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Menopause

Definition

Menopause is when the menstrual period ends permanently. It is a natural process that can begin over several years. Menopause is confirmed when it has been a year without a period. It most often occurs naturally around age 52, but can happen any time between ages 40 and 60. Menopause that occurs before age 40 is considered premature menopause.

Menopause is a gradual process. Perimenopause is the time before, when your body is gradually moving towards menopause. It includes changes to hormone levels and irregular pattern of periods.

Causes    TOP

Menstrual period happens because of hormones called estrogen and progresterone. These hormones are released by the ovaries. Natural menopause is caused by a gradual decrease in estrogen. The decrease in hormones eventually stops the ovaries from releasing eggs.

Menopause can also be caused by surgery that removes the uterus or ovaries. Menopause will occur immediately after surgery in these cases.

Risk Factors    TOP

Menopause is a natural process associated with aging.

Risk factors for early menopause include:

  • Smoking
  • Radiation or chemotherapy

Symptoms    TOP

Menopause itself may not have symptoms. Symptoms are more common in the time leading up to menopause and may include:

  • Irregular menstrual periods
  • Hot flashes and night sweats
  • Disturbed sleep patterns, such as insomnia
  • Mood changes, which may include irritability, anxiety or depression
  • Vaginal dryness and pain with sexual intercourse
  • Dry skin
  • Decreased interest in sex
  • Frequent urination or leaking of urine

Diagnosis    TOP

Your doctor will ask you about your period cycle. Perimenopause or menopause is suspected based on symptoms and age. Once the menstrual period is absent for 12 months it is considered menopause.

Menopause may need to be confirmed after a surgery. A blood test may be done to look for follicle-stimulating hormone (FSH). High levels of FSH suggest menopause.

Treatment    TOP

Menopause is a natural part of life that does not need treatment itself.

The changes in hormones can cause symptoms in the early stages. Certain treatments and lifestyle changes may help decrease symptoms that are causing problems.

These hormones also play a role in protecting the bones and heart. The decrease in hormones can increase your risk of heart disease or osteoporosis. Lifestyle changes can help decrease the risk of these conditions.

Osteoporosis in Hip

Osteoporosis
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Hormone Replacement Therapy (HRT)

HRT may help decrease symptoms by replacing some of the hormones for a short time. HRT medications may include:

  • Estrogens
  • Progesterone
  • Combinations of estrogen and progesterone
  • Low amounts of male hormones

HRT is available as tablets, gels, skin patches, vaginal rings, vaginal tablets, injections, and pellets inserted into the skin.

Hormones affect the entire body. While it may reduce certain symptoms it can also increase the risk of other illnesses. Some risks associated with HRT include:

Nonhormonal Options

HRT is not a good choice for some women due to personal choice or high risk of some cancers. Other options to help deal with symptoms includes:

  • Medication to help decrease hot flashes:
    • Certain blood pressure medications
    • Antiseizure medications
    • Antidepressant medications
  • Vaginal moisturizers and vaginal lubricants to help decrease vaginal dryness.

Lifestyle Changes    TOP

A healthful diet during menopause may decrease some of your symptoms. It can also help you feel better overall and reduce the risk of heart disease and osteoporosis. Aim for a balanced diet that has:

  • Plenty of fruits, vegetables, and whole grains
  • Low amounts of saturated fats (found in animal products), trans fats, processed foods, and sugars
  • Lean protein options such as chicken, fish, eggs, or nuts

Your diet should also include enough calcium and vitamin D for healthy bones. Look for foods high in calcium (such as milk, yogurt) and vitamin D (such as fish). Ask your doctor if vitamin D or calcium supplements are needed. Sun exposure also increases the amount of vitamin D.

Regular physical activity may help decrease symptoms, manage weight, and decrease stress. Weight-bearing exercises like walking and strength exercises may also help keep bones healthy.

Certain habits can make symptoms worse. For example:

  • Caffeine and alcohol may increase your symptoms of anxiety and insomnia. They can also increase your loss of calcium. If you drink alcohol, only drink in moderation. Moderation is 1 drink or less per day.
  • Spicy or hot foods may make hot flashes worse.
  • Smoking can increase the risk of early menopause, heart disease, and osteoporosis.

Stress management may help ease tension and anxiety. Find methods that work best for you such as breathing exercises, massage, warm baths, and quiet music.

Prevention    TOP

Menopause is a natural event that cannot be prevented.

RESOURCES:

Office on Women's Health
http://www.womenshealth.gov
The North American Menopause Society
http://www.menopause.org

CANADIAN RESOURCES:

Women's Health Matters
http://www.womenshealthmatters.ca

References:

Menopause. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114698/Menopause. Updated July 22, 2016. Accessed September 28, 2016.
Menopause. Planned Parenthood website. Available at: https://www.plannedparenthood.org/learn/womens-health/menopause. Accessed April 18, 2013.
Menopause 101: A primer for the perimenopausal. North American Menopause Society website. Available at:
...(Click grey area to select URL)
Accessed April 18, 2013.
9/30/2008 DynaMed Plus Systematic Literature Surveillance. Available at: http://www.dynamed.com/topics/dmp~AN~T114698/Menopause: Jacobson BC, Moy B, Colditz GA, Fuchs CS. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168(16):1798-1804.
1/30/2009 DynaMed Plus Systematic Literature Surveillance. Available at: http://www.dynamed.com/topics/dmp~AN~T114698/Menopause: Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa): A systematic review of adverse events. Am J Obstet Gynecol. 2008;199(5):455-466.
1/30/2009 DynaMed Plus Systematic Literature Surveillance. Available at: http://www.dynamed.com/topics/dmp~AN~T114698/Menopause: Kaszkin-Bettag M, Ventskovskiy BM, Solskyy S, et al. Confirmation of the efficacy of ERr 731 in perimenopausal women with menopausal symptoms. Altern Ther Health Med. 2009;15(1):24-34.
4/14/2009 DynaMed Plus Systematic Literature Surveillance. Available at: http://www.dynamed.com/topics/dmp~AN~T114698/Menopause: Archer DF, Dupont CM, Constantine GD, et al. Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: A double-blind, randomized, placebo-controlled trial of efficacy and safety. Am J Obstet Gynecol. 2009;200(3):238.
11/4/2013 DynaMed Plus Systematic Literature Surveillance. Available at: http://www.dynamed.com/topics/dmp~AN~T114698/Menopause: Moilanen JM, Mikkola TS, Raitanen JA, et al. Effect of aerobic training on menopausal symptoms: A randomized controlled trial. Menopause. 2012;19(6):691-696.
Last reviewed February 2016 by Kim Carmichael, MD
Last Updated: 11/4/2013