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Menopause is the time when your menstrual cycles come to an end. It is diagnosed after 12 months of not having a menstrual period. Menopause can occur in your 40s or 50s, but the average age in the United States is 51.
Menopause is a completely natural biological process. However, the physical and emotional symptoms of menopause, such as hot flashes, can disrupt your sleep, lower your energy, and affect your emotional health. There are numerous effective treatments available, ranging from lifestyle changes to hormone therapy.
WHAT ARE THE SYMPTOMS OF MENOPAUSE?
You may experience the following signs and symptoms in the months or years preceding menopause (perimenopause):
- Periods of inconsistency
- Dryness of the vagina
- Hot flashes
- Chills
- Sweating at night
- Sleep issues
- Mood swings
- Obesity and slowed metabolism
- Hair loss and dry skin
- Loss of breast fullness
Signs and symptoms, such as changes in menstruation, can differ between women. You'll most likely notice some irregularity in your periods before they end.
Period skipping is common and expected during perimenopause. Menstrual cycles frequently skip a month and then return, or skip several months and then restart monthly cycles for a few months. Periods also tend to occur on shorter cycles, bringing them closer together. Pregnancy is possible despite irregular periods. Consider a pregnancy test if you've missed a period but aren't sure if you've begun the menopausal transition.
WHAT ARE THE CAUSES OF MENOPAUSE?
Causes
Menopause can be caused by:
Reproductive hormones that are naturally declining: As you reach your late 30s, your ovaries begin to produce less estrogen and progesterone, the hormones that regulate menstruation, and your fertility begins to decline.
Menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent in your 40s, until eventually, on average, by age 51, your ovaries stop producing eggs and you no longer have periods.
Ovaries removal surgery (oophorectomy): Your ovaries produce hormones that regulate the menstrual cycle, such as estrogen and progesterone. Menopause occurs immediately after surgery to remove your ovaries. Your periods stop, and you're more likely to have hot flashes and other menopausal symptoms. Because hormonal changes occur abruptly rather than gradually over time, the signs and symptoms can be severe.
A hysterectomy, which removes your uterus but not your ovaries, usually does not result in immediate menopause. Even if you no longer have periods, your ovaries continue to produce eggs as well as estrogen and progesterone.
Primary ovarian insufficiency: Menopause affects about 1% of women before the age of 40. (premature menopause). Premature menopause can be caused by your ovaries' inability to produce normal levels of reproductive hormones (primary ovarian insufficiency), which can be caused by genetic factors or an autoimmune disease. However, in many cases, no cause of premature menopause can be identified. Hormone therapy is typically recommended for these women until the natural age of menopause in order to protect the brain, heart, and bones.
Chemotherapy and radiation therapy: These cancer treatments can cause menopause, resulting in symptoms such as hot flashes during or shortly after treatment. Because the cessation of menstruation (and fertility) is not always permanent after chemotherapy, birth control measures may still be required. Radiation therapy only has an effect on ovarian function when it is directed at the ovaries. Other parts of the body, such as breast tissue or the head and neck, will not be affected by radiation therapy.
WHAT ARE THE COMPLICATIONS OF MENOPAUSE?
Certain medical conditions become more likely after menopause. Here are some examples:
- Heart and blood vessel (cardiovascular) disease: Your risk of cardiovascular disease rises as your estrogen levels fall. Heart disease is the leading cause of death in both men and women. As a result, it's critical to get regular exercise, eat a healthy diet, and maintain a healthy weight. Consult your doctor for advice on how to protect your heart, such as how to lower high cholesterol or blood pressure.
- Urinary incontinence: You may experience frequent, sudden, strong urges to urinate, followed by involuntary loss of urine (urge incontinence), or loss of urine with coughing, laughing, or lifting as the tissues of your vagina and urethra lose elasticity (stress incontinence). Urinary tract infections may become more common.
Strengthening the pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help alleviate incontinence symptoms. Hormone therapy may also be an effective treatment option for menopausal urinary tract and vaginal changes that can lead to incontinence.
- Osteoporosis: This condition causes bones to become brittle and weak, increasing the likelihood of fractures. You may lose bone density at a rapid rate in the first few years after menopause, increasing your risk of osteoporosis. Postmenopausal women with osteoporosis are especially vulnerable to spine, hip, and wrist fractures.
- Sexual function: During sexual intercourse, vaginal dryness caused by decreased moisture production and loss of elasticity can cause discomfort and minor bleeding. In addition, decreased sensation may decrease your desire for sexual activity (libido).
Vaginal moisturizers and lubricants based on water may be beneficial. If a vaginal lubricant isn't enough, many women benefit from local vaginal estrogen treatment, which comes in the form of a vaginal cream, tablet, or ring.
- Gain in weight: Because metabolism slows during the menopausal transition and after menopause, many women gain weight. To maintain your current weight, you may need to eat less and exercise more.
HOW IS MENOPAUSE DIAGNOSED?
Menopausal signs and symptoms are usually enough to alert most women that they have begun the menopausal transition. Consult your doctor if you are concerned about irregular periods or hot flashes. Further evaluation may be recommended in some cases.
Menopause is usually diagnosed without the use of tests. However, under certain conditions, your doctor may advise you to have blood tests to determine your level of:
- Follicle-stimulating hormone (FSH) and estrogen (estradiol), because FSH levels rise and estradiol levels fall as you approach menopause.
- Thyroid-stimulating hormone (TSH), because an underactive thyroid (hypothyroidism) can cause menopausal symptoms.
There are over-the-counter home tests available to check FSH levels in your urine. The tests could reveal whether you have high FSH levels and are in perimenopause or menopause. However, because FSH levels rise and fall throughout your menstrual cycle, home FSH tests can't really tell you whether or not you're in a stage of menopause.
WHAT ARE THE TREATMENTS FOR MENOPAUSE?
Menopause does not necessitate medical intervention. Instead, treatments focus on alleviating your signs and symptoms as well as preventing or managing chronic conditions that may arise as you age. Treatment options may include:
- Hormone therapy: The most effective treatment option for menopausal hot flashes is estrogen therapy. Depending on your personal and family medical history, your doctor may advise you to take estrogen in the smallest dose and for the shortest period of time necessary to provide you with symptom relief. If you still have your uterus, progestin will be required in addition to estrogen. Estrogen also aids in the prevention of bone loss. Long-term hormone therapy use may pose some cardiovascular and breast cancer risks, but starting hormones around menopause has been shown to benefit some women. Consult your doctor about the benefits and risks of hormone therapy, as well as whether it is a safe option for you.
- Clonidine (Kapvay, Catapres): Clonidine, a pill or patch commonly used to treat high blood pressure, may help with hot flashes.
- Medications for osteoporosis prevention and treatment: Doctors may recommend medication to prevent or treat osteoporosis based on an individual's needs. There are several medications available to help reduce bone loss and the risk of fractures. Your doctor may advise you to take vitamin D supplements to help strengthen your bones.
- Low-dose antidepressants: Certain antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), have been shown to reduce menopausal hot flashes. A low-dose antidepressant for hot flashes may be beneficial for women who are unable to take estrogen due to medical reasons or for women who require an antidepressant for a mood disorder.
- Gabapentin (Gralise, Horizant, and Neurontin): Gabapentin is approved for the treatment of seizures, but it has also been shown to help with hot flashes. This medication is beneficial for women who are unable to use estrogen therapy and who also experience nighttime hot flashes.
- Vaginal estrogen: Estrogen can be administered directly to the vagina using a vaginal cream, tablet, or ring to relieve vaginal dryness. This treatment only produces a trace amount of estrogen, which is absorbed by vaginal tissues. It can help relieve vaginal dryness, intercourse discomfort, and some urinary symptoms.
Before deciding on a course of treatment, consult your doctor about your options and the risks and benefits of each. Your options should be reviewed at least once a year, as your needs and treatment options may change.
HOME REMEDIES FOR TREATING MENOPAUSE
Fortunately, many of the signs and symptoms of menopause are only temporary. Take the following steps to help mitigate or prevent their effects:
- Cool hot flashes: Dress in layers, drink cold water, or go somewhere cooler. Try to figure out what causes your hot flashes. Hot beverages, caffeine, spicy foods, alcohol, stress, hot weather, and even a warm room can all be triggers for many women.
- Consume a well-balanced diet: Consume a wide range of fruits, vegetables, and whole grains. Limit your intake of saturated fats, oils, and sugars. Inquire with your doctor if you need calcium or vitamin D supplements to help you meet your daily requirements.
- Avoid smoke: Smoking increases your chances of developing heart disease, stroke, osteoporosis, cancer, and a variety of other health issues. It may also cause hot flashes and hasten the onset of menopause.
- Regular exercise: Get regular physical activity or exercise on most days to help prevent heart disease, diabetes, osteoporosis, and other aging-related conditions.
- Reduce vaginal discomfort: Try a water-based vaginal lubricant (Astroglide, K-Y jelly, Sliquid, and others) or a silicone-based lubricant or moisturizer (Replens, K-Y Liquibeads, Sliquid, others).
If you're sensitive to glycerin, you should look for a product that doesn't contain it, as it can cause burning or irritation. Maintaining sexual activity reduces vaginal discomfort by increasing blood flow to the vagina.
- Get enough rest: Avoid caffeine, which can make it difficult to fall asleep, and excessive alcohol consumption, which can disrupt sleep. Exercise during the day, but not right before going to bed. If hot flashes are interfering with your sleep, you may need to find a way to deal with them before you can get enough rest.
- Use relaxation techniques: Deep breathing, paced breathing, guided imagery, massage, and progressive muscle relaxation are all techniques that may help with menopausal symptoms. There are numerous books and online resources that demonstrate various relaxation exercises.
Boost your pelvic floor strength: Pelvic floor muscle exercises, also known as Kegel exercises, can help with some types of urinary incontinence.