Menopause

Menopause, which is defined as the cessation of a woman's menstrual cycle, is a natural part of aging in women. Defined as not having a period for at least a year, menopause occurs at an average age of 51, although the age of onset can vary widely.

Going through menopause is a natural and gradual change where a woman's ovaries begin to produce less estrogen and progesterone. During this time, periods become irregular, which is often one of the first signs that menopause is beginning.

While the average age of menopause is 51, this is not a discrete event that suddenly happens to you one day. Rather, there are years before menopause (called perimenopause) and after menopause (called postmenopause). For most women, this transition begins between ages 45 and 55 and it lasts for a number of years.

During this time, not only will you notice changes in your menstrual cycle, but you may also experience many other symptoms—some of which may be profound—as your body adjusts to these hormonal changes. Symptoms can include hot flashes, night sweats, and trouble sleeping.

Menopause is generally broken down into three time periods in a woman's life, all of which can come with the symptoms of menopause:

Perimenopause

This refers to the years when a woman is transitioning into menopause. A woman may be in perimenopause for two to eight years, during which time periods will become irregular until they stop completely.

Menopause

A woman is said to reach menopause when she has gone one full year without a period.

Postmenopause

This is the time after menopause when periods have stopped completely. During postmenopause, estrogen and progesterone levels remain extremely low, which raises the risk of certain health conditions, such as heart disease and osteoporosis. While it's natural to expect that the symptoms of menopause would go away—and they do for some women—unfortunately, many find they may linger for a decade, even up to 14 years later.

The changes a woman's body will experience during menopause can vary so much from person to person but can acutely affect a woman's quality of life. She may notice:

Change in menstrual cycle. Periods become irregular and can become shorter or longer with heavier or lighter bleeding. Some months you may ovulate, while other months you may not. While there are many other causes of cycle changes, this is often one of the initial signs of perimenopause.

Hot flashes. Up to three-quarters of women experience hot flashes during perimenopause.

Night sweats. Waking up to sheets suddenly, and bafflingly, drenched in sweat may become a regular occurrence.

Trouble sleeping. This can include insomnia or sleep disruption from night sweats. Insomnia can also have many other causes, such as anxiety or underlying medical problems like sleep apnea, so it's important to check in with your provider.

Headaches. Hormonal changes can trigger headaches and migraines

Memory problems. That fuzzy-headed feeling may go away after menopause.

Decreased sex drive and vaginal dryness and atrophy. Can make penetrative sex uncomfortable or painful.

Mood changes. Anxiety, depression, or a low mood are often reported. There are many contributing factors, including dealing with physical symptoms of menopause and life transitions common in mid-life that may be difficult.

Weight gain. While weight gain or a redistribution of weight around the middle is considered to be caused more by lifestyle and metabolic changes that accompany aging, rather than hormonal shifts during menopause, many women do notice a change in their weight and shape around this time.

Facial hair. Hormonal changes can lead to hair growth on your face.

Menopause is a natural body process that occurs with aging. It signals when the ovaries begin to produce less reproductive hormones. However, menopause can also be induced through surgery, for instance, if a woman needs to have a hysterectomy that includes removal of her ovaries.

In addition, a woman can experience early or premature menopause, which happens in about 5% of women under age 45. Along with surgery to remove the ovaries, other factors that can lead to premature menopause include smoking, chemotherapy or pelvic radiation, family history (genetics), and certain medical conditions, like autoimmune disease (e.g., thyroid disease or rheumatoid arthritis).

A woman has reached menopause when she has not had a period or spotting for one full year. There are numerous hormonal tests available that claim to tell a woman if she is in perimenopause, including saliva and FSH testing, though these are not reliable ways to confirm perimenopause. Instead, schedule an evaluation with your healthcare provider and talk about the symptoms you're experiencing. Your doctor can confirm that symptoms are likely due to perimenopause or menopause (or rule out other underlying medical conditions) and then offer suggestions for treatment in order to help you feel more comfortable in your everyday life.

The unfortunate reality is that many doctors are not well-versed in menopause, and many women feel left alone to figure out symptom management for themselves. In some areas, you may be able to find a menopause specialist who can help guide your care, listen to your needs, and develop a treatment plan that works for you.

Because symptoms are so wide-ranging, menopause can be challenging to treat. Doctors may suggest treatments for each symptom, and they can also recommend hormone therapy. Throughout this time, until menopause is confirmed, you should also use birth control if you do not want to get pregnant.

Hormone therapy. This involves taking estrogen and progestin to relieve symptoms of menopause. (If you don't have a uterus, you'll take estrogen only.) Estrogen can be taken as a pill, patch, gel, or spray. It's often recommended as a treatment for hot flashes, night sweats, and vaginal dryness. Supplementing the body with estrogen also decreases the risks of lower estrogen levels in the body and may be beneficial for bone health.

Vaginal estrogen therapy. If vaginal atrophy (dryness and thinning) is your main symptom, then your doctor may suggest vaginal estrogen therapy, which is estrogen that's inserted into the vagina via ring, tablet, or cream.

Medications. Certain medications, such as antidepressants, can be taken to help ease hot flashes.

Herbal supplements. While herbal supplements are popular, there is not enough solid evidence to suggest they are effective in relieving menopause symptoms, and some can cause dangerous side effects. 

Avoiding triggers. Caffeine, spicy foods, alcohol, and stress are all common triggers for hot flashes. Learning what sets off yours can help you avoid the foods or develop stress management techniques that may make them less likely.

Specific-symptom management. For example, if you notice an influx of new hair growth on your chin, then you'll want to look into the hair removal option you're comfortable with. If you have frequent headaches, then talk to your doctor about pain medications like NSAIDs or if there are other options. Sleep problems, which can also be a sign of certain mood disorders, can be treated with following a regular sleep schedule, developing a wind-down routine before bed, and limiting caffeine and alcohol intake, as well as other sleep hygiene practices.

There is nothing that can prevent perimenopause or menopause itself. It is part of the aging process.

There are few lifestyle factors—such as smoking—that can make it entering into menopause early more likely, making it important to maintain healthy habits at every age.

Eating a healthy diet and regular physical activity will decrease the risk of heart disease, counteract bone loss, help maintain your weight, and is good for your mood, too. Wearing sunscreen regularly will improve skin health and maintain the collagen and elasticity that can be lost due to aging and loss of estrogen.

Lastly, be sure to schedule regular doctor exams and preventative screenings as recommended by your doctor to catch diseases that you may be more at risk for after menopause early.

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