoms that occur during menopause.
There are benefits to HRT, but be conscious of the risks:
Benefits of HRT
- HRT effectively treats many troublesome menopausal symptoms.
- It can help prevent osteoporosis.
- HRT can lower the risk of colorectal cancer.
Risks of HRT
- HRT raises the risk of breast cancer, ovarian cancer, and uterine cancer.
- It increases the risk of coronary heart disease risk and stroke.
Hormonal therapy slightly accelerates loss of tissue in the areas of the brain important for thinking and memory among women aged 65 years and over.
There are other medicines available to help reduce the effects of menopause.
- venlafaxine (Effexor)
- fluoxetine (Prozac, Sarafem)
- paroxetine (Paxil, others)
- citalopram (Celexa)
Drug treatment for hot flashes
Hot flashes can be treated using gabapentin, available under the brand name Neurontin, and clonidine, which is often sold as Catapres.
Clonidine can be taken either orally as a pill or placed on the skin as a patch. It is effective in treating hot flashes, but unpleasant side effects are common, including constipation, dry eyes, and nightmares.
Treatments for osteoporosis include dietary supplements and drug therapy.
Drug treatments for vaginal symptoms
Vaginal estrogen may be applied to the area as a tablet, ring, or cream. This medication effectively treats vaginal dryness, dyspareunia, and some urinary problems.
Moisturisers are available over-the-counter.
A woman's estrogen levels drop during the aging process.
A reduction in levels of the hormones estrogen and progesterone triggers the effects of menopause.
Estrogen regulates menstruation, and progesterone is involved with preparing the body for pregnancy.
Perimenopause begins when the ovaries start producing less of these two hormones. By the time a woman reaches her late thirties, the ovaries start producing less progesterone and estrogen. Fertility starts to decline long before the onset of any menopausal or perimenopausal symptoms.
The ovaries produce less estrogen and progesterone over time until they shut down completely. Menstruation will then stop completely. This change is gradual in most women, but some find that their menstrual cycle continues as normal and then suddenly stops.
Ovaries tend to stop producing eggs after the age of 45 years, but they may cease production before then. This is known as premature menopause. Although rare, this can occur at any age. A number of underlying conditions can cause premature menopause, including:
Certain surgeries and procedures may also lead to premature ovarian failure, such as:
- surgery to remove the ovaries
- surgery to remove the womb
- radiotherapy to the pelvic area
- chemotherapy to the pelvic area
There is no way to prevent menopause, but its symptoms and effects can be managed.
A doctor should be able to diagnose menopause or perimenopause in a woman using her age, questions about her menstrual patterns, and feedback about any physical signs.
Since October 2018, anyone who wishes to know if they have entered menopause, or when they will do so, may be able to undergo a test to find out.
The test works by measuring anti-Müllerian hormone (AMH) in the blood, according to the U.S. Food and Drug Administration. This hormone is a marker of ovarian function. Used with other clinical evaluations and laboratory findings, it can give a better idea of a woman's menopausal status than was previously possible.
The test may also help those who have symptoms of perimenopause, which is the stage before menopause. At this stage, too there may also be adverse health impacts.
Early menopause is associated with a higher risk of:
- osteoporosis and fracture
- heart disease
- cognitive changes
- vaginal changes
- loss of libido
- mood changes
Another types of test is for follicle-stimulating hormone (FSH). During menopause FSH levels rise.
However, FSH is also not always a reliable indicator of menopause, as levels tend to fluctuate during menopause and perimenopause.
A study of 96 patients that was published in 2015 concluded that the AMH serum levels were more sensitive than FSH serum levels in tests. A doctor can also use the AMH test at any time during the menstrual cycle, unlike the FHS test.
Under certain circumstances, a doctor may order a blood test to determine the estrogen level. Low thyroid activity can cause similar symptoms to those seen in menopause, so a doctor may recommend a blood test to determine the level of thyroid-stimulating hormone.
It is often possible to manage the symptoms of menopause without medical intervention.
Exercise during menopause can have a range of benefits, including preventing weight gain, reducing cancer risk, protecting the bones, and boosting general mood.
Pilates, for example, has shown great benefit in reducing all menopausal symptoms not related to the urinary system and genitals, including sleep problems and hot flashes.
Women should exercise earlier in the day during menopause to avoid causing any interruptions to their sleep cycle.
Kegel exercises can be useful for preventing urinary incontinence. These are exercises to strengthen the pelvic floor. Practicing 3 or 4 times a day can lead to a noticeable improvement in symptoms within months.
It is important to maintain a healthful and varied diet when managing the bodily effects of menopause.
Omega-3 is available in foods such as oily fish. Supplements are also available.
Women experiencing menopause should eat a well-balanced diet that includes:
- whole grains
- unsaturated fats
- unrefined carbohydrates
Research, published in the journal Menopause, found that hypnosis can reduce the symptoms of menopausal hot flashes by up to 74 percent. The investigators found that those in the hypnosis group had considerably fewer hot flashes, and much milder symptoms, than the women in the control group.
Deep breathing techniques, guided meditation, and progressive relaxation can also help limit sleep disturbance. Stress can aggravate hot flashes and night sweats, so avoiding known stressors and practicing relaxation techniques can help these symptoms.
Other steps to self-manage menopause symptoms
There are a few ways for a woman to comfortably accommodate the effects of menopause:
- Avoid tight clothing.
- Limit the consumption of spicy food, caffeine, and alcohol.
- Stay sexually active to reduce vaginal dryness.
- Keep stress levels to a minimum, and get plenty of rest.
- Maintain a cool and comfortable temperature in the bedroom at night to minimize night sweats.
- Wake up and go to sleep at the same times every day to regulate the sleep cycle.
Smoking can exacerbate symptoms, so avoiding it is important. Staying active and healthy and responding to symptoms rapidly can help a woman maintain a good quality of life during menopause.