What Is It?
Most women think of menopause as the time of life when their menstrual periods end. This usually occurs during middle age, when women are also experiencing other hormonal and physical changes. For this reason, menopause is sometimes called the "change of life."
A woman is said to be in menopause after she has gone for one full year without periods. While most women in the United States go through menopause around the age of 51, a small number will experience menopause as early as age 40 or as late as their late 50s. Rarely, menopause occurs after age 60. When menopause is diagnosed before age 40, it is considered to be abnormal or premature menopause.
In women, the ovaries produce the female hormones estrogen and progesterone. Estrogen and progesterone control a woman's periods and other processes in her body. As a woman approaches menopause, her ovaries gradually makes less and less of these hormones.
As hormone levels fall, a woman's pattern of menstrual bleeding usually becomes irregular. Many women experience light, skipped or late periods for several months to a year before their periods stop altogether. Some women may experience heavier-than-normal bleeding. Heavier-than-normal bleeding should be evaluated by a doctor to exclude problems in the genital tract.
It is important to realize that until menopause is complete, a woman still can become pregnant even when periods are light or missed.
For most women, menopause is a normal process of aging. If a woman has had her ovaries removed by surgery or has had damage to her ovaries for other reasons, such as radiation therapy, she may become menopausal from that process.
Perimenopause, also known as the climacteric, includes the time before menopause when hormonal and biological changes and physical symptoms begin to occur. This period lasts for an average of three to five years.
Some women don't have any symptoms during menopause or only have a few symptoms. Others develop disturbing and even severe, disabling symptoms. Studies of women around the world suggest that differences in lifestyle, diet and activity may play a role in the severity and type of symptoms women have during menopause. Symptoms can be noticed for several months to years before the last menstrual period and can continue for several years after.
Symptoms of menopause or perimenopause include:
For most women, the diagnosis of menopause is made based on a woman's description of her symptoms and the ending of her menstrual periods. Laboratory testing is not usually needed.
Because women can still become pregnant while they are perimenopausal, doctors may do a pregnancy test when a woman's periods become irregular, infrequent or light. In some cases, a blood test for levels of follicle-stimulating hormone (FSH) may be recommended. FSH levels are normally high in menopause, so high FSH levels can help to confirm that a woman is in menopause.
At the time of menopause, doctors often recommend a bone density measurement. The test result sometimes will detect early osteoporosis. More often the result is used as a baseline to compare rate of bone loss in the future.
Another test is endometrial biopsy. An endometrial biopsy is an office procedure in which a tiny piece of endometrial tissue from inside the uterus is taken and examined under a microscope for signs of cancer. This test may be done when a woman is having irregular, frequent or heavy bleeding, but it is not routinely recommended as a test for menopause.
Perimenopause usually lasts three to five years but it can take as few as two years or as many as eight years for some women. The changes in the body that occur during menopause last for the rest of a woman's life. However hot flashes usually improve over time, becoming less frequent and less severe.
Menopause is a natural event and cannot be prevented. Medications, diet and exercise can prevent or eliminate some symptoms of menopause and enhance a woman's quality of life as she grows older.
Diet, exercise and lifestyle changes can reduce the symptoms and complications of menopause. The following recommendations are appropriate for all women who are approaching menopause or who are in menopause.
A number of medications are used to treat the symptoms of menopause. The type of medication needed is a complicated decision and each woman should discuss the issue with her doctor. The treatment will depend on what symptoms are most bothersome and how bothersome they are.
Estrogen taken as a pill or applied to the skin as a patch can reduce hot flashes, sleep disturbances, mood changes and vaginal dryness. Estrogen can be prescribed alone when a woman no longer has her uterus. A combination of estrogen and progesterone is used when a woman still has her uterus. Progesterone is necessary to balance estrogen's effect on the uterus and prevent changes that can lead to uterine cancer.
However, evidence has shown that there are some risks associated with the use of these medicines. Estrogen therapy can increase the risk of heart disease, stroke, breast cancer and blood clots in a small number of women. On the other hand, it prevents fractures and can decrease the risk of colon cancer. Therefore, the decision to use hormone replacement therapy to treat symptoms of menopause is an individual decision. A woman should talk to her doctor about the risks and benefits of hormone replacement therapy for her.
There are several other medications that can be used to treat the symptoms of menopause:
Several alternative treatments have been proposed to treat the symptoms of menopause. Many of these treatments have not been studied in large clinical trials. Although black cohosh has been previously promoted as a treatment for hot flashes, well-done medical studies conclude the root is no more effective than a placebo. Some women have found St. John's wort to be effective in treating mood disorders related to menopause.
The use of soy products in the diet such as tofu is controversial. While it may improve symptoms for some women, the phytoestrogens (plant estrogens) that may help relieve hot flashes may also increase the risk of breast cancer.
Scientific studies have found no benefit to the use of vitamin E or primrose oil. No evidence has been found to support the use of acupuncture or homeopathy, but few studies of these therapies have been done.
When to Call a Professional
You should see your doctor if you have any of the following:
Although menopause can cause some uncomfortable symptoms, both lifestyle practices and medication can help to ease these symptoms and complications.
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