Menopause

What is menopause?

Menopause is the stage in a woman’s life when the ovaries no longer produce reproductive hormones. It is the permanent end of menstruation, defined as 12 consecutive months without a menstrual period and is a natural part of aging. Menopause can also happen if you have surgery or medical treatment, which is called induced menopause.

Menopause usually happens to women between the ages of 45 and 55. If it happens before age 45, it is classified as early menopause. If it happens before age 40, it is classified as premature menopause.

What are the stages of menopause?

Menopause usually happens in gradual stages:

• Perimenopause: This is the transition to menopause, which can begin years before menopause. You begin to produce less estrogen, and you may experience symptoms such as irregular or lighter periods, mood swings, disturbed sleep, night sweats and hot flushes.
• Menopause: Estrogen declines significantly and your menstrual periods stop for 12 consecutive months.
• Postmenopause: You remain in this stage for the rest of your life after menopause. Some women continue to experience menopause symptoms.

What are the signs of menopause?

The symptoms of menopause are caused by changes in hormone levels. Some women experience severe menopause symptoms, while symptoms are mild for others. The transition to menopause may have begun if you experience any of the following:

• Irregular periods or heavier or lighter periods than normal
• Emotional changes
• Hot flushes
• Night sweats
• Vaginal dryness
• Urinary urgency
• Dry skin, mouth or eyes
• Tender breasts
• Difficulty sleeping
• Changes in libido
• Weight gain
• Headaches
• Thinning hair
• Difficulty concentrating

Menopause symptoms can last for many years before your menstrual periods stop. Always talk to your doctor if you are unsure whether your symptoms are related to menopause or may be due to another health condition.

What causes menopause?

Menopause is a natural part of aging. Your ovaries produce less estrogen as you age, and this affects your menstrual cycle. Your periods can become irregular before stopping completely.

If you have had surgery, such as removal of your ovaries, menopause will occur as a result of the surgery (induced menopause). Some medical treatments, such as birth control, radiation therapy and chemotherapy, can also cause bleeding to stop.

How is menopause diagnosed?

Menopause is a clinical diagnosis. Your doctor will discuss your menstrual cycle with you and ask questions about your symptoms over the last 12 months. Sometimes, a blood test may be ordered to help differentiate between menopause and other conditions which may cause similar symptoms. It is important to note that hormone tests can be normal during perimenopause and are not always helpful.

How is menopause treated?

Treatment of menopause focuses on the symptoms that may be affecting everyday life. Lifestyle modifications can often help reduce symptoms and some women do not need any other treatment. Other women may benefit from hormone therapy (HT) for symptom relief.

Hormone therapy can also be offered to women experiencing perimenopausal symptoms. Symptoms may improve by adding back small amounts of the hormones which have naturally declined. There are two main types of systemic hormone therapy:

• Estrogen therapy: A low dose of estrogen given as a pill, patch, gel or cream. This is suitable for women without a uterus.
• Estrogen-progesterone therapy: A combination of estrogen and progesterone. This is suitable for women with a uterus.
• Vaginal estrogen: For localized vaginal symptoms.
• Hormone replacement therapy (HRT): This is recommended for many women who experience menopause before age 40.

Nonhormonal treatments can also be effective for some women and include lifestyle changes and medications. These include:

• Changes to your diet: Reducing caffeine may be helpful. Eating more foods containing phytoestrogens (nutrients with properties similar to estrogen).
• Avoiding triggers of hot flushes: Keeping your bedroom cool, maintaining a healthy weight, and quitting smoking may all help.
• Exercising more: Exercise can relieve some of the symptoms of menopause.
• Non-hormonal prescription medications: Medications can help with a number of symptoms, such as mood swings, hot flashes, overactive bladder and vaginal dryness.

When should I see my doctor about menopause?

If the symptoms of perimenopause or menopause are concerning you, talk to your doctor.

Changes in vaginal bleeding can be a sign of other health conditions. Always see your doctor if your periods become heavier or longer than normal, if you experience bleeding or spotting between your periods or if your periods stop before age 45.