Menopause

Menopause Overview

What Is Menopause?

Menopause is a normal condition that all women experience as they age. The term “menopause” can describe any of the changes a woman goes through either just before or after she stops menstruating, marking the end of her reproductive period.

What Causes Menopause?

A woman is born with a finite number of eggs, which are stored in the ovaries. The ovaries also make the hormones estrogen and progesterone, which control menstruation and ovulation. Menopause happens when the ovaries no longer release an egg every month and menstruationstops.

Menopause is considered a normal part of aging when it happens after the age of 40. But some women can go through menopause early, either as a result of surgery, such as hysterectomy, or damage to the ovaries, such as from chemotherapy. Menopause that happens before 40, regardless of the cause, is called premature menopause.

How Does Natural Menopause Happen?

Natural menopause is not brought on by any type of medical or surgical treatment. The process is gradual and has three stages:

Perimenopause

This typically begins several years before menopause, when the ovaries gradually make less estrogen. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, the drop in estrogen quickens. At this stage, many women have menopause symptoms.

Menopause

This is the point when it’s been a year since a woman last had her last menstrual period. At this stage, the ovaries have stopped releasing eggs and making most of their estrogen.

Postmenopause

These are the years after menopause. During this stage, menopausal symptoms such as hot flashes ease for most women. But health risks related to the loss of estrogen rise as the woman ages.

What Conditions Cause Premature Menopause?

Premature menopause can be the result of genetics, autoimmune disorders, or medical procedures. Other conditions that may cause early menopause include:

Premature ovarian failure

Normally, the ovaries make both estrogen and progesterone. Changes in the levels of these two hormones happen when the ovaries, for unknown reasons, prematurely stop releasing eggs. When this happens before the age of 40, it’s called premature ovarian failure. Unlike premature menopause, premature ovarian failure is not always permanent.

Induced menopause

“Induced” menopause happens when the ovaries are surgically removed for medical reasons, such as uterine cancer or endometriosis. Induced menopause can also result from damage to the ovaries caused by radiation or chemotherapy.

Symptoms

Most women approaching menopause will have hot flashes, a sudden feeling of warmth that spreads over the upper body, often with blushing and some sweating. The severity of hot flashes varies from mild in most women to severe in others.

Other common symptoms around the time of menopause include:

  • Irregular or skipped periods
  • Insomnia
  • Mood swings
  • Fatigue
  • Depression
  • Irritability
  • Racing heart
  • Headaches
  • Joint and muscle aches and pains
  • Changes in libido (sex drive)
  • Vaginal dryness
  • Bladder control problems

Not all women get all of these symptoms.

How Do I Know When I’m Going Through Menopause?

Either you’ll suspect the approach of menopause on your own, or your doctor will, based on symptoms you’ve told her about. To help figure it out, your doctor can do a certain blood test.

It also helps if you keep track of your periods and chart them as they become irregular. Your menstrual pattern will be an added clue to your doctor about whether you’re premenopausal.

What Long-Term Health Problems Are Tied to Menopause?

The loss of estrogen linked with menopause has been tied to a number of health problems that become more common as women age.

After menopause, women are more likely to have:

  • Osteoporosis
  • Heart disease
  • A poorly working bladder and bowel
  • Greater risk of Alzheimer’s disease
  • Poor skin elasticity (increased wrinkling)
  • Poor muscle power and tone
  • Some weakening in vision, such as from cataracts (clouding of the lens of the eye) and macular degeneration (breakdown of the tiny spot in the center of the retina that is the center of vision)

A number of treatments can help lower risks that are linked with these conditions.

What Is Menopause?

Menopause simply means the end of menstruation for one year. As a woman ages, there is a gradual decline in the function of her ovaries and the production of estrogen. Around the time a woman turns 40, this process speeds up. This transition is known as perimenopause.

Women typically menstruate for the last time at about 51 years of age. A few stop menstruating as young as 40, and a very small percentage as late as 60. Women who smoke tend to go through menopause a few years earlier than nonsmokers. Most women notice some menstrual changes — such as periods occurring closer together, skipped menstrual periods, and occasional heavy periods — up to a few years before menstruation ceases. Women who have menses which occur very close together, are heavier, and last longer than normal should call their health care provider because these could be signs of uterine cancer as well.

There is great variation in how different women experience menopause. About 75% of women have hot flashes. Nighttime hot flashes and sweats are more common and may result in chronic sleep deprivation. Mood changes aren’t as well understood, but some women report an obvious change in mood. In addition, women may experience vaginal dryness, painful intercourse, and urinary symptoms. These symptoms are often temporary and pass as your body adjusts. Hormone replacement therapy (HRT) can help relieve these symptoms in the meantime. Non-hormonal treatment options also are available. Talk to your health care provider to see what approach is right for you.

Menopause does increase your risk of osteoporosis (thinning of the bones) and heart disease. Talk with your health care provider about how you can decrease these risks.

If you’re looking for relief from menopause symptoms, knowing the pros and cons of hormone replacement therapy (HRT) can help you decide whether it’s right for you.

What Is Hormone Replacement Therapy?

During menopause, your estrogen levels fall. Some women get uncomfortable symptoms like hot flashes and vaginal dryness. HRT (also known as hormone therapy, menopausal hormone therapy, and estrogen replacement therapy) is the most effective treatment for menopause symptoms. .

Estrogen Therapy

Estrogen Therapy: Doctors generally suggest a low dose of estrogen for women who have had a hysterectomy, the surgery to remove the uterus. Estrogen comes in different forms. The daily pill and patch are the most popular, but the hormone also is available in a vaginal ring, gel, or spray.

Estrogen pill​: ​Pills are the most common treatment for menopausal symptoms. Among the many forms of pills available are conjugated estrogens (Cenestin, Estrace, Estratab, Femtrace, Ogen, and Premarin) or estrogens-bazedoxifene (Duavee). Follow your doctor’s instructions for dosing. Most estrogen pills are taken once a day without food. Some have more complicated dosing schedules. As noted above, estradiol is the same estrogen that the ovary makes before menopause. (note there are also combination pills that include both estrogen and progestin)
Estrogen patch — the patch is worn on the skin of your abdomen. Depending on the dose, some patches are replaced every few days, while others can be worn for a week. Examples are Alora, Climara, Estraderm, and Vivelle-Dot. Combination estrogen and progestin patches — like Climara Pro and Combipatch — are also available. Menostar has a lower dose of estrogen than other patches, and it’s only used for reducing the risk of osteoporosis. It doesn’t help with other menopause symptoms.
Topical Estrogen – Creams, gels and sprays offer other ways of getting estrogen into your system. Examples include gels (like Estroge and Divigell), creams (like Estrasorb), and sprays (like Evamist). As with patches, this type of estrogen treatment is absorbed through the skin directly into the bloodstream. The specifics on how to apply these creams vary, although they’re usually used once a day. Estrogel is applied on one arm, from the wrist to the shoulder. Estrasorb is applied to the legs. Evamist is applied to the arm.
Vaginal estrogen​: ​Vaginal estrogen comes in a cream, vaginal ring, or vaginal estrogen tablets. In general, these treatments are for women who are troubled specifically by vaginal dryness, itchiness, and burning or pain during intercourse. Examples are vaginal tablets (Vagifem), creams (Estrace or Premarin), and insertable rings (Estring or Femring). Dosing schedules vary, depending on the product. Most vaginal rings need to be replaced every three months. Vaginal tablets are often used daily for a couple of weeks; after that, you only need to use them twice a week. Creams might be used daily, several times a week, or according to a different schedule.

Estrogen/Progesterone/Progestin Hormone Therapy

This is often called combination therapy, since it combines doses of estrogen and progestin, the synthetic form of progesterone. It’s meant for women who still have their uterus. Taking estrogen with progesterone lowers your risk for cancer of the endometrium, the lining of the uterus.

While generally used as a form of birth control​,​ Progesterone can help treat many menopausal symptoms such as hot flashes

Oral progestins – Taken in pill form, progestin medications include medroxyprogesterone acetate (Provera) and the synthetic progestin pills (norethindrone, norgestrel). Many experts now treat the majority of their menopausal patients with natural progesterone rather than synthetic progestins. Natural progesterone has no negative effect on lipids and is a good choice for women with high cholesterol levels. In addition, natural progesterone might have other advantages when compared with medroxyprogesterone acetate.
Intrauterine progestin – Not approved for this use in the United States, the low-dose intrauterine devices (IUD) levonorgestrel are sold under the brand names: Liletta, Kyleena, Mirena and Skyla). If you had one of these IUDs when you enter perimenopause, your doctor may suggest that you keep it in until after menopause is complete.

Who Shouldn’t Take Hormone Replacement Therapy?

If you have these conditions, you may want to avoid HRT:

  • Blood clots
  • Cancer (such as breast, uterine, or endometrial)
  • Heart or liver disease
  • Heart attack
  • Known or suspected pregnancy
  • Stroke

What Are the Side Effects of Hormone Replacement Therapy?

HRT comes with side effects. Call your doctor if you have any of these:

  • Bloating
  • Breast swelling or tenderness
  • Headaches
  • Mood changes
  • Nausea
  • Vaginal bleeding

How Do I Know If Hormone Replacement Therapy Is Right for Me?

Your doctor can help you weigh the pros and cons and suggest choices based on the severity of your symptoms and your medical history.

Some risk factors and symptoms linked with aging and menopausecan’t be changed. But good nutrition can help prevent or ease certain conditions that may develop during and after menopause.

Basic Dietary Guidelines for Menopause

During menopause, eat a variety of foods to get all the nutrientsyou need. Since women’s diets are often low in iron and calcium, follow these guidelines:

Get enough calcium​:​ Eat and drink two to four servings of dairy products and calcium-rich foods a day. Calcium is found in dairy products, fish with bones (such as sardines and canned salmon), broccoli, and legumes. Aim to get 1,200 milligrams per day.
Pump up your iron​:​ Eat at least three servings of iron-rich foods a day. Iron is found in lean red meat, poultry, fish, eggs, leafy green vegetables, nuts, and enriched grain products. The recommended dietary allowance for iron in older women is 8 milligrams a day.
Get enough fiber​:​ Help yourself to foods high in fiber, such as whole-grain breads, cereals, pasta, rice, fresh fruits, and vegetables. Most adult women should get about 21 grams of fiber a day.
Eat fruits and vegetables: Have at least 1 1/2 cups of fruit and 2 cups of vegetables each day.
Read labels​:​ Use the package label information to help yourself make the best choices for a healthy lifestyle.
Drink plenty of water​: ​As a general rule, drink eight glasses of water every day. That fulfills the daily requirement for most healthy adults.
Maintain a healthy weight​: ​If you’re overweight, cut down on portion sizesand eat fewer foods that are high in fat. Don’t skip meals, though. A registered dietitian or your doctor can help you figure out your ideal body weight.
Cut back on high-fat foods​: ​Fat should provide 25% to 35% or less of your total daily calories. Also, limit saturated fat to less than 7% of your total daily calories. Saturated fat raises cholesterol and boosts your risk for heart disease. It’s found in fatty meats, whole milk, ice cream, and cheese. Limit cholesterol to 300 milligrams or less per day. And watch out for trans fats, found in vegetable oils, many baked goods, and some margarine. Trans fat also raises cholesterol and increases your risk for heart disease.
Use sugar and salt in moderation​: ​Too much sodium in the diet is linked to high blood pressure. Also, go easy on smoked, salt-cured, and charbroiled foods — these foods have high levels of nitrates, which have been linked to cancer.
Limit alcohol to one or fewer drinks a day.
Foods to Help Menopause Symptoms​: ​Plant-based foods that have isoflavones (plant estrogens) work in the body like a weak form of estrogen. For this reason, soy may help relieve menopause symptoms, although research results are unclear. Some may help lower cholesterol levels and have been suggested to relieve hot flashes and night sweats. Isoflavones can be found in foods such as tofu and soy milk.
Avoid ​Certain ​Foods During Menopause​:​ If you’re having hot flashes during menopause, you may find it helps to avoid certain “trigger” foods and drinks, like spicy foods, caffeine, and alcohol.
Supplements After Menopause​: ​Because there is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis, the following supplements, combined with a healthy diet, may help prevent the onset of this condition:
Calcium​: ​If you think you need to take a supplement to get enough calcium, check with your doctor first. A 2012 study suggests that taking calcium supplements may raise the risk for heart attacks in some people — but the study showed that increasing calcium in the diet through food sources didn’t seem to raise the risk.
Vitamin D​: ​Your body uses vitamin D to absorb calcium. People ages 51 to 70 should get 600 IU each day. Those over 70 should get 800 IU daily. More than 4,000 IU of vitamin D each day is not recommended, because it may harm the kidneys and weaken bones.

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