Menopause is the transition
period in a woman's life when her ovaries stop producing eggs, her body
produces less estrogen and progesterone, and menstruation becomes less
frequent, eventually stopping altogether.
Menopause is a natural event
that normally occurs between the ages of 45 and 55.
Once menopause is complete (called postmenopause) and you have not had a
period for 1 year, you are no longer at risk of becoming pregnant.
The symptoms of menopause are caused by changes in estrogen and progesterone
levels. The ovaries make less of these hormones over time. The specific
symptoms and how significant (mild, moderate, or severe) they are varies
from woman to woman.
A gradual decrease of estrogen generally allows your body to slowly adjust
to the hormonal changes. Hot flashes and sweats are at their worst for the
first 1 - 2 years after the last period. Menopause symptoms may last 5 or
Estrogen levels may drop suddenly after some medical treatments, as is seen
when the ovaries are removed surgically (called surgical menopause).
Chemotherapy and anti-estrogen treatment for breast cancer are other
examples. Symptoms can be more severe and start more suddenly in these
As a result of the fall in hormone levels, changes occur in the entire
female reproductive system. The vaginal walls become less elastic and
thinner. The vagina becomes shorter. Lubricating secretions from the vagina
become watery. The outside genital tissue thins. This is called atrophy of
In some women, menstrual flow
comes to a sudden halt. More commonly, it slowly stops over time. During
this time, the menstrual periods generally become either more closely or
more widely spaced. This irregularity may last for 1 - 3 years before
menstruation finally ends completely. Before this the cycle length may
shorten to as little as every 3 weeks.
Common symptoms of menopause include:
1. Heart pounding or racing
2. Hot flashes
3. Night sweats
4. Skin flushing
5. Sleeping problems (insomnia)
Other symptoms of menopause
1. Decreased interest in sex, possibly decreased response to sexual
2. Forgetfulness (in some women)
4. Irregular menstrual periods
5. Mood swings including irritability, depression, and anxiety
6. Urine leakage
7. Vaginal dryness and painful sexual intercourse
8. Vaginal infections
9. Joint aches and pains
10. Irregular heartbeat (palpitations)
Blood and urine tests can be
used to measure changes in hormone levels that may signal when a woman is
close to menopause or has already gone through menopause. Examples of these
A pelvic exam may indicate
changes in the vaginal lining caused by declining estrogen levels. The
doctor may perform a bone density test to screen for low bone density levels
that occur with osteoporosis. The rate of bone loss increases during the
first few years after the last period.
Treatment with hormones may be
helpful if you have severe symptoms such as hot flashes, night sweats, mood
issues, or vaginal dryness.
Discuss the decision to take hormones thoroughly with your doctor, weighing
your risks against any possible benefits. Learn about the many options
currently available to you that do not involve taking hormones. Every woman
is different. Your doctor should be aware of your entire medical history
before prescribing hormone therapy (HT).
If you have a uterus and decide to take estrogen, you must also take
progesterone to prevent endometrial cancer (cancer of the lining of the
uterus). If you do not have a uterus, progesterone is not necessary.
Several major studies have questioned the health benefits and risks of
hormone replacement therapy, including the risk of developing breast cancer,
heart attacks, strokes, and blood clots.
Current guidelines support the use of HT for the treatment of hot flashes.
1. HT may be started in women who have recently entered menopause.
2. HT should not be used in women who started menopause many years ago,
except for . An exception is estrogen vaginal creams.
3. The medicine should not be used for longer than 5 years.
4. Women taking HT should have a baseline low risk for stroke, heart
disease, blood clots, or breast cancer.
To reduce the risks of
estrogen therapy and still gain the benefits of the treatment, your doctor
1. Using a lower dose of estrogen or a different estrogen preparation (for
instance, a vaginal cream rather than a pill)
2. Having frequent and regular pelvic exams and Pap smears to detect
problems as early as possible
3. Having frequent and regular physical exams, including breast exams and
ALTERNATIVES TO HT
There are some medications available to help with mood swings, hot flashes,
and other symptoms. These include low doses of antidepressants such as
paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and
fluoxetine (Prozac), or clonidine, which is normally used to control high
blood pressure. Gabapentin is also effective for reducing hot flashes.
The good news is that you can take many steps to reduce your symptoms
without taking hormones:
1. Avoid caffeine, alcohol, and spicy foods
2. Dress lightly and in layers
3. Eat soy foods
4. Get adequate calcium and vitamin D in food or supplements
5. Get plenty of exercise
6. Perform Kegel exercises daily to strengthen the muscles of your vagina
7. Practice slow, deep breathing whenever a hot flash starts to come on (try
taking six breaths per minute)
8. Remain sexually active
9. See an acupuncture specialist
10. Try relaxation techniques such as yoga, tai chi, or meditation
11. Use water-based lubricants during sexual intercourse
Postmenopausal bleeding may
occur. This bleeding is often nothing to worry about. However, your health
care provider should always check any postmenopausal bleeding, because it
may be an early sign of other problems, including cancer.
Decreased estrogen levels are also associated with the following long-term
1. Bone loss and eventual osteoporosis in some women
2. Changes in cholesterol levels and greater risk of heart disease
Contact a Medical Professional
Call your health care provider
1. You are spotting blood between periods
2. You have had 12 consecutive months with no period and suddenly vaginal
bleeding or spotting begins again, even if it is a very small amount
Menopause is a natural and
expected part of a woman's development and does not need to be prevented.
However, there are ways to reduce or eliminate some of the symptoms of
You can reduce your risk of long-term problems such as osteoporosis and
heart disease by taking the following steps:
1. Control your blood pressure, cholesterol, and other risk factors for
2. Do NOT smoke. Cigarette use can cause early menopause.
3. Eat a low-fat diet.
4. Get regular exercise. Resistance exercises help strengthen your bones and
improve your balance.
5. If you show early signs of bone loss or have a strong family history of
osteoporosis, talk to your doctor about medications that can help stop
6. Take calcium and vitamin D.
American College of
Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG
Committee Opinion No. 420, November 2008: hormone therapy and heart disease.
Obstet Gynecol. 2008 Nov;112(5):1189-92.
Management of osteoporosis in postmenopausal women: 2010 position statement
of The North American Menopause Society. Menopause. 2010
Jan-Feb;17(1):25-54; quiz 55-6.
North American Menopause Society. Estrogen and progestogen use in
postmenopausal women: 2010 position statement of The North American
Menopause Society. Menopause. 2010 Mar;17(2):242-55.
Col NF, Fairfield KM, Ewan-Whyte C, Miller H. In the clinic. Menopause. Ann
Intern Med. 2009 Apr 7;150(7):ITC4-1-15.