Menopause

Menopause is the time in a woman’s life when her period stops. It usually occurs naturally, most often after age 45. Menopause happens because the woman’s ovary stops producing the hormones estrogen and progesterone.

A woman has reached menopause when she has not had a period for one year. Changes and symptoms can start several years earlier. They include

• A change in periods – shorter or longer, lighter or heavier, with more or less time in between
• Hot flashes and/or night sweats
• Trouble sleeping
• Vaginal dryness
• Mood swings
• Trouble focusing
• Less hair on head, more on face

Some symptoms require treatment. Talk to your doctor about how to best manage menopause. Make sure the doctor knows your medical history and your family medical history. This includes whether you are at risk for heart disease, osteoporosis, or breast cancer.

Menopause is the point in time when a woman’s menstrual periods stop. Menopause happens because the ovaries stop producing the hormones estrogen and progesterone. Once you have gone through menopause, you can’t get pregnant anymore. Some people call the years leading up to a woman’s last period menopause, but that time actually is the menopausal transition, or perimenopause (PER-ee-MEN-oh-pawz).

During the time of the menopausal transition (perimenopause), your periods can stop for a while and then start again. Therefore, the only way to know if you have gone through menopause is if you have not had your period for one year. (And it’s not menopause if your periods stop for some other reason, like being sick.) The average age of menopause is 51, but for some women it happens as early as 40 or as late as 55.

After you go through menopause, you are considered in the post-menopausal stage of your life. Your female hormones won’t go up and down the way they used to with your periods. They will stay at very low levels.

Some women worry about menopause, and it can cause uncomfortable symptoms. But there are many ways to treat symptoms and stay active and strong.

Usually, menopause is natural. That means it happens on its own, and you don’t need medical treatment unless your symptoms bother you. Sometimes, though, menopause is medically induced, which means it’s caused by an operation or medication. If so, you should work closely with your doctor to feel comfortable and take good care of your health.

What is perimenopause?

Perimenopause, or the menopausal transition, is the time leading up to a woman’s last period. Periods can stop and then start again, so you are in perimenopause until a year has passed since you’ve had a period. During perimenopause a woman will have changes in her levels of estrogen (ES-truh-jin) and progesterone (proh-JES-tuh-RONE), two female hormones made in the ovaries. These changes may lead to symptoms like hot flashes. Some symptoms can last for months or years after a woman’s period stops.

There is no way to tell in advance how long it will take you to go through the menopausal transition. It could take between two and eight years.

Sometimes it’s hard to tell if you are in the menopausal transition. Symptoms, a physical exam, and your medical history may provide clues to you and your doctor. Your doctor also could test the amount of hormones in your blood. But because hormones change during your menstrual cycle, these tests alone can’t tell for sure that you have gone through menopause or are getting close to it. Unless there is a medical reason to test, doctors usually don’t recommend it.

Symptoms

Menopause affects every woman differently. Some women have no symptoms, but some women have changes in several areas of their lives. It’s not always possible to tell if these changes are related to aging, menopause, or both.

Some changes that might start in the years around menopause include:

• Irregular periods. Your periods can come more often or less, last more days or fewer, and be lighter or heavier. Do not assume that missing a couple of periods means you are beginning the menopausal transition. Check with your doctor to see if you are pregnant or if there is another medical cause for your missed periods. Also, if you have not had a period for a year and start “spotting,” see your doctor. Spotting could be caused by cancer or another health condition.
• Hot flashes. Also called hot flushes, these are a sudden feeling of heat in the upper part or all of your body. Your face and neck may become red. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow.
• Trouble sleeping. You may find it hard to sleep through the night. You may have night sweats, which are hot flashes that make you perspire while you sleep. You may also feel extra tired during the day.
• Vaginal and urinary problems. These problems may start or increase in the time around menopause. The walls of your vagina may get drier and thinner because of lower levels of the hormone estrogen. Estrogen also helps protect the health of your bladder and urethra, the tube that empties your urine. With less estrogen, sex may become less comfortable. You also could have more vaginal infections or urinary tract infections. Some women find it hard to hold their urine long enough to get to the bathroom (which is called urinary urge incontinence). Urine might also leak out when you sneeze, cough, or laugh (called urinary stress incontinence).
• Mood changes. You could have mood swings, feel crabby, or have crying spells. If you had mood swings before your monthly periods or if you had depression after giving birth, you may have more mood issues around the time of menopause. Mood changes at this time also could be coming from stress, family changes, or feeling tired. Mood swings are not the same as depression.
• Changing feelings about sex. Some women feel less aroused, while others feel more comfortable with their sexuality after menopause. Some women may be less interested in sex because sex can be more physically uncomfortable. Learn about what you can do to address any concerns about sex.
• Osteoporosis (OS-tee-oh-poh-ROH-sis). This is a condition in which your bones get thin and weak. It can lead to loss of height and broken bones.
• Other changes. You might become forgetful or have trouble focusing. Your waist could become larger. You could lose muscle and gain fat. Your joints and muscles also could feel stiff and achy. Experts do not know if some of these changes are a result of the lower estrogen levels of menopause or are a result of growing older.

The symptoms that come with menopause can seem challenging. You can feel better, though.

Tracking your symptoms

Writing down your menopause-related symptoms can give you a better sense of how many symptoms you have, how often they come, and how much they bother you.

Print out our tracking chart and take it with you when you visit your doctor. Together, you can work on how to handle your symptoms.

Menopause and your health

Changes in your body in the years around menopause increase your chances of having certain health problems. Lower levels of estrogen and other changes related to aging (like possibly gaining weight) increase women’s risk of heart disease, stroke, and osteoporosis.

There are many important steps you can take to build your health in the years around menopause:

• Eat well. Keep some key points in mind:
  • Older people need just as many nutrients but tend to need fewer calories for energy. Make sure you have a balanced diet.
  • Women over 50 need 2.4 micrograms (mcg) of vitamin B₁₂ and 1.5 milligrams of vitamin B₆ each day. Ask your doctor if you need a vitamin supplement.
  • After menopause, a woman’s calcium needs go up to maintain bone health. Women 51 and older should get 1,200 milligrams (mg) of calcium each day. Vitamin D also is important to bone health. Women 51 to 70 should get 600 international units (IU) of vitamin D each day. Women ages 71 and older need 800 IU of vitamin D each day.
  • Women past menopause who are still having vaginal bleeding because they are using menopausal hormone therapy might need extra iron.
• Be active. Exercise can help your bones, heart, mood, and more. Ask your doctor about what activities are right for you. Aim to do:
  • At least 2 hours and 30 minutes a week of moderate aerobic physical activity or 1 hour and 15 minutes of vigorous aerobic activity or some combination of the two
  • Exercises that build muscle strength on two days each week
• Quit smoking. Smoking hurts your health in many ways, including by damaging your bones. Stay away from secondhand smoke and get help quitting if you need it.
• Take care of your gynecological health. You will still need certain tests like a pelvic exam after menopause. Most women need a Pap test every three years. Depending on your health history, you may need a Pap test more often, so check with your doctor. Also, remember to ask how often you need mammograms (breast x-rays). In addition to gynecologists, your internist or family physician can do many gynecological screenings. You also may need to see a specialist for some specific problems, like a urogynecologist for urinary incontinence.
• Ask your doctor about immunizations and screenings. Discuss blood pressure, bone density, and other tests. Find out about flu and other shots.