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Menopause Overview

Menopause is the time that marks the end of your menstrual cycles. It's diagnosed after you've gone 12 months without a menstrual period. Menopause can happen in your 40s or 50s, but the average age is 51 in the United States.

Menopause is a natural biological process. But the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt your sleep, lower your energy or affect emotional health. There are many effective treatments available, from lifestyle adjustments to hormone therapy.

Symptoms

In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:

   Irregular periods

   Vaginal dryness

   Hot flashes

   Chills

   Night sweats

   Sleep problems

   Mood changes

   Weight gain and slowed metabolism

   Thinning hair and dry skin

   Loss of breast fullness

Symptoms, including changes in menstruation, are different for every woman. Most likely, you'll experience some irregularity in your periods before they end.

Skipping periods during perimenopause is common and expected. Often, menstrual periods will skip a month and return, or skip several months and then start monthly cycles again for a few months. Periods also tend to happen on shorter cycles, so they are closer together. Despite irregular periods, pregnancy is possible. If you've skipped a period but aren't sure you've started the menopausal transition, consider a pregnancy test.

When to see a doctor

Keep up with regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause.

Preventive health care as you age may include recommended health screening tests, such as colonoscopy, mammography and triglyceride screening. Your doctor might recommend other tests and exams, too, including thyroid testing if suggested by your history, and breast and pelvic exams.

Always seek medical advice if you have bleeding from your vagina after menopause.

Causes

Menopause can result from:

   Natural decline of reproductive hormones. As you approach your late 30s, your ovaries start making less estrogen and progesterone — the hormones that regulate menstruation — and your fertility declines. In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually — on average, by age 51 — your ovaries stop producing eggs, and you have no more periods.

   Hysterectomy. A hysterectomy that removes your uterus but not your ovaries usually doesn't cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone. But surgery that removes both your uterus and your ovaries (total hysterectomy and bilateral oophorectomy) does cause immediate menopause. Your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptoms, which can be severe, as these hormonal changes occur abruptly rather than over several years.

   Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures may still be desired.

   Primary ovarian insufficiency. About 1 percent of women experience menopause before age 40 (premature menopause). Menopause may result from primary ovarian insufficiency — when your ovaries fail to produce normal levels of reproductive hormones — stemming from genetic factors or autoimmune disease. But often no cause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones.

Complications

After menopause, your risk of certain medical conditions increases. Examples include:

   Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. So it's important to get regular exercise, eat a healthy diet and maintain a normal weight. Ask your doctor for advice on how to protect your heart, such as how to reduce your cholesterol or blood pressure if it's too high.

   Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists.

   Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). You may have urinary tract infections more often.

   Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help relieve symptoms of incontinence. Hormone therapy may also be an effective treatment option for menopausal urinary tract and vaginal changes which can result in urinary incontinence.

   Sexual function. Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido).

   Water-based vaginal moisturizers and lubricants may help. If a vaginal lubricant isn't enough, many women benefit from the use of local vaginal estrogen treatment, available as a vaginal cream, tablet or ring.

   Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows. You may need to eat less and exercise more, just to maintain your current weight.

By Mayo Clinic Staff

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Menopause definition and facts

   Menopause is defined as the absence of menstrual periods for 12 months. It is the time in a woman's life when the function of the ovaries ceases.

   The process of menopause does not occur overnight, but rather is a gradual process. This so-called perimenopausal transition period is a different experience for each woman.

   The average age of menopause is 51 years old, but menopause may occur as early as the 30s or as late as the 60s. There is no reliable lab test to predict when a woman will experience menopause.

   The age at which a woman starts having menstrual periods is not related to the age of menopause onset.

   Symptoms of menopause can include abnormal vaginal bleeding, hot flashes, vaginal and urinary symptoms, and mood changes.

   Complications that women may develop after menopause include osteoporosis and heart disease.

   Treatments for menopause are customized for each woman.

   Treatments are directed toward alleviating uncomfortable or distressing symptoms.

Quick GuideMenopause & Perimenopause: Symptoms, Signs

Menopause & Perimenopause: Symptoms, Signs

Menopause Symptoms

 

Menopause is the time in a woman's life at which she can no longer reproduce. Symptoms of perimenopause, menopause, and postmenopause vary greatly from woman to woman. However, common symptoms of menopause include

   Hot flashes

   Mood changes

   Fatigue

   Stress

   Tiredness

   Vaginal dryness and itching

Read more about perimenopause and menopause symptoms »

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What is menopause?

 

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Menopause is defined as the state of an absence of menstrual periods for 12 months. The menopausal transition starts with varying menstrual cycle length and ends with the final menstrual period. Perimenopause is a term sometimes used and means "the time around menopause." It is often used to refer to the menopausal transitional period. It is not officially a medical term, but is sometimes used to explain certain aspects of the menopause transition in lay terms. "Postmenopausal" is a term used to as an adjective to refer to the time after menopause has occurred. For example, doctors may speak of a condition that occurs in "postmenopausal women." This refers to women who have already reached menopause.

 

Menopause is the time in a woman's life when the function of the ovaries ceases and she can no longer become pregnant. The ovary (female gonad), is one of a pair of reproductive glands in women. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones such as estrogen. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a Fallopian tube to the uterus.

The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. The hormones also regulate the menstrual cycle and pregnancy. Estrogens also protect the bone. Therefore, a woman can develop osteoporosis (thinning of bone) later in life when her ovaries do not produce adequate estrogen.

What is perimenopause?

Perimenopause is different for each woman. Scientists are still trying to identify all the factors that initiate and influence this transition period.

At what age does a woman typically reach menopause?

 

The average age of menopause is 51 years old. However, there is no way to predict when an individual woman will have menopause or begin having symptoms suggestive of menopause. The age at which a woman starts having menstrual periods is also not related to the age of menopause onset. Most women reach menopause between the ages of 45 and 55, but menopause may occur as earlier as ages 30s or 40s, or may not occur until a woman reaches her 60s. As a rough "rule of thumb," women tend to undergo menopause at an age similar to that of their mothers.

Perimenopause, often accompanied by irregularities in the menstrual cycle along with the typical symptoms of early menopause, can begin up to 10 years prior to the last menstrual period.

How long does menopause last?

 

Menopause is a point in time and not a process- it is the time point in at which a woman’s last period ends. Of course, a woman will not know when that time point has occurred until she has been 12 consecutive months without a period. The symptoms of menopause, on the other hand, may begin years before the actual menopause occurs and may persist for some years afterward as well.

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What are the signs and symptoms of menopause?

It is important to remember that each woman's experience is highly individual. Some women may experience few or no symptoms of menopause, while others experience multiple physical and psychological symptoms. The extent and severity of symptoms varies significantly among women. It is also important to remember that symptoms may come and go over an extended period for some women. This, too, is highly individual. These symptoms of menopause and perimenopause are discussed in detail below.

  1. Irregular vaginal bleeding

Irregular vaginal bleeding may occur as a woman reaches menopause. Some women have minimal problems with abnormal bleeding during the prior time to menopause whereas others have unpredictable, excessive bleeding. Menstrual periods (menses) may occur more frequently (meaning the cycle shortens in duration), or they may get farther and farther apart (meaning the cycle lengthens in duration) before stopping. There is no "normal" pattern of bleeding during the perimenopause, and patterns vary from woman to woman. It is common for women in perimenopause to have a period after going for several months without one. There is also no set length of time it takes for a woman to complete the menopausal transition. A woman can have irregular periods for years prior to reaching menopause. It is important to remember that all women who develop irregular menses should be evaluated by their doctor to confirm that the irregular menses are due to perimenopause and not as a sign of another medical condition.

The menstrual abnormalities that begin in the perimenopause are also associated with a decrease in fertility, since ovulation has become irregular. However, women who are perimenopausal may still become pregnant until they have reached true menopause (the absence of periods for one year) and should still use contraception if they do not wish to become pregnant.

  1. Hot flashes

 

Hot flashes are common among women undergoing menopause. A hot flash is a feeling of warmth that spreads over the body and is often most pronounced in the head and chest. A hot flash is sometimes associated with flushing and is sometimes followed by perspiration. Hot flashes usually last from 30 seconds to several minutes. Although the exact cause of hot flashes is not fully understood, hot flashes are likely due to a combination of hormonal and biochemical fluctuations brought on by declining estrogen levels.

There is currently no method to predict when hot flashes will begin and how long they will last. Hot flashes occur in up to 40% of regularly menstruating women in their forties, so they may begin before the menstrual irregularities characteristic of menopause even begin. About 80% of women will be finished having hot flashes after five years. Sometimes (in about 10% of women), hot flashes can last as long as 10 years. There is no way to predict when hot flashes will cease, though they tend to decrease in frequency over time. They may also wax and wane in their severity. The average woman who has hot flashes will have them for about five years.

 

Sometimes hot flashes are accompanied by night sweats (episodes of drenching sweats at nighttime). This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.

  1. Night sweats

Night sweats (episodes of drenching sweats at nighttime) sometimes accompany hot flashes. This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.

  1. Vaginal symptoms

Vaginal symptoms occurs because the tissues lining the vagina becoming thinner, drier, and less elastic as estrogen levels fall. Symptoms may include vaginal dryness, itching, or irritation and/or pain with sexual intercourse (dyspareunia). The vaginal changes also lead to an increased risk of vaginal infections.

  1. Urinary symptoms

 

The lining of the urethra (the transport tube leading from the bladder to discharge urine outside the body) also undergoes changes similar to the tissues of the vagina, and becomes drier, thinner, and less elastic with declining estrogen levels. This can lead to an increased risk of urinary tract infection, feeling the need to urinate more frequently, or leakage of urine (urinary incontinence). The incontinence can result from a strong, sudden urge to urinate or may occur during straining when coughing, laughing, or lifting heavy objects.

  1. Emotional and cognitive symptoms

 

Women in perimenopause often report a variety of thinking (cognitive) and/or emotional symptoms, including fatigue, memory problems, irritability, and rapid changes in mood. It is difficult to determine exactly which behavioral symptoms are due directly to the hormonal changes of menopause. Research in this area has been difficult for many reasons.

Emotional and cognitive symptoms are so common that it is sometimes difficult in a given woman to know if they are due to menopause. The night sweats that may occur during perimenopause can also contribute to feelings of tiredness and fatigue, which can have an effect on mood and cognitive performance. Finally, many women may be experiencing other life changes during the time of perimenopause or after menopause, such as stressful life events, that may also cause emotional symptoms.

  1. Other physical changes

 

Many women report some degree of weight gain along with menopause. The distribution of body fat may change, with body fat being deposited more in the waist and abdominal area than in the hips and thighs. Changes in skin texture, including wrinkles, may develop along with worsening of adult acne in those affected by this condition. Since the body continues to produce small levels of the male hormone testosterone, some women may experience some hair growth on the chin, upper lip, chest, or abdomen.

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Menopause & Perimenopause: Symptoms, Signs

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What conditions can cause early menopause?

 

Certain medical and surgical conditions can influence the timing of menopause.

Surgical removal of the ovaries

The surgical removal of the ovaries (oophorectomy) in an ovulating woman will result in an immediate menopause, sometimes termed a surgical menopause, or induced menopause. In this case, there is no perimenopause, and after surgery, a woman will generally experience the signs and symptoms of menopause. In cases of surgical menopause, women often report that the abrupt onset of menopausal symptoms results in particularly severe symptoms, but this is not always the case.

 

The ovaries are often removed together with the removal of the uterus (hysterectomy). If a hysterectomy is performed without removal of both ovaries in a woman who has not yet reached menopause, the remaining ovary or ovaries are still capable of normal hormone production. While a woman cannot menstruate after the uterus is removed by a hysterectomy, the ovaries themselves can continue to produce hormones up until the normal time when menopause would naturally occur. At this time, a woman could experience the other symptoms of menopause such as hot flashes and mood swings. These symptoms would then not be associated with the cessation of menstruation. Another possibility is that premature ovarian failure will occur earlier than the expected time of menopause, as early as 1 to 2 years following the hysterectomy. If this happens, a woman may or may not experience symptoms of menopause.

Cancer chemotherapy and radiation therapy

 

Depending upon the type and location of the cancer and its treatment, these types of cancer therapy (chemotherapy and/or radiation therapy) can result in menopause if given to an ovulating woman. In this case, the symptoms of menopause may begin during the cancer treatment or may develop in the months following the treatment.

Premature ovarian failure

Premature ovarian failure is defined as the occurrence of menopause before the age of 40. This condition occurs in about 1% of all women. The cause of premature ovarian failure is not fully understood, but it may be related to autoimmune diseases or inherited (genetic) factors.

A doctor and patient discuss menopause.

What tests diagnose menopause?

Because hormone levels may fluctuate greatly in an individual woman, even from one day to the next, hormone levels are not a reliable method for diagnosing menopause. Even if levels are low one day, they may be high the next day in the same woman. There is no single blood test that reliably predicts when a woman is going through the menopausal transition. Therefore, there is currently no proven role for blood testing regarding menopause except for tests to exclude medical causes of erratic menstrual periods other than menopause. The only way to diagnose menopause is to observe the lack of menstrual periods for 12 months in a woman in the expected age range.

What are the treatment options for menopause?

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Menopause itself is a normal part of life and not a disease that requires treatment. However, treatment of associated symptoms is possible if these become substantial or severe.

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Hormone treatment and therapy for menopause

Estrogen and progesterone therapy

 

Hormone therapy (HT), also referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of estrogens or a combination of estrogens and progesterone (progestin). Hormone therapy has been used to control the symptoms of menopause related to declining estrogen levels such as hot flashes and vaginal dryness, and HT is still the most effective way to treat these symptoms. But long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.

Hormone therapy is available in oral (pill), transdermal form (for example, patch and spray such as Vivelle, Climara, Estraderm, Esclim, Alora). Transdermal hormone products are already in their active form without the need for "first pass" metabolism in the liver to be converted to an active form. Since transdermal hormone products do not have effects on the liver, this route of administration has become the preferred form for most women. A number of preparations are available for oral and transdermal forms of HT, varying in the both type and amount of hormones in the products.

 

There has been increasing interest in recent years in the use of so-called "bioidentical" hormone therapy for perimenopausal women. Bioidentical hormone preparations are medications that contain hormones that have the same chemical formula as those made naturally in the body. The hormones are created in a laboratory by altering compounds derived from naturally occurring plant products. Some of these so-called bioidentical hormone preparations are U.S. FDA-approved and manufactured by drug companies, while others are made at special pharmacies called compounding pharmacies that make the preparations on a case-by-case basis for each patient. The does not regulate individual FDA compound preparations because compounded products are not standardized.

Boidentical hormone therapy products are administered transdermally. They are typically applied as cream or gels. Their advocates believe that their use may avoid potentially dangerous side effects of synthetic hormones used in conventional hormone therapy. However, studies to establish the long-term safety and effectiveness of these products have not been carried out.

The decision about hormone therapy is a very individual decision in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman's own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time. It is currently recommended that hormone therapy be used if the balance of risks and benefits is favorable for the individual woman.

Oral contraceptive pills provide hormone therapy for some women in perimenopause.

Oral contraceptives and vaginal treatments for menopause

Oral contraceptive pills

 

Oral contraceptive pills are another form of hormone therapy often prescribed for women in perimenopause to treat irregular vaginal bleeding.

Prior to treatment, a doctor must exclude other causes of erratic vaginal bleeding. Women in the menopausal transition tend to have considerable breakthrough bleeding when given estrogen therapy. Therefore, oral contraceptives are often given to women in the menopause transition to regulate menstrual periods, relieve hot flashes, as well as to provide contraception. The list of contraindications for oral contraceptives in women going through the menopause transition is the same as that for premenopausal women.

Local (vaginal) hormone and non-hormone treatments

There are also local (meaning applied directly to the vagina) hormonal treatments for the symptoms of vaginal estrogen deficiency. Local treatments include the vaginal estrogen ring (Estring), vaginal estrogen cream, or vaginal estrogen tablets. Local and oral estrogen treatments are sometimes combined for this purpose.

Vaginal moisturizing agents such as creams or lotions (for example, K-Y Silk-E Vaginal Moisturizer or KY Liquibeads Vaginal Moisturizer) as well as the use of lubricants during intercourse are non-hormonal options for managing the discomfort of vaginal dryness.

Applying Betadine topically on the outer vaginal area, and soaking in a sitz bath or soaking in a bathtub of warm water may be helpful for relieving symptoms of burning and vaginal pain after intercourse.

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Antidepressants and other medications for menopause

Antidepressant medications: The class of drugs known as selective serotonin reuptake inhibitors (SSRIs) and related medications have been shown to be effective in controlling the symptoms of hot flashes in up to 60% of women. Specifically, venlafaxine (Effexor), a drug related to the SSRIs, and the SSRIs fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), desvenlafaxine (Pristiq), and citalopram (Celexa) have all been shown to decrease the severity of hot flashes in some women. However, antidepressant medications may be associated with side effects, including decreased libido or sexual dysfunction.

Other medications: Other prescription medications have been shown to provide some relief for hot flashes, although their specific purpose is not the treatment of hot flashes. All of these may have side effects, and their use should be discussed with and monitored by a doctor. Some of these medications that have been shown to help relieve hot flashes include the antiseizure drug gabapentin (Neurontin) and clonidine (Catapres), a drug used to treat high blood pressure.

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An array of soy beans, chick peas and lentils, which are examples of plant estrogens.

Home remedies: Plant estrogens for menopause

Plant estrogens (phytoestrogens, isoflavones)

 

Isoflavones are chemical compounds found in soy and other plants that are phytoestrogens, or plant-derived estrogens. They have a chemical structure that is similar to the estrogens naturally produced by the body, but their effectiveness as an estrogen has been estimated to be much lower than true estrogens. Their estrogen potency has been estimated to be only 1/1000 to 1/100,000 of that of estradiol, a natural estrogen.

 

Two types of isoflavones, genistein and daidzein, are found in soybeans, chickpeas, and lentils, and are considered to be the most potent estrogens of the phytoestrogens.

 

Studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. In particular, women who have had breast cancer and do not want to take hormone therapy (HT) with estrogen sometimes use soy products for relief of menopausal symptoms.

There is also a perception among many women that plant estrogens are "natural" and therefore safer than HT, but this has never been proven scientifically. Further research is needed to fully characterize the safety and potential risks of phytoestrogens.

Quick GuideMenopause & Perimenopause: Symptoms, Signs

Menopause & Perimenopause: Symptoms, Signs

Alternative medical therapies for menopause include vitamin E and black cohosh capsules.

Home remedies: vitamin E, black cohosh, and herbs for menopause

Vitamin E

Some women report that vitamin E supplements can provide relief from mild hot flashes, but scientific studies are lacking to prove the effectiveness of vitamin E in relieving symptoms of menopause. Taking a dosage greater than 400 international units (IU) of vitamin E may not be safe, since some studies have suggested that greater dosages may be associated with cardiovascular disease risk.

Black Cohosh

 

Black cohosh is an herbal preparation that has been popular in Europe for the relief of hot flashes. This herb has become more and more popular in the U.S., and the North American Menopause Society does support the short-term use of black cohosh for treating menopausal symptoms, for a period of up to six months, because of its relatively low incidence of side effects when used short term. However, there have still been very few scientific studies done to establish the benefits and safety of this product. Research is ongoing to further determine the effectiveness and safety of black cohosh.

A large study known as the Herbal Alternatives for Menopause Trial (HALT) tested the effectiveness of different herbal or alternative ingredients versus estrogen therapy or placebo for the relief of menopausal symptoms. After one year of therapy, there was no significant reduction in the frequency or severity of hot flashes in women receiving any of the herbal preparations (including a group who received black cohosh) when compared to placebo at any of the follow-up times (3, 6, and 12 months).

Other alternative therapies for menopause symptoms

 

There are many supplements and substances that have been advertised as "natural" treatments for symptoms of menopause, including licorice, dong quai, chasteberry, and wild yam. Scientific studies have not proven the safety or effectiveness of these products.

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Vaginal lubricants for menopause symptoms

In women for whom oral or vaginal estrogens are deemed inappropriate, such as breast cancer survivors, or women who do not wish to take oral or vaginal estrogen, there are varieties of over-the-counter vaginal lubricants. However, they are probably not as effective in relieving vaginal symptoms as replacing the estrogen deficiency with oral or local estrogen.

Lifestyle factors in controlling the symptoms and complications of menopause

 

Many of the symptoms of menopause and the medical complications that may develop in postmenopausal women can be lessened or even avoided by taking steps to lead a healthy lifestyle.

   Regular exercise can help protect against cardiovascular disease and osteoporosis. Exercise also has proven mental health benefits.

   Proper nutrition

   Stop smoking

Which specialties of doctors treat menopausal symptoms?

The symptoms of menopause are often treated by a woman’s gynecologist. Primary care providers, including family medicine specialists and internists, may also treat the symptoms of menopause.

What are the complications and effects of menopause on chronic medical conditions?

Osteoporosis

Osteoporosis is the deterioration of the quantity and quality of bone that causes an increased risk of fracture. The density of the bone (bone mineral density) normally begins to decrease in women during the fourth decade of life. However, that normal decline in bone density is accelerated during the menopausal transition. Consequently, both age and the hormonal changes due to the menopause transition act together to cause osteoporosis.

The process leading to osteoporosis can operate silently for decades. Women may not be aware of their osteoporosis until suffering a painful fracture. The symptoms are then related to the location and severity of the fractures.

Treatment of osteoporosis

 

The goal of osteoporosis treatment is the prevention of bone fractures by slowing bone loss and increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture, none of the available treatments for osteoporosis are complete cures for the condition. Therefore, the prevention of osteoporosis is as important as treatment.

Osteoporosis treatment and prevention measures are:

   Lifestyle changes including cessation of cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D.

   Calcium and vitamin D supplements may be recommended for women who do not consume sufficient quantities of these nutrients.

   Medications that stop bone loss and increase bone strength include alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), zoledronic acid (Reclast), raloxifene (Evista), denosumab (Prolia), and calcitonin (Calcimar). Teriparatide (Forteo) is a medication that increases bone formation.

Cardiovascular disease

Prior to menopause, women have a decreased risk of heart disease and stroke when compared with men. Around the time of menopause, however, a women's risk of cardiovascular disease increases. Heart disease is the leading cause of death in both men and women in the U.S.

Coronary heart disease rates in postmenopausal women are two to three times higher than in women of the same age who have not reached menopause. This increased risk for cardiovascular disease may be related to declining estrogen levels, but in light of other factors (see Treatment section below), postmenopausal women are not advised to take hormone therapy simply as a preventive measure to decrease their risk of heart attack or stroke.

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Menopause

 

Menopause is the time when your menstrual periods stop permanently and you can no longer get pregnant. Some people call the time leading up to a woman’s last period menopause. This time actually is the transition to menopause, or perimenopause. After menopause, your body makes much less of the hormones estrogen and progesterone. Very low estrogen levels after menopause can affect your health and cause symptoms such as hot flashes. You can take steps to protect your health and relieve your symptoms.

 

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The Office on Women's Health is grateful for the medical review in 2017 by:

 

   Chhanda Dutta, Ph.D., Chief, Clinical Gerontology Branch, Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health

 

   Hadine Joffe, M.D., MsC, Associate Professor of Psychiatry, Harvard Medical School, Director of Division of Women’s Mental Health, Brigham and Women’s Hospital, Director of Psycho-Oncology Research, Dana Farber Cancer Institute

 

All material contained on these pages are free of copyright restrictions and may be copied, reproduced, or duplicated without permission of the Office on Women’s Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated.

 

Page last updated: May 23, 2018.

Everything You Should Know About Menopause

 

   Timeline

   Symptoms

   Complications

   Causes

   Diagnosis

   Treatments

   Home remedies

   Outlook

 

Overview

 

Menopause occurs when a woman hasn’t menstruated in 12 consecutive months and can no longer become pregnant naturally. It usually begins between the ages of 45 and 55, but can develop before or after this age range.

 

Menopause can cause uncomfortable symptoms, such as hot flashes and weight gain. For most women, medical treatment isn’t needed for menopause. Read on to learn what you need to know about menopause.

When does menopause begin and how long does it last?

 

Most women first begin developing menopause symptoms about four years before their last period. Symptoms often continue until about four years after a woman’s last period. A small number of women experience menopause symptoms for up to a decade before menopause actually occurs, and 1 in 10 women experience menopausal symptoms for 12 years following their last period.

 

The median age for menopause is 51, though it may occur on average up to 2 years earlier for African American and Latina women. More studies are needed to understand the onset of menopause for non-Caucasian women.

 

There are many factors that help determine when you’ll begin menopause, including genetics and ovary health. Perimenopause often occurs before menopause. Perimenopause is a time when your hormones begin to change in preparation for menopause. It can last anywhere from a few months to several years. Many women begin perimenopause some point after their mid-40s. Other women skip perimenopause and enter menopause suddenly.

 

About 1 percent of women begin menopause before the age of 40, and about 5 percent undergo menopause between the ages of 40 and 45. This is referred to as early or premature menopause, or primary ovarian insufficiency.

Perimenopause vs. menopause vs. postmenopause

 

During perimenopause, menstrual periods become irregular. Your periods may be late, or you may completely skip one or more periods. Menstrual flow may also become heavier or lighter.

 

Menopause is defined as a lack of menstruation for one full year.

 

Postmenopause refers to the years after menopause has occurred.

What are the symptoms of menopause?

 

Every woman’s menopause experience is unique. Symptoms are usually more severe when menopause occurs suddenly or over a shorter period of time. Conditions that impact the health of the ovary, like cancer or hysterectomy, or certain lifestyle choices, like smoking, tend to increase the severity and duration of symptoms.

 

Aside from menstruation changes, the symptoms of perimenopause, menopause, and postmenopause are generally the same. The most common early signs of perimenopause are:

 

   less frequent menstruation

   heavier or lighter periods than you normally experience

   vasomotor symptoms, including hot flashes, night sweats, and flushing

 

An estimated 75 percent of women experience vasomotor symptoms with menopause.

 

Other common symptoms of menopause include:

 

   insomnia

   vaginal dryness

   weight gain

   depression

   anxiety

   difficulty concentrating

   memory problems

   reduced libido, or sex drive

   dry skin, mouth, and eyes

   increased urination

   sore or tender breasts

   headaches

   racing heart

   urinary tract infections (UTIs)

   reduced muscle mass

   painful or stiff joints

   reduced bone mass

   less full breasts

   hair thinning or loss

   increased hair growth on other areas of the body, like the face, neck, chest, and upper back

 

Complications

 

Common complications of menopause include:

 

   vulvovaginal atrophy

   dyspareunia, or painful intercourse

   slower metabolic function

   osteoporosis, or weaker bones with reduced mass and strength

   mood or sudden emotional changes

   cataracts

   periodontal disease

   overactive bladder

   heart or blood vessel disease

 

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Why does menopause occur?

 

Menopause is a natural process that occurs as the ovaries age and produce less reproductive hormones.

 

The body begins to undergo several changes in response to lower levels of:

 

   estrogen

   progesterone

   testosterone

   follicle-stimulating hormone (FSH)

   luteinizing hormone (LH)

 

One of the most notable changes is the loss of active ovarian follicles. Ovarian follicles are the structures that produce and release eggs from the ovary wall, allowing menstruation and fertility.

 

Most women first notice the frequency of their period becoming less consistent, as the flow becomes heavier and longer. This usually occurs at some point in the mid-to-late 40s. By the age of 52, most U.S. women have undergone menopause.

 

In some cases, menopause is induced, or caused by injury or surgical removal of the ovaries and related pelvic structures.

 

Common causes of induced menopause include:

 

   bilateral oophorectomy, or surgical removal of the ovaries

   ovarian ablation, or the shutdown of ovary function, which may be done by hormone therapy, surgery, or radiotherapy techniques in women with estrogen receptor-positive tumors

   pelvic radiation

   pelvic injuries that severely damage or destroy the ovaries

 

How is menopause diagnosed?

 

It’s worth talking with your healthcare provider if you’re experiencing troublesome or disabling menopause symptoms, or you’re experiencing menopause symptoms and are 45 years of age or younger.

 

There’s no single test to diagnose menopause, but your doctor can order a blood test that will measure the level of certain hormones in the blood, usually FSH and a form of estrogen called estradiol. Consistently elevated FSH blood levels of 30 mIU/mL or higher, combined with a lack of menstruation for one consecutive year, is usually confirmation of menopause. Saliva tests and over-the-counter (OTC) urine tests are also available, but they’re unreliable and expensive.

 

During perimenopause, FSH and estrogen levels fluctuate daily, so most healthcare providers will diagnosis this condition based on symptoms, medical history, and menstrual information.

 

Depending on your symptoms and health history, your healthcare provider may also order additional blood tests to help rule out other underlying conditions that may be responsible for your symptoms.

 

Additional blood tests commonly used to help confirm menopause include:

 

   thyroid function tests

   blood lipid profile

   liver function tests

   kidney function tests

   testosterone, progesterone, prolactin, estradiol, and chorionic gonadotropin (hCG) tests

 

Treatments

 

You may need treatment if your symptoms are severe or affecting your quality of life. Hormone therapy may be an effective treatment in women under the age of 60, or within 10 years of menopause onset, for the reduction or management of:

 

   hot flashes

   night sweats

   flushing

   vaginal atrophy

   osteoporosis

 

Other medications may be used to treat more specific menopause symptoms, like hair loss and vaginal dryness.

 

Additional medications sometimes used for menopause symptoms include:

 

   topical minoxidil 5 percent, used once daily for hair thinning and loss

   antidandruff shampoos, commonly ketoconazole 2 percent and zinc pyrithione 1 percent, used for hair loss

   eflornithine hydrochloride topical cream for unwanted hair growth

   topical lubricants and anti-inflammatory agents for severely dry eyes

   selective serotonin reuptake inhibitors (SSRIs), commonly paroxetine 7.5 milligrams for hot flashes, anxiety, and depression

   nonhormonal vaginal moisturizers and lubricants

   low-dose estrogen-based vaginal lubricants in the form of a cream, ring, or tablet

   ospemifene for vaginal dryness and painful intercourse

   prophylactic antibiotics for UTIs

   sleep medications for insomnia

   denosumab, teriparatide, raloxifene, or calcitonin for postmenstrual osteoporosis

 

Home remedies and lifestyle changes

 

There are several ways to reduce minor-to-moderate menopause symptoms naturally, using home remedies, lifestyle changes, and alternative treatments.

 

Common at-home tips for managing menopause symptoms include:

Keeping cool and staying comfortable

 

Dress in loose, layered clothing, especially during the nighttime and during warm or unpredictable weather. This can help you manage hot flashes.

 

Keeping your bedroom cool and avoiding heavy blankets at night can also help reduce your chances of night sweats. If you regularly have night sweats, consider using a waterproof sheet under your bedding to protect your mattress.

 

You can also carry a portable fan to help cool you down if you’re feeling flushed.

Exercising and managing your weight

 

Reduce your daily calorie intake by 400 to 600 calories to help manage your weight. It’s also important to exercise moderately for 20-30 minutes a day. This can help:

 

   increase energy

   promote a better night’s sleep

   improve mood

   promote your general well-being

 

Communicating your needs

 

Talk to a therapist or psychologist about any feelings of depression, anxiety, sadness, isolation, insomnia, and identity changes.

 

You should also try talking to your family members, loved ones, or friends about feelings of anxiety, mood changes, or depression so that they know your needs.

Supplementing your diet

 

Take calcium, vitamin D, and magnesium supplements to help reduce your risk for osteoporosis and improve energy levels and sleep. Talk to your doctor about supplements that can help you for your individual health needs.

Practicing relaxation techniques

 

Practice relaxation and breathing techniques, like:

 

   yoga

   box breathing

   meditation

 

Taking care of your skin

 

Apply moisturizers daily to reduce skin dryness. You should also avoid excessive bathing or swimming, which can dry out or irritate your skin.

Managing sleeping issues

 

Use OTC sleep medications to temporarily manage your insomnia or consider discussing natural sleep aids with your doctor. Talk to your doctor if you regularly have trouble sleeping so they can help you manage it and get a better night’s rest.

Quitting smoking and limiting alcohol use

 

Stop smoking and avoid exposure to secondhand smoke. Exposure to cigarettes may make your symptoms worse.

 

You should also limit your alcohol intake to reduce worsening symptoms. Heavy drinking during menopause may increase your risk of health concerns.

Other remedies

 

Some limited studies have supported the use of herbal remedies for menopausal symptoms caused by estrogen deficiency.

 

Natural supplements and nutrients that may help limit menopause symptoms include:

 

   soy

   vitamin E

   isoflavone

   melatonin

   flax seed

 

There are also claims that black cohosh may improve some symptoms, such as hot flashes and night sweats. But in a recent review of studies, little evidence was found to support these claims. More research is needed.

 

Similarly, research from 2015 found no evidence to support claims that omega-3 fatty acids can improve vasomotor symptoms associated with menopause.

Outlook

 

Menopause is the natural cessation, or stopping, of a woman’s menstrual cycle, and marks the end of fertility. Most women experience menopause by the age of 52, but pelvic or ovarian damage may cause sudden menopause earlier in life. Genetics or underlying conditions may also lead to early onset of menopause.

 

Many women experience menopause symptoms in the few years before menopause, most commonly hot flashes, night sweats, and flushing. Symptoms can continue for four or more years after menopause.

 

You may benefit from treatment, such as hormone therapy, if your symptoms are severe or affecting your quality of life. Generally, menopause symptoms can be managed or reduced using natural remedies and lifestyle adjustments.

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   Black cohosh [Fact sheet]. (2017).

   ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/

   Cetisli NE, et al. (2015). The effects of flaxseed on menopausal symptoms and quality of life. DOI:

   10.1097/HNP.0000000000000085

   Cheng G, et al. (2007). Isoflavone treatment for acute menopausal symptoms. DOI:

   10.1097/GME.0b013e31802cc7d0

   Cohen LS, et al. (2014). Efficacy of omega-3 treatment for vasomotor symptoms: A randomized controlled trial. DOI:

   10.1097/GME.0b013e31829e40b8

   Gold EB. (2012). The timing of the age at which natural menopause occurs. DOI:

   10.1016/j.ogc.2011.05.002

   How do I know I’m in menopause? (n.d.)

   menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/how-do-i-know-i'm-in-menopause-

   Jehan S, et al. (2017). Sleep, melatonin, and the menopausal transition: What are the links? DOI:

   10.5935/1984-0063.20170003

   Levis S, et al. (2010). The role of soy foods in the treatment of menopausal symptoms. DOI:

   10.3945/jn.110.124388

   Menopause. (2015).

   nhs.uk/conditions/menopause/

   Newton KM, et al. (2014). Efficacy of yoga for vasomotor symptoms: A randomized trial. DOI:

   10.1097/GME.0b013e31829e4baa

   Ovarian ablation. (2016).

   cancer.ie/cancer-information/breast-cancer/ovarian-ablation#sthash.AcTjoBg0.dpbs

   Pinkerton JV, et al. (2017). The 2017 hormone therapy position statement of the North American Menopause Society. DOI:  

   10.1097/GME.0000000000000921

   Santoro N, et al. (2011). Reproductive hormones and the menopause transition. DOI:

   10.1016/j.ogc.2011.05.004

   Shifren JL, et al. (2014). The North American Menopause Society recommendations for clinical care of midlife women. DOI:

   10.1097/GME.0000000000000319

   Ziaei S, et al. (2007). The effect of vitamin E on hot flashes in menopausal women. DOI:

   10.1159/000106491

 

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