Menopause

What is menopause?

Menopause is the time in a woman's life when menstruation stops permanently.

Menopause is usually a gradual process. The ovaries begin to produce less hormone. The reduced amount of hormone causes menstrual periods to become irregular and eventually to stop completely. The hormonal changes often cause other symptoms.

Menopause can also occur when the ovaries are surgically removed.

Most women go through menopause between ages 45 and 55. In the US the average age for menstrual periods to stop completely is 51.

What are the symptoms?

You may have both physical and psychological symptoms during menopause. Symptoms may occur for a few weeks, a few months, or sometimes over several years. Your symptoms may come and go, or they may occur regularly.

These physical symptoms are common during menopause:

• irregular menstrual periods
• hot flashes
• night sweats
• changes in your sleep patterns
• dizziness
• headaches
• muscle and joint pain
• dry skin
• palpitations (awareness of a fast or irregular heartbeat)
• fatigue
• vaginal dryness and shrinkage of genital tissues, sometimes resulting in discomfort or pain during sexual intercourse
• grayish vaginal discharge with a bad odor
• more frequent need to urinate or leakage of urine (urinary incontinence)
• more frequent minor vaginal and urinary infections.

Menopause usually occurs at a time in life when other dramatic changes take place. Some of these changes may include loss of parents, adjustment to children growing up and leaving home, becoming a grandparent, retirement, or career changes. These changes, in addition to the changes in your body, may result in psychological or emotional stress. Psychological symptoms of menopause may include:

• anxiety
• depression
• tearfulness, irritability
• sleeplessness
• less desire for sex
• lack of concentration
• more trouble remembering things.

How is it diagnosed?

Your health care provider will ask about your medical history and examine you. If you have not had a menstrual period for 12 months in a row, you are probably in menopause. You may have blood tests. A pelvic exam and Pap smear may show the effects of less estrogen in your body.

How is it treated?

Menopause is a natural part of a woman's life. It is not a disease and does not necessarily require any treatment. However, some health problems, such as osteoporosis, are associated with low estrogen. To treat menopause symptoms and help prevent health problems, your health care provider may recommend lifestyle changes and possibly also drug treatment.

Treatment of menopause symptoms should start with:

• regular exercise
• a healthy, calcium-rich diet that includes foods with estrogenlike substances, such as soybean products and whole grains
• a program to reduce stress (if exercise is not enough).

Hormone Replacement Therapy

Your health care provider might recommend that you take estrogen to replace the hormones your body is no longer producing. This treatment is called estrogen replacement therapy (ERT), or hormone replacement therapy (HRT). You and your health care provider should discuss the risks and benefits of hormone replacement therapy for you. Factors such as your age, race, family history, and health history should be considered. HRT helps prevent osteoporosis (loss of bone density). However, it is not the right treatment for every woman. For example, women who have had some types of breast cancer or other cancer, blood clots, or certain liver diseases should not take estrogen.

If you decide to start taking estrogen, you may take it as tablets to be swallowed, patches to be put on the skin, a vaginal ring, a cream to be put into the vagina, or pellets placed under the skin. You may continue the treatment for several months and possibly many years.

If you still have your uterus and want to take estrogen, you will need to take progesterone with the estrogen because taking estrogen alone will increase your risk of cancer of the uterus. If your uterus has been removed, it is OK to take just estrogen.

You may want to try HRT for several months to see how you feel when you take hormones. Ask your health care provider about any side effects or special precautions you should know about while you are taking hormones. Make sure that your provider knows about any other medicines you are taking.

Other treatment options

The prescription medicines progesterone, clonidine, or a combination of belladonna alkaloids and phenobarbital may be taken to treat hot flashes. Clonidine is a blood-pressure-lowering drug and may cause side effects if your blood pressure gets too low.

Other medicines are available to treat or prevent osteoporosis. You should do weight-bearing exercise (such as walking) regularly. It can help to take calcium supplements with vitamin D.

Some women have found ginseng root and vitamin E to be helpful with hot flashes, but medical studies have not yet supported this. However, a group of estrogenlike plant substances may help. Good sources of these substances are soybean products, other beans, rhubarb, carrots, and whole grains. Examples of soybean products include soy milk, tofu, roasted soybeans ("soy nuts"), and soy flour.

How long will the effects last?

Symptoms of menopause may last just a month, or they may continue for several years.

If you have had no menstrual periods for several months or years and then have bleeding from the vagina, check with your health care provider promptly. Unusual vaginal bleeding like this can be a sign of a precancerous problem or cancer of the uterus.

How can I take care of myself?

To help your general mental and physical well-being, you should:

• Have a physical exam, Pap smear, and cholesterol and liver function tests every year.
• Have a mammogram every 1 or 2 years between the ages of 40 and 50, and every year after age 50.
• Eat more foods that are high in calcium, such as dark green vegetables and nonfat (skim) milk and dairy products.
• Reduce saturated fats in your diet. Check labels for product contents before you buy them.
• Get regular physical exercise according to your health care provider's advice. Exercise will help you fight depression and maintain good blood circulation, mobility, bone density, and a sense of well-being.
• Use birth control during sexual intercourse until your health care provider says that you may stop. It is not possible to know exactly when you will stop being able to get pregnant, and it is important to avoid high-risk pregnancies.

You may also choose to:

• Wear cotton sleep wear to reduce discomfort from night sweats.
• Use a vaginal lubricating cream or jelly if intercourse is painful. This problem is usually caused by a lack of estrogen and shrinkage of the vagina. Discuss this with your health care provider.
• Talk and share feelings with a friend or family member who understands what you are experiencing.
• Join a support group for women who have been or are going through menopause.

For more information, call or write:

North American Menopause Society
P.O. Box 94527
Cleveland, OH 44101-4527

216-844-8748

440-442-7550

For ordering material only: 800-774-5342

Web site: http://www.menopause.org

Nonprofit professional organization dedicated to increasing understanding of menopause. Materials available in Spanish and English.