Menopause

What is Menopause?

You may think of menopause as the time when your menstrual periods stop permanently. But doctors define menopause as the time after 12 months have passed since your last period. Although your mother or grandmother may have called menopause the change, it isn’t a single event. Instead, it’s a series of changes that can start in your 30s or 40s and last into your 50s or even 60s.

Menopause is a natural biological process, not a medical illness. Although it’s associated with hormonal, physical and psychosocial changes in your life, menopause isn’t the end of your youth or your sexuality. Several generations ago, few women lived beyond menopause. Today, you may spend as much as half of your life after menopause.

Fortunately, much more is known about menopause now than was known when your mother and grandmother experienced it. You can do more to relieve bothersome symptoms, avoid complications and improve your health and vigor during this important phase of your life.

Signs and symptoms of menopause

Every woman experiences menopause differently. Even the age at which menopause begins may be unique to you. Some women reach menopause in their 30s or 40s, and some not until their 60s, but menopause most often occurs between the ages of 50 and 51.

Your signs and symptoms are also likely to be very individual. You may breeze through menopause with few signs and symptoms. Or you may experience a number of physical and emotional changes, including:

• Irregular menstruation. Your cycle may stop suddenly, or gradually get lighter or heavier and then stop. The unpredictability of your periods may be your first clue that menopause is approaching.
• Decreased fertility. When ovulation begins to fluctuate, you’re less likely to become pregnant. Until you haven’t had a period for a year, however, pregnancy is still possible.
• Vaginal changes. As your estrogen level declines, the tissues lining your vagina and urethra — the opening to your bladder — become drier, thinner and less elastic. With decreased lubrication you may experience burning or itching, along with increased risk of infections of your urinary tract or vagina. These changes may make sexual intercourse uncomfortable or even painful.
• Hot flashes. As your estrogen level drops, your blood vessels may expand rapidly, causing your skin temperature to rise. This can lead to a feeling of warmth that moves upward from your chest to your shoulders, neck and head. You may sweat, and as the sweat evaporates from your skin, you may feel chilled, weak and slightly faint. Your face might look flushed, and red blotches may appear on your chest, neck and arms. Most hot flashes last from 30 seconds to several minutes, although they can last much longer. The frequency, as well as the duration, of hot flashes varies from person to person. You may have them once every hour or only occasionally. They can occur any time during the day or night. They may be a part of your life for a year or more, or you may never have them.
• Sleep disturbances and night sweats. Night sweats are often a consequence of hot flashes. You may awaken from a sound sleep with soaking night sweats followed by chills. You may have difficulty falling back to sleep or achieving a deep, restful sleep. Lack of sleep may affect your mood and overall health.
• Changes in appearance. After menopause, the fat that once was concentrated in your hips and thighs may settle above your waist and in your abdomen. You may notice a loss of fullness in your breasts, thinning hair and wrinkles in your skin. If you previously experienced adult acne, it may become worse. Although your estrogen level drops, your body continues to produce small amounts of the male hormone testosterone. As a result, you may develop coarse hair on your chin, upper lip, chest and abdomen.
• Emotional changes. As you go through menopause, you may experience mood swings, be more irritable or be more prone to emotional upsets. In the past, these symptoms were attributed to hormonal fluctuations. Yet other factors may contribute to these changes in mood, including stress, insomnia and life events that can occur in this stage of adulthood — such as the illness or death of a parent, grown children leaving home and retirement.

What causes menopause?

Menopause begins naturally when your ovaries start making less estrogen and progesterone. During your reproductive years, these hormones regulate your monthly cycles of ovulation and menstruation. In your late 30s, the amount of progesterone your body produces diminishes, and the remaining eggs from your ovaries are less likely to be fertilized. Eventually your menstrual periods stop, and you can no longer become pregnant. Because this process takes place over years, menopause is commonly divided into the following two stages:

• Perimenopause. This is the time you begin experiencing menopausal signs and symptoms even though you’re still ovulating. Your hormone levels rise and fall unevenly, and you may have hot flashes and variations in your periods. For instance, your flow may be irregular, or heavier or lighter than usual. This is a normal process leading up to menopause and may last four to five years or more.
• Postmenopause. Once 12 months have passed since your last period, you’re considered postmenopausal. Your ovaries no longer produce estrogen or progesterone, and they don’t release eggs.

What are the risk factors for menopause?

Menopause is usually a natural process. But certain surgical or medical treatments can bring on menopause earlier than expected. These include:

• Hysterectomy. A hysterectomy that removes your uterus but not your ovaries usually doesn’t cause menopause. Although you no longer have periods, your ovaries still release eggs. But an operation that removes both your uterus and ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause. There’s no perimenopausal phase. Instead, your periods stop immediately, and you’re likely to have hot flashes and other menopausal signs and symptoms.
• Chemotherapy and radiation therapy. These cancer therapies can induce menopause. But they usually do so gradually, and you may have months or years of perimenopausal symptoms before you actually reach menopause.

How is menopause diagnosed?

Usually you don’t need a laboratory test to confirm menopause. The signs and symptoms are enough to tell most women they have begun going through this process. If you have concerns about irregular periods or hot flashes, talk with your doctor. In some cases it may be important to rule out other problems.

Your doctor can check your level of follicle-stimulating hormone (FSH) and estrogen (estradiol) with a blood test. As menopause occurs, FSH levels increase, and estradiol levels decrease. If your FSH level is above 30 and your estradiol level is less than 20, you’ve probably gone through menopause. If these levels are checked while you’re still taking birth-control pills, these tests need to be done at the end of your hormone-free week.

How is menopause treated?

Menopause itself requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and on preventing or lessening chronic conditions that may occur during the postmenopausal years. Treatments include:

• Hormone replacement therapy (HRT). This therapy, which provides a low dose of estrogen, often in combination with progestin, has been shown to be effective in treating many of the signs and symptoms of menopause, such as hot flashes, vaginal dryness and discomfort with intercourse. HRT may be taken in a variety of forms — including pill, patch, cream or vaginal ring — and customized to fit each woman’s needs. Women who have had a hysterectomy take HRT as estrogen alone, also referred to as estrogen replacement therapy (ERT). Most other women who take HRT are advised to use a combination of estrogen and progestin because progestin helps protect against uterine cancer. HRT taken as estrogen alone or as a combination therapy protects against bone loss and osteoporosis. Oral ERT raises levels of high-density lipoprotein (HDL) cholesterol (the “good” cholesterol) and lowers levels of low-density lipoprotein (LDL) (the “bad” cholesterol).But not all effects of HRT are positive. Taking HRT as a combination therapy — estrogen plus progestin — can result in serious side effects and health risks. Work with your doctor to discuss the options and decide what’s best for you.
• Bisphosphonates. Doctors use these nonhormonal medications, which include alendronate (Fosamax) and risedronate (Actonel), to prevent or treat osteoporosis. Although these medications don’t provide the same protection for your bones as estrogen does, they effectively reduce both bone loss and your risk of fractures. Aldendronate may cause gastrointestinal problems and irritation of your esophagus.
• Selective estrogen receptor modulators (SERMs). SERMs are among a group of drugs that includes raloxifene (Evista). They have some of the beneficial effects of estrogen, especially improved bone strength, but no increased risk of breast cancer or uterine bleeding. But these medications tend to cause, rather than relieve, hot flashes, and increase your risk of blood clots and gallstones.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved in each.

Self-care

Fortunately, many of the signs and symptoms associated with menopause are temporary. Take these steps to help reduce or prevent their effects:

• Cool hot flashes. If you’re experiencing hot flashes, get regular exercise, dress in layers and try to pinpoint what triggers your hot flashes. For many women, triggers may include hot beverages, spicy foods, alcohol, hot weather and even a warm room.
• Decrease vaginal discomforts. For vaginal dryness or discomfort with intercourse, use over-the-counter water-based vaginal lubricants (Astroglide, K-Y Jelly) or moisturizers (Replens, Vagisil). Staying sexually active also helps minimize these problems.
• Optimize your sleep. If you have trouble sleeping, avoid caffeinated beverages and exercise right before bedtime. Practicing relaxation techniques such as deep breathing, guided imagery and progressive muscle relaxation can be very helpful. You can find a number of books and tapes on different relaxation exercises.
• Stay dry. If you experience night sweats, wear cool cotton clothing to bed and keep an extra set handy.
• Strengthen your pelvic floor. Pelvic floor muscle exercises, called Kegel exercises, can improve some forms of urinary incontinence.
• Eat well. Eat a balanced diet that includes a variety of fruits, vegetables and grains and that limits fats, oils and sugars. In particular, make sure your intake of calcium is at least 1,200 to 1,500 mg. If you’re not taking estrogen, ask your physician about additional calcium supplements.
• Don’t smoke. Smoking increases your risk of heart disease, stroke, cancer and a range of other health problems. It may also increase hot flashes and bring on earlier menopause.
• Exercise regularly. Thirty minutes most days is a good goal to protect against cardiovascular disease, diabetes and osteoporosis. It also can help reduce stress. Try a combination of weight-bearing aerobic activities, such as walking, jogging and dancing, and strength-training exercises. Just staying physically active each day by taking stairs instead of an elevator or by parking farther away and walking to your destination also can make a difference.
• Schedule regular checkups. Talk with your doctor about how often you should have mammograms, Pap tests and other screening tests.