Menopause

Menopause
Menopause

Overview Of Menopause

Menopause is the time in a woman’s life when her periods (menstruation) stop. Most often, it is a natural, normal body change that most often occurs between ages 45 to 55. After menopause, a woman can no longer become pregnant.

Commonly Associated With

Postmenopause; Perimenopause

Causes Of Menopause

During menopause, a woman’s ovaries stop releasing eggs. The body produces less of the female hormones estrogen and progesterone. Lower levels of these hormones cause menopause symptoms.

Periods occur less often and eventually stop. Sometimes this happens suddenly. But most of the time, periods slowly stop over time.

Menopause is complete when you have not had a period of 1 year. This is called postmenopause. Surgical menopause takes place when surgical treatments cause a drop in estrogen. This can happen if both of your ovaries are removed.

Menopause can also sometimes be caused by drugs used for chemotherapy or hormone therapy (HT) for breast cancer.

Symptoms Of Menopause

Symptoms vary from woman to woman. They may last 5 or more years. Symptoms may be worse for some women than others. Symptoms of surgical menopause can be more severe and start more suddenly.

The first thing you may notice is that periods start to change. They might occur more often or less often. Some women might get their period every 3 weeks before starting to skip periods You may have irregular periods for 1 to 3 years before they stop completely.

Common symptoms of menopause include:

  • Menstrual periods that occur less often and eventually stop
  • Heart pounding or racing
  • Hot flashes, usually worst during the first 1 to 2 years
  • Night sweats
  • Skin flushing
  • Sleeping problems (insomnia)

Other symptoms of menopause may include:

  • Decreased interest in sex or changes in sexual response
  • Forgetfulness (in some women)
  • Headaches
  • Mood swings, including irritability, depression, and anxiety
  • Urine leakage
  • Vaginal dryness and painful sexual intercourse
  • Vaginal infections
  • Joint aches and pains
  • Irregular heartbeat (palpitations)

Exams & Tests

Blood and urine tests can be used to look for changes in hormone levels. Test results can help your health care provider determine if you are close to menopause or if you have already gone through menopause. Your provider may need to repeat testing your hormone levels several times to confirm your menopausal status if you have not completely stopped menstruating.

Tests that may be done include:

  • Estradiol
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Your provider will perform a pelvic exam. Decreased estrogen can cause changes in the lining of the vagina.

Bone loss increases during the first few years after your last period. Your provider may order a bone density test to look for bone loss related to osteoporosis. This bone density test is recommended for all women over age 65. This test may be recommended sooner if you are at higher risk for osteoporosis because of your family history or the medicines that you take.

Treatment Of Menopause

Treatment may include lifestyle changes or HT.

Treatment depends on many factors such as:

  • How bad your symptoms are
  • Your overall health
  • Your preferences

HORMONE THERAPY

HT may help if you have severe hot flashes, night sweats, mood issues, or vaginal dryness. HT is treatment with estrogen and, sometimes, progesterone.

Talk to your provider about the benefits and risks of HT. Your provider should be aware of your entire medical and family history before prescribing HT.

Several major studies have questioned the health benefits and risks of HT, including the risk of developing breast cancer, heart attacks, strokes, and blood clots. However, using HT for the 10 years after developing menopause is associated with a lower chance of death.

Current guidelines support the use of HT for the treatment of hot flashes.

Specific recommendations:

  • HT may be started in women who have recently entered menopause.
  • HT should not be used in women who started menopause many years ago, except for vaginal estrogen treatments.
  • The medicine should not be used for longer than necessary. Some women may require prolonged estrogen use due to troublesome hot flashes. This is safe in healthy women.
  • Women taking HT should have a low risk for stroke, heart disease, blood clots, or breast cancer.
  • To reduce the risks of estrogen therapy, your provider may recommend:
  • A lower dose of estrogen or a different estrogen preparation (for instance, vaginal cream or skin patch rather than a pill).
  • Using patches appears to be safer than oral estrogen, as it avoids the increased risk for blood clots seen with oral estrogen use.
  • Frequent and regular physical exams, including breast exams and mammograms
  • Women who still have a uterus (that is, have not had surgery to remove it for any reason) should take estrogen combined with progesterone to prevent cancer of the lining of the uterus (endometrial cancer).

ALTERNATIVES TO HORMONE THERAPY

There are other medicines that can help with mood swings, hot flashes, and other symptoms.

These include:

  • Antidepressants, including paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac)
  • A blood pressure medicine called clonidine
  • Gabapentin, a seizure drug that also helps reduce hot flashes

DIET AND LIFESTYLE CHANGES

Lifestyle steps you can take to reduce menopause symptoms include:

Diet changes:

  • Avoid caffeine, alcohol, and spicy foods.
  • Eat soy foods. Soy contains estrogen.
  • Get plenty of calcium and vitamin D in food or supplements.

Exercise and relaxation techniques:

  • Get plenty of exercises.
  • Do Kegel exercises every day. They strengthen the muscles of your vagina and pelvis.
  • Practice slow, deep breathing whenever a hot flash begins. Try taking 6 breaths a minute.
  • Try yoga, tai chi, or meditation.

Other tips:

  • Dress lightly and in layers.
  • Keep having sex.
  • Use water-based lubricants or a vaginal moisturizer during sex.
  • See an acupuncture specialist.