Menopause

What is menopause?

Menopause is the time when a woman stops having menstrual periods.

How does it occur?

Menopause usually starts slowly as a woman gets older. The ovaries start making less hormone (estrogen and progesterone). Menstrual periods start being irregular. After a time, periods stop completely.

Menopause happens suddenly if the ovaries are removed.

Most women go through menopause between ages 45 and 55. In the US the average age when menstrual periods stop completely is 51.

What are the symptoms?

Hormonal changes can cause physical and psychological symptoms before and during menopause. The symptoms may come and go. Some women don’t have any symptoms.

Common physical symptoms are:

• irregular menstrual periods and finally no periods
• hot flashes
• night sweats
• changes in your sleep patterns
• dizziness
• headaches
• muscle and joint pain
• dry skin
• palpitations (a fast or irregular heartbeat)
• tiredness
• vaginal dryness, sometimes causing discomfort or pain during sex
• more frequent need to urinate, or leakage of urine
• more frequent vaginal and urinary infections
• trouble sleeping.

Menopause can also cause psychological symptoms, such as:

• anxiety
• depression
• tearfulness and irritability
• mood swings
• less interest in sex
• lack of concentration
• more trouble remembering things

How is it diagnosed?

Your healthcare provider will ask about your medical history and examine you. You may have blood tests. A pelvic exam and Pap test may show the effects of less estrogen in your body.

If you have not had a menstrual period for 12 months, you are probably in menopause.

How is it treated?

Menopause is a natural part of a woman's life. It is not a disease and does not have to be treated. However, some health problems, such as osteoporosis, are associated with low estrogen. (Osteoporosis is a thinning and weakening of the bones.) To treat menopause symptoms and help prevent osteoporosis, your healthcare provider may recommend lifestyle changes and possibly also medicine.

Treatment of menopause symptoms should start with:

• regular exercise
• a healthy, calcium-rich diet
• a program to lower stress

Prescription medicines such as progesterone, clonidine, or an anxiety medicine may help treat hot flashes. Some women have found ginseng root and vitamin E to be helpful with hot flashes, but medical studies have not yet supported this.

Estrogen-like plant substances may help. Good sources of these substances are soybean products, other beans, rhubarb, carrots, and whole grains. Examples of soybean products include soy milk, tofu, roasted soybeans ("soy nuts"), and soy flour. Soy products can act like estrogen in the body. Tell your healthcare provider if you eat a lot of these foods or are taking supplements or herbal remedies.

Things you can do to keep your bones healthy are:

• Get regular, weight-bearing exercise, such as walking.
• Make sure that you have enough calcium and vitamin D in your diet. Your healthcare provider may recommend calcium supplements with vitamin D.
• Take medicine prescribed by your healthcare provider for osteoporosis.

Treatment with estrogen and progesterone may be prescribed to treat symptoms of menopause if other treatments are not helping enough. This treatment is called estrogen therapy or menopausal hormone therapy (MHT). In addition to treating menopausal symptoms, MHT can help prevent bone loss (osteoporosis).

Hormone therapy may increase your risk for heart disease. It may also increase your risk for stroke, breast cancer, blood clots, some gallbladder problems, and possibly dementia. Also, estrogen taken without progesterone increases the risk of uterine cancer if your uterus has not been removed. Discuss the risks and benefits of hormone therapy with your healthcare provider.

If you are going to take hormone therapy, ask your healthcare provider about:

• the different types and dosages of hormone therapy
• any side effects or special precautions you should know about
• when you should start and stop taking the hormones

Estrogen may be taken in many different forms, such as:

• tablets to be swallowed
• patches or lotion to be put on the skin
• a cream, ring, or tablet put into the vagina
• pellets placed under the skin
• shots

If you still have your uterus and choose to take hormones, you will need to take progesterone with the estrogen. Taking estrogen alone may increase your risk of cancer of the uterus. The risk of cancer of the uterus may be less if you are using a vaginal form of estrogen treatment. Vaginal estrogen treatment is often prescribed for vaginal atrophy symptoms. It may not help as much as oral or skin treatments for the other symptoms of menopause.

If your uterus has been removed, you can take estrogen alone.

How long will the effects last?

Symptoms of menopause may last just a few weeks or months. Some women keep having symptoms for several years.

How can I take care of myself?

To help your general mental and physical well-being, you should:

• Have a physical exam, including a pelvic exam, every year.
• Have a mammogram and Pap test as often as your provider recommends.
• Eat a healthy diet. Be sure to include foods that are high in calcium, such as dark green vegetables and nonfat or low-fat dairy products.
• Get regular physical exercise according to your provider's advice. Exercise will help you feel better and keep a healthy weight. Weight-bearing exercise, such as walking or stair climbing, will help keep your bones strong.
• Don’t smoke.
• If you have had no menstrual periods for several months or years and then have bleeding from the vagina, check with your healthcare provider right away. Unusual vaginal bleeding can be a sign of a precancerous problem or cancer of the uterus.

You may find it helps to:

• Wear cotton sleepwear to reduce discomfort from night sweats.
• Use a vaginal lubricating cream or jelly if sex is painful.
• Talk and share feelings with a friend or family member.
• Join a support group for women who have been or are going through menopause.

For more information, contact:

North American Menopause Society
Phone: 440-442-7550 or 800-774-5342
Web site: http://www.menopause.org