Menopause

Menopause is a natural biological process that marks the end of a woman's reproductive years. It occurs when the ovaries gradually stop producing less estrogen and progesterone, the hormones that regulate menstruation. Menopause is diagnosed after a woman has gone 12 consecutive months without a menstrual period. Natural menopause typically begins in a woman's 40s or 50s, with the average age in the United States being around 51 years. When women experience menopause before the age of 45, it is called early menopause. When it occurs at 40 years of age or younger, it is considered premature menopause.

The period leading up to menopause, when women may experience symptoms such as changes in their monthly cycles and hot flashes, is called perimenopause (menopause transition). Symptoms of menopause can vary widely from one woman to another. They may include hot flashes, night sweats, mood changes, sleep disturbances, vaginal dryness, and thinning of the bones (osteoporosis).

While menopause is a natural part of aging, it can also be caused by surgery, treatment of disease, or illness. For instance, the removal of the ovaries (oophorectomy) or certain cancer treatments can cause menopause.

The management of menopausal symptoms often involves lifestyle changes, hormone replacement therapy (HRT), and other FDA-approved medications to address specific symptoms. Women are encouraged to consult with healthcare providers to manage their menopausal symptoms and to address health risks that may increase after menopause, such as heart disease and osteoporosis.

Menopause is primarily caused by the natural decline in the production of reproductive hormones (estrogen and progesterone) by the ovaries. This decline in hormone levels is a normal part of aging for women. Some other factors that cause menopause include:

• Oophorectomy: Surgical removal of the ovaries (oophorectomy), which produce most of the body's estrogen, will cause immediate menopause. This is typically done for medical reasons, such as uterine cancer or endometriosis. Symptoms can be severe, as hormonal changes occur abruptly rather than gradually over several years.
• Chemotherapy and Radiation Therapy: Chemotherapy or hormone therapy (HT) for breast cancer can induce menopause, causing symptoms such as hot flushes during or shortly after treatment.
• Primary Ovarian Insufficiency (POI): For about 1% of women, menopause occurs before the age of 40, which is considered premature menopause. This can be due to primary ovarian insufficiency, where the ovaries fail to produce normal levels of reproductive hormones. This can be caused by genetic factors or autoimmune disease, but often the cause is not known.
• Hysterectomy: A hysterectomy that removes the uterus but not the 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 the uterus and the ovaries does cause immediate menopause.

Menopause can cause a variety of symptoms, ranging from mild to severe, as the body adjusts to changing hormone levels. Common symptoms of menopause include:

• Hot Flashes (Vasomotor Symptoms): Sudden feelings of warmth, usually most intense over the face, neck, and chest, which can cause sweating and then feeling cold afterwards.
• Night Sweats: Hot flashes that occur at night can disrupt sleep.
• Irregular Periods: Leading up to menopause (perimenopause), menstrual periods can become irregular. Periods may skip months or occur more frequently, and the flow may be lighter or heavier.
• Mood Changes: Some women experience mood swings, irritability, or increased risk of depression during menopause.
• Vaginal Dryness: Decreased moisture production and thinning of the vaginal walls can make sexual intercourse uncomfortable or painful. Water-based vaginal moisturizers and lubricants may help relieve this symptom.
• Sleep Problems: Many women experience insomnia or disturbed sleep patterns, often due to night sweats.
• Thinning Hair and Dry Skin: Lowered estrogen levels can lead to thinner hair and drier skin.
• Bladder Control Issues: Urinary incontinence can occur as the tissues of the vagina and urethra lose elasticity. It can cause frequent, sudden, strong urges to urinate or urine may leak during exercise, sneezing, or laughing.

• Weight Gain and Slowed Metabolism: Some women may notice weight gain and a slower metabolism during menopause.

• Osteoporosis: The decrease in estrogen levels during menopause can lead to a loss of bone density, increasing the risk of osteoporosis.
• Changes in Cholesterol Levels: Menopause can lead to changes in your cholesterol levels, including an increase in bad cholesterol (LDL) which contributes to an increased risk of heart disease.

It should be noted that if any type of vaginal bleeding occurs after menopause, contact a healthcare professional right away.

Menopause is primarily diagnosed based on symptoms and menstrual cycle changes. Typically, a diagnosis of menopause can be made when a woman has not had a menstrual period for 12 consecutive months without any surgery or medical condition such as hormonal birth control, radiation therapy or surgical removal of your ovaries that may be the cause of it.

In cases where a woman has had surgery to remove her ovaries (oophorectomy), menopause is considered to have occurred immediately at the time of surgery, regardless of age. For these women, the diagnosis is based on their surgical history and immediate symptoms.

Tests are not usually needed for a diagnosis. However, blood tests may be performed to check the levels of:

• Follicle-Stimulating Hormone (FSH) and Estrogen: During menopause, FSH levels increase and estrogen levels decrease. However, FSH and estrogen levels fluctuate daily, so these tests alone cannot diagnose menopause.
• Thyroid-Stimulating Hormone (TSH): In some cases, a thyroid function test might also be done to rule out thyroid issues, which can cause symptoms similar to those of menopause.

Treatment for menopause focuses on relieving symptoms and managing any long-term health changes that occur due to decreased levels of estrogen. Treatment options vary based on the severity of symptoms, health history, and personal preferences. Some common treatments for menopause include:

• Hormone Replacement Therapy (HRT): This is also called menopausal hormone therapy. It is one of the most effective treatments for relieving menopausal hot flashes and night sweats. HRT can also help prevent bone loss and fracture that can occur with menopause. However, HRT is not suitable for everyone and can have risks, such as an increased risk of blood clots, stroke, and some types of cancer.
• Vaginal Estrogen: Applied as a vaginal cream, tablet, or ring, vaginal estrogen can relieve vaginal dryness, discomfort with intercourse, and some urinary symptoms.
• Low-Dose Antidepressants: Certain low-dose antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) can decrease menopausal hot flashes. They are often recommended for women who cannot take estrogen for health reasons.
• Gabapentin: Originally used to treat seizures, gabapentin can be effective in reducing hot flashes for some women.
• Clonidine: Clonidine, a pill or patch typically used to treat high blood pressure, can provide some relief from hot flashes for certain women.
• Osteoporosis Treatments: To address the risk of osteoporosis during menopause, treatments may include calcium and vitamin D supplements, as well as prescription medications to prevent bone loss and strengthen bones.
• Lifestyle Changes and Natural Remedies: Many women find relief from symptoms through lifestyle modifications, such as practicing stress reduction techniques (e.g., yoga, meditation), maintaining a healthy diet, exercising regularly, quitting smoking, and dressing in layers to manage hot flashes. Some also explore natural remedies and supplements, though it's important to discuss these with a healthcare provider, as not all are safe or effective.

This is the name given to the time after it has been at least a year since your last period. During this stage, menopausal symptoms, such as hot flashes, may get better. However, some people continue to experience menopausal symptoms for a decade or longer after the menopause transition. As a result of a lower estrogen level, postmenopausal women are at an increased risk for several health conditions, such as osteoporosis and cardiovascular disease.

During perimenopause, the ovaries begin to make less estrogen and progesterone. It can begin up to 10 years before entering menopause. It often begins for women in their 40s, but some women enter perimenopause in their 30s. Doctors will determine that a woman has reached menopause when they haven’t had a period for 12 consecutive months. After that, theyl enter the postmenopausal stage. If a woman has had their ovaries surgically removed, menopause is considered to have occurred immediately at the time of surgery, regardless of age.

Sources

• Menopause basics. Office on Women's Health. Accessed Apr. 11, 2024.
• Menopausal symptoms: In depth. National Center for Complementary and Integrative Health. Accessed Apr. 11, 2024.
• Menopause. NIH. Accessed Apr. 11, 2024.
• What is Menopause? National Institute on Aging. Accessed Apr. 11, 2024.