Menopause is time in a woman's life when her periods (menstruation) eventually stop and the body goes through changes that no longer allow her to get pregnant. It is a natural event that normally occurs in women age 45 - 55.
During menopause, a woman's ovaries stop making eggs and they produce less estrogen and progesterone. Changes in 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 for 1 year. This is called postmenopause. Women who are postmenopausal can no longer get pregnant.
Surgical menopause is when medical treatments cause a drop in estrogen. This can happen if your ovaries are removed or if you receive chemotherapy or hormone therapy for breast cancer.
Symptoms vary from woman to woman. They may last 5 or more years. Some women may have worse symptoms than others. Symptoms of surgical menopause can be more severe and start more suddenly.
The first thing you may notice is that your periods start to change. They might occur more often or less often. Some women might get their period every 3 weeks. This might last for 1 - 3 years before the periods completely stop.
Common symptoms of menopause include:
Other symptoms of menopause may include:
Blood and urine tests can be used to look for changes in hormone levels. Test results can help your doctor determine if you are close to menopause or if you have already gone through menopause.
Tests that may be done include:
Your health care 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 doctor may order a bone density test to look for bone loss related to osteoporosis.
Treatment for menopause depends on many things, including how bad your symptoms are, your overall health, and your preference. It may include lifestyle changes or hormone therapy.
Hormone therapy may help if you have severe hot flashes, night sweats, mood issues, or vaginal dryness. Hormone therapy is treatment with estrogen and, sometimes, progesterone.
Talk to your doctor about the benefits and risks of hormone therapy. Your doctor should be aware of your entire medical history before prescribing hormone therapy (HT). Learn about options that do not involve taking hormones.
Several major studies have questioned the health benefits and risks of hormone 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. Specific recommendations:
To reduce the risks of estrogen therapy, your doctor may recommend:
If you have a uterus and decide to take estrogen, you should also take progesterone to prevent cancer of the lining of the uterus (endometrial cancer). If you do not have a uterus, you do not need progesterone.
See also: Hormone therapy
ALTERNATIVES TO HORMONE THERAPY
There are other medicines available to help with mood swings, hot flashes, and other symptoms. These include:
DIET AND LIFESTYLE CHANGES
Hormones are not always needed to reduce symptoms of menopause. There are many steps you can take to reduce symptoms.
Exercise and relaxation techniques:
See also: Managing menopause at home
Some women have vaginal bleeding after menopause. This is often nothing to worry about. However, you should tell your health care provider if this occurs. It may be an early sign of other health problems, including cancer.
Decreased estrogen levels have been linked with some long-term effects, including:
Call your health care provider if:
Menopause is a natural and expected part of a woman's development and does not need to be prevented. You can reduce your risk of long-term problems such as osteoporosis and heart disease by taking the following steps:
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;112:1189-1192.
Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause. 2010;17:25-54.
North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause. 2010;17:242-255.
Col NF, Fairfield KM, Ewan-Whyte C, Miller H. In the clinic. Menopause. Ann Intern Med. 2009;150:ITC4-1-ITC4-15.
Brunner RL, Aragaki A, Barnabei V, et al. Menopausal symptom experience before and after stopping estrogen therapy in the Women's Health Initiative randomized, placebo-controlled trial. Menopause. 2010;17:946-954.
Freeman EW, et al. Efficacy of escitalopram for hot flashes in healthy postmenopausal women. JAMA. 2011;305:267-274.
Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.
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