Menopause is the time in a woman's life when her periods (menstruation) stop. It is a natural, normal body change that most often occurs between ages 45 - 55. After menopause, a woman can no longer become pregnant.
During menopause, a woman's ovaries stop making eggs. The body produces less of the 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 for 1 year. This is called postmenopause. Surgical menopause takes place when surgical treatments cause a drop in estrogen. This can happen if your ovaries are removed.
Menopause can also sometimes be caused by drugs used for chemotherapy or hormone therapy for breast cancer.
Symptoms vary from woman to woman and can be worse for some than others.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 - 3 years before they stop completely.
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. This bone density test is recommended in all women ages 60 - 65. This test may be recommended sooner if you are at higher risk for osteoporosis because of on your family history or medicines that you take.
Treatment may include lifestyle changes or hormone therapy. Treatment depends on many factors such as:
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 and family history before prescribing hormone therapy (HT).
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:
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:
DIET AND LIFESTYLE CHANGES
Lifestyle steps you can take to reduce menopause symptoms include:
Exercise and relaxation techniques:
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 part of a woman's development. It 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:
The 2012 hormone therapy position statement of the North American Menopause Society. Menopause. 2012;19(3):257-271.
Lobo R. Menopause and care of the mature woman. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 14.
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.
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: 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, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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