What is menopause?

Menopause is when a woman’s menstrual periods permanently end. It happens because, as a woman ages, her ovaries make fewer female hormones (estrogen and progesterone). These are the hormones that regulate your menstrual cycle. The timing of actual menopause is different for each woman. It’s normal for menopause to occur any time from age 40 to age 59. Menopause is a gradual process that can take a number of years.

Perimenopause is the term for the 3 to 5 years around the time of menopause and before your final period.

Symptoms of menopause

Symptoms of menopause vary. Some women just stop having periods. Most women experience some symptoms, such as the following:

  • A change in your menstrual cycle. This is one of the first signs of menopause. You may skip periods or they may occur closer together. Your flow may be lighter or heavier than usual.
  • Hot flashes. Hot flashes are the most common symptom of menopause. When you have a hot flash, you’ll feel warm from your chest to your head. These often happen in wave-like sensations. Your skin may turn red and you may sweat. You may feel sick to your stomach and dizzy. You may also have a headache and feel like your heart is beating very fast and hard.
  • Vaginal dryness. During and after menopause, the skin of your vagina and vulva (the area around your vagina) becomes thinner. Your vagina also loses its ability to produce as much lubrication (wetness) during sexual arousal. These changes can lead to pain during sex. You may need to help supplement vaginal moisture to make sex less painful. You can use an over-the-counter water-based sexual lubricant (such as K-Y Jelly). Or you can use moisturizers for the vaginal area (such as Vagisil). You can also talk to your doctor about the benefits and risks of using prescription estrogen cream for vaginal changes.
  • Urinary tract problems. You’re more likely to have bladder and urinary tract infections during and after menopause. Talk to your doctor if you have to go to the bathroom often or feel an urgent need to urinate. Also let your doctor know if you feel a burning sensation when urinating or are not able to urinate.
  • Headaches, night sweats, trouble sleeping, and tiredness. As you’re going through menopause, you may have trouble falling asleep or staying asleep. Night sweats may wake you up. You may not get enough rapid eye movement (REM) sleep (the stage of sleep during which you dream). A lack of REM sleep may make you feel tired, moody, and stressed out.
  • Weight gain. Many women gain weight during menopause. A healthy diet and exercising most, if not all, days of the week will help keep you fit.

Talk to your doctor if you have:

  • A change in your monthly cycle.
  • Heavy bleeding.
  • Bleeding that lasts longer than usual.
  • Bleeding more often than every 3 weeks.
  • Bleeding after sexual intercourse.
  • Any blood spotting between periods.

Does menopause have emotional symptoms?

Many women experience emotional symptoms during menopause. These symptoms may include sadness, anxiety, and mood swings. For some women, symptoms can be severe. If you find that you’re having emotional problems, talk to your family doctor.

When does menopause occur?

The timing of actual menopause is different for each woman. The average age for women to have their last period is about 51. But it’s normal for menopause to occur any time from age 40 to 59. A woman often goes through menopause at about the same age as her mother. You may stop having periods early (before age 40). If so, your doctor can do a blood test to see if you’re actually going through menopause. If you’re not, the doctor will look for another cause for your missed periods.

Menopause is a gradual process that can take several years. You’re not really through menopause until you haven’t had a period for 12 months. (During this time, keep using birth control if you don’t want to become pregnant.)

Women who have both ovaries removed during surgery will go through “surgical menopause” at the time of their surgery. If the uterus is taken out but the ovaries are not, a woman will stop having periods, but she will not go through surgical menopause.

What causes menopause?

Menopause is what happens when your ovaries stop producing the hormones that control menstruation. These hormones are estrogen and progesterone. Without these hormones, your body will no longer release an egg each month.

How is menopause diagnosed?

If you believe you are going through menopause and have concerns, talk to your doctor. Menopause does not require an official diagnosis unless you want to confirm it. Your doctor will order a blood test to check your hormone levels. He or she will check for estrogen as well as a follicle-stimulating hormone (FSH).

Can menopause be prevented or avoided?

Menopause cannot be prevented or avoided. It may happen early or late. For most women, menopause occurs in their 50s.

Menopause treatment

There isn’t a set treatment for menopause. There are ways to manage some of the symptoms that accompany menopause. Talk to your doctor if you are struggling with hot flashes, if sex is painful, or if your emotions seem unbalanced.

What is hormone replacement therapy?

Hormone replacement therapy (HRT) is a treatment for menopause symptoms. It involves taking synthetic hormones (which are made in a laboratory rather than by the body). HRT can involve taking estrogen alone or estrogen combined with another hormone, progestin. Some women have found that HRT can relieve menopause symptoms. These symptoms include hot flashes, vaginal dryness, and some urinary problems. However, HRT is not for everyone. Recent studies suggests that for most women, the risks of using HRT may outweigh the benefits. Talk to your doctor about the risks and benefits of HRT.

The American Academy of Family Physicians (AAFP) recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women. The AAFP also recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.

According to the AAFP, “This recommendation applies to postmenopausal women who are considering hormone replacement therapy for the primary prevention of chronic medical conditions. This recommendation does not apply to women younger than age 50 years who have undergone surgical menopause. This recommendation does not consider the use of hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness.”

Are other treatments available?

Yes. There are other medicines that may help ease some menopausal symptoms. These include estrogen cream, low-dose antidepressants, soy products, and certain herbal supplements. Discuss these options with your doctor.

What are phytoestrogens?

Phytoestrogens are plant-based substances found in some cereals, vegetables, beans and other legumes, and herbs. They may work in the body like a weak form of estrogen. Researchers are studying whether phytoestrogens can be used to relieve some symptoms of menopause. They are also studying the side effects caused by these substances. Many soy products are good sources of phytoestrogens. These include tofu, tempeh, soymilk, and soy nuts. Some studies indicate that soy supplements may reduce hot flashes in women after menopause.

However, the results haven’t been consistent. There is not enough scientific evidence to recommend the use of herbs that contain phytoestrogens to treat symptoms of menopause. This is also true of pills and creams made with these herbs. In addition, not enough is known about the risks of using these products. Herbs and supplements are not regulated in the way that medicines are. Some herbs and supplements can be harmful when combined with certain medicines. If you’re considering using any natural or herbal products to ease your symptoms, talk to your doctor first.

Living with menopause

Living with menopause is easier for some women than others. It depends on the severity of your symptoms. Use these tips to help ease symptoms and to learn more about how to deal with menopause.

Should I avoid certain foods or drinks during menopause?

If you have hot flashes, you may want to avoid spicy or hot foods and drinks. These can trigger hot flashes. Alcohol can trigger hot flashes, too. It also interferes with bone growth and calcium absorption. Women who are going through menopause should avoid or limit alcohol.

Can my diet affect how well I sleep?

The following tips can help reduce sleep problems:

  • Eat regular meals at regular times.
  • Avoid late-night meals and heavy late-night snacks.
  • Limit caffeine, which is found in coffee, tea, chocolate, and cola drinks. Caffeine stays in the bloodstream for up to 6 hours and can interfere with sleep.
  • Avoid alcohol. It may make you feel sleepy, but it actually affects the cycle of REM and non-REM sleep. This may cause you to wake up throughout the night.

Help for hot flashes

  • Turn your thermostat down. Sleep in a cool room.
  • Dress in layers, so you can remove clothing when you get too warm.
  • Wear cotton and other natural fabrics that “breathe” so you don’t get overheated. Use cotton sheets on your bed.
  • Drink cool water or other beverages when a hot flash starts.
  • Get plenty of exercise.
  • Find out what triggers your hot flashes and avoid them. Spicy foods, alcohol, tight clothing, and hot, humid weather are some common triggers.

How does menopause affect bone health?

The older a woman is, the greater her risk of osteoporosis. A woman’s risk becomes even greater when she goes through menopause. When your estrogen level decreases during menopause, you lose more bone than your body can replace. This makes your bones weaker and more likely to break. To keep your bones strong, it’s important to get enough calcium and vitamin D in your diet. These help your body absorb calcium. Your doctor can suggest ways to get more calcium through food, drink, and, possibly, a calcium supplement. He or she may also suggest that you take a vitamin D supplement to help your body process calcium. Ask your doctor what amount of daily calcium and vitamin D is right for you.

In general, women 30 to 50 years of age need 1,000 mg of calcium each day. Women older than 50 years of age need 1,200 mg of calcium each day. Milk, yogurt, and other dairy foods are good sources of calcium. Soybeans, broccoli, and tofu are, too. Women 30 to 70 years of age usually need at least 600 international units (IU) of vitamin D each day. Women older than 70 years of age need at least 800 IU of vitamin D each day. Fatty fish, such as salmon and tuna, are a good source of vitamin D.

How does menopause affect heart health?

Women are more likely to develop heart disease after menopause. Lower estrogen levels may be part of the cause. It also could be that other health issues that are more common as women get older. These include gaining weight, becoming less active, and developing high blood pressure or diabetes. You can reduce your risk of these health problems by eating a variety of healthy, nutrient-rich foods. It also helps to stay active and maintain an appropriate weight.

How does menopause affect iron levels in my blood?

If you are still having periods as you go through menopause, you may continue to be at risk of a low iron level. This is especially true if your bleeding is heavy or you spot between periods. This can lead to anemia. Eating at least 3 servings of iron-rich foods a day will help you get enough iron in your diet. Good sources of iron include spinach, beans, and meat. Your doctor may also suggest that you take an iron supplement.

Questions to ask your doctor

  • Do my symptoms indicate that I might be going through menopause?
  • My menstrual cycle is irregular. What symptoms might indicate that the irregularity is caused by something other than menopause?
  • I’m uncomfortable and/or don’t feel well. Is there a way to safely treat my symptoms?
  • I’ve heard that soy products or herbal supplements may help. Are these effective? Are they good options for me?
  • Am I a candidate for hormone replacement therapy?
  • What are the risks and benefits of hormone replacement therapy?
  • Am I at risk for heart disease or osteoporosis?
  • Do I need any tests, such as bone density screening?
  • Now that I’m going through menopause, what changes, if any, should I make to my diet and exercise?