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What is menopause?

Menopause is the time in a woman's life when her normal menstrual periods have stopped for at least 12 months and she can no longer become pregnant. It is a natural part of female aging. Menopause can occur anytime after the age of 35, but the typical age of onset is in the late 40s to early 50s; the average age of onset in American women is 51.

During child-bearing years, the hormones FSH (follicle-stimulating hormone), LH (luteinizing hormone), estradiol, and progesterone work in concert each month to develop and release an egg from the ovaries (ovulate) and to either regulate the monthly menstrual period or support the beginning of a pregnancy. As menopause approaches, the cyclical production of estradiol and progesterone by the ovaries diminishes and becomes less consistent.

The beginning of the menopausal process is called menopausal transition or perimenopause. It may begin sometime in a woman's 40s, but may be earlier in the late thirties. It is a gradual process and usually takes two to five years to complete.

During perimenopause, hormone levels can fluctuate high to low from one month to the next, with periods and ovulation becoming irregular. A woman may have a period and then go for several months before having another, and some women may find that the frequency and intensity of their periods actually increase during perimenopause. Even though irregularities during menopause transition are to be expected, a woman should discuss all changes with her healthcare practitioner so that she can ensure that symptoms are not being caused by something other than hormone fluctuations. Perimenopausal women must also keep in mind that although it becomes less likely, a woman in transition can still become pregnant.

Once a menopausal woman has gone twelve months without a period, the transition is generally considered complete and she enters post-menopause. At this stage, her ovaries have essentially stopped producing estradiol and progesterone, she is no longer ovulating, and can no longer become pregnant. Though this is all part of the normal course of aging, there are some health issues that are associated with menopause and the post-menopausal stage of life:

  • Decreased levels of estrogen may lead to an increased risk of osteoporosis.
  • The change in the level of estrogen may also be a contributing factor for the development of heart disease.
  • Tissues of the vagina tend to thin (atrophy), causing chronic irritation, vaginal dryness, and susceptibility to infection.
  • Decreased estrogen level is accompanied with decreased production of collagen and elastin, two proteins responsible for maintaining skin integrity. As these levels decrease, the skin becomes thinner, dryer, and more susceptible to injury.

Menopause happens naturally as a woman ages, but it can also occur for a variety of other reasons. Surgical menopause occurs when the ovaries are removed, such as with ovarian cancer or along with a hysterectomy. Since this removal stops ovary hormone production, it can cause menopausal symptoms to emerge soon after surgery. Menopause can also occur with excessive exposure to radiation or chemotherapy, pituitary gland disorders, or in women with very poor health.

Women who experience menopausal symptoms and hormonal irregularities before the age of 40 were once referred to as having "premature menopause." They are now said to have "premature ovarian failure" or "primary ovarian insufficiency." Some of the women with these conditions may still become pregnant.

Accordion Title
About Menopause
  • Signs and Symptoms

    A woman's body goes through several changes during menopause. Some of the more common signs and symptoms of menopause occur when estrogen levels start to drop. Women may experience:

    • Hot flashes
    • Changes in menstrual frequency and flow intensity (to include heavier or more frequent periods for some)
    • Night sweats
    • Rapid mood swings ranging from depression to euphoria
    • Decreased sex drive (libido)
    • Increased frequency or sudden urge to urinate
    • Vaginal dryness that can cause pain during intercourse
    • Increased bone loss that can lead to osteoporosis
    • Higher risk of heart disease (because the levels of LDL "bad" cholesterol in the blood may rise)
  • Tests

    Not all women going through or who have gone through menopause will have laboratory testing done. However, women with menopausal symptoms who may have premature ovarian failure or who are being evaluated for risk of other health problems, such as osteoporosis, may have one or more of the following tests ordered:

    • Follicle-stimulating hormone (FSH): to learn whether a woman is approaching, transitioning, or has gone through menopause; in general, the FSH level rises during transition.
    • Estradiol: to measure ovarian production of estrogen and to evaluate whether the menstrual cycle is normal
    • Thyroid function testing (free T4 and TSH): to test the function of the thyroid gland, which can slow with age, affect menstruation, and cause some symptoms similar to those seen with menopause
    • Anti-mullerian hormone (AMH): to predict the onset of menopause and/or when a woman is concerned about the related loss of fertility

    Additional tests that may be ordered include:

    As estrogen levels drop, bones can get weaker. For guidelines on bone density testing, see the National Osteoporosis Foundation.

  • Treatment

    Treatment for normal menopause has been somewhat controversial. While symptoms of menopause will naturally diminish over time, there are coping strategies that may be considered to relieve and manage some of the most bothersome ones. Lifestyle changes, including eating a healthy diet, getting regular exercise and stopping smoking, may be helpful. Avoiding certain spicy foods, coffee, or tea may minimize the effects of hot flashes.

    There are claims that over-the-counter products such as black cohosh, DHEA (dehydroepiandrosterone), dong quai, evening primrose, ginseng, and St. John's wort may offer some relief, but as such, are not regulated by the FDA nor have been shown to be medically effective. Further, use of such products may actually be more harmful by exacerbating the symptoms or interfering with other medications. Women should discuss this with their healthcare practitioner before taking such supplements.

    Women with severe symptoms and those with menopause due to surgery or another non-age-related cause may choose hormone replacement therapy (HRT; also called menopausal hormone therapy or MHT) to minimize accompanying symptoms. Depending on a woman's medical history and preferences, HRT involves taking oral doses of estrogen or using transdermal patches or creams and, for a woman with a uterus (no hysterectomy), oral doses of progesterone.

    Risks that have been associated with HRT include blood clots, deep vein thrombosis (DVT), breast cancer, uterine/endometrial cancer, and heart disease. Estrogen taken alone slightly increases the risk for endometrial cancer, thus is often taken with a progestin, greatly reducing the risk. For more information about HRT, visit the Hormone Health Network website. Women should discuss their symptoms, coping strategies, and treatment options with their healthcare practitioner to make the choices that are right for them.

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Sources Used in Current Review

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