What is menopause?
Menopause is a natural biological process that marks the end of a woman’s reproductive years. It occurs when the ovaries gradually produce less estrogen and progesterone, the hormones regulating menstruation. Menopause is diagnosed after a woman has gone 12 consecutive months without a menstrual period. In the United States, the average age of natural menopause is around 51 years. When menopause occurs before age 45, it is called early menopause; before age 40, it is considered premature menopause.
The transition leading up to menopause, called perimenopause, may last several years and is characterized by menstrual irregularities and symptoms such as hot flashes. Common symptoms of menopause include hot flashes, night sweats, mood changes, sleep disturbances, vaginal dryness, and increased risk of osteoporosis. Menopause can also be induced surgically or by certain medical treatments.
What causes menopause?
Menopause results primarily from the natural decline in ovarian hormone production. Other causes include:
- Oophorectomy: Surgical removal of the ovaries causes immediate menopause and often severe symptoms due to abrupt hormonal changes.
- Chemotherapy and radiation therapy: Treatments for cancer can induce menopause during or shortly after therapy.
- Primary ovarian insufficiency (POI): In about 1% of women, ovarian function fails before age 40, often for unknown or genetic reasons.
- Hysterectomy: Removal of the uterus alone does not immediately cause menopause; however, removal of both uterus and ovaries does.
What are the signs and symptoms of menopause?
- Hot flashes: Sudden warmth, often over the face, neck, and chest, followed by sweating and chills.
- Night sweats: Hot flashes during sleep, leading to disrupted rest.
- Irregular periods: During perimenopause, cycles may become shorter, longer, heavier, or lighter.
- Mood changes: Increased irritability, anxiety, or risk of depression.
- Vaginal dryness: Reduced lubrication and thinning of vaginal tissues, which can cause discomfort during intercourse.
- Sleep problems: Insomnia or poor sleep quality, often related to night sweats.
- Thinning hair and dry skin: Changes in hormone levels can affect skin and hair health.
- Bladder control issues: Loss of tissue elasticity can lead to incontinence or urgency.
- Weight gain and slowed metabolism: Hormonal shifts can make weight management more difficult.
- Osteoporosis: Lower estrogen levels contribute to bone density loss.
- Cholesterol changes: Menopause may increase LDL (“bad”) cholesterol, raising cardiovascular risk.
If any vaginal bleeding occurs after menopause, seek medical attention immediately.
How is menopause diagnosed?
Diagnosis is based on menstrual history and symptoms. A woman who has not menstruated for 12 months is considered menopausal, unless menopause was induced surgically or by treatments. Blood tests may include:
- Follicle-stimulating hormone (FSH): Levels rise as ovarian function declines.
- Estrogen: Levels fall during the transition.
- Thyroid-stimulating hormone (TSH): Measured if thyroid disorders are suspected.
How is menopause treated?
Treatment aims to relieve symptoms and reduce long-term risks:
- Hormone replacement therapy (HRT): Effective for hot flashes, night sweats, and osteoporosis prevention; carries some risks and requires individualized assessment.
- Vaginal estrogen: Administered as a cream, tablet, or ring to alleviate dryness and urinary symptoms.
- Low-dose antidepressants: Certain SSRIs can reduce hot flashes.
- Gabapentin: Originally for seizures, can also help with vasomotor symptoms.
- Clonidine: A blood pressure medication that may ease hot flashes.
- Osteoporosis treatments: Calcium, vitamin D, and medications to strengthen bone.
- Lifestyle changes: Stress reduction (yoga, meditation), healthy diet, regular exercise, smoking cessation, and layered clothing for hot flashes.
What is postmenopause?
Postmenopause begins 12 months after the final menstrual period. While many symptoms improve, some women continue experiencing hot flashes and other effects for years. Lower estrogen levels increase the risk of osteoporosis and cardiovascular disease.
How long does menopause typically last?
Perimenopause can begin up to 10 years before the final period, often in the 40s. Once 12 consecutive months without menstruation have passed, a woman is postmenopausal. Surgical removal of ovaries causes immediate menopause.
Sources
- Menopause basics. Office on Women’s Health. Accessed Apr. 11, 2024.
- Menopausal symptoms: In depth. National Center for Complementary and Integrative Health. Accessed Apr. 11, 2024.
- Menopause. National Institutes of Health. Accessed Apr. 11, 2024.
- What is Menopause? National Institute on Aging. Accessed Apr. 11, 2024.