Menopause is the time in a woman’s life when she stops having menstrual periods. The years leading up to this point are called perimenopause or “around menopause.” Menopause marks the end of the reproductive years that began in puberty.
The average age that women go through menopause is 51 years. Most women enjoy a healthy lifestyle for years afterward. Menopause is a natural event. The physical changes that occur around menopause should not prevent you from enjoying this time of your life.
What is Menopause?
The Menstrual Cycle
The ovaries, two glands on either side of the uterus, make estrogen from puberty until menopause. Estrogen is made during the entire menstrual cycle. It causes the lining of the uterus (the endometrium) to thicken each month.
On about day 14 of your menstrual cycle, an egg is released from one of the ovaries. This is called ovulation. After ovulation, progesterone levels increase. If the egg is not fertilized, no pregnancy occurs. This causes the levels of estrogen and progesterone to decrease. This signals the uterus to shed its lining. This shedding is your monthly period.
Estrogen and Menstrual Changes
As menopause nears, the ovaries make less estrogen. One of the earliest and most common signs that menopause may be approaching is a change in your menstrual periods. You may skip one or more periods. The amount of flow may become lighter or heavier. Bleeding may last shorter or longer than usual.
Even though periods tend to be irregular around the time of menopause, you should be aware of bleeding that is not normal for you. This could be a sign of a problem. Talk to your doctor if you:
- Have a change in your monthly cycle
- Have very heavy bleeding with clots
- Have bleeding that lasts longer than normal
- Bleed more frequently than every three weeks
- Bleed after sex or between periods
At some point, the ovaries stop making enough estrogen to thicken the lining of the uterus. This is when menstrual periods stop.
A small amount of estrogen is made by other glands and body fat after menopause. Women who are very overweight may not have symptoms of menopause because their extra body fat allows them to make estrogen even after the ovaries stop working.
Menopause also can occur when a woman’s ovaries are surgically removed. This may trigger severe symptoms. Women who have surgically induced menopause may choose to take hormones to replace those made by the ovaries.
Although the removal of the uterus (a hysterectomy) ends menstrual periods, it will not cause early menopause unless the ovaries also are removed. If at least one ovary remains after surgery, most women will go through menopause around the normal age.
What to Expect
Menopause is a natural part of aging. The lower amounts of estrogen that come with menopause will cause changes in your body. These changes occur slowly over time. Menopause is different for everyone. Some women notice little difference in their bodies or with their mood. Others may find it difficult to cope with their symptoms.
Hot Flashes
The most common symptom of menopause is hot flashes. As many as 75 percent of menopausal women in the United States will have them. A hot flash is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush. You also may break out in a sweat. A hot flash may last form a few seconds to several minutes or longer.
Hot flashes can happen at any time—day or night. They can be mild or severe. Hot flashes may come a few times a month or several times a day, depending on the woman. Some women will have hot flashes for a few months, some for a few years, and some not at all. Even though hot flashes are a nuisance, are sometimes embarrassing, and may interfere with daily life, they are not harmful.
Sleep Problems
Hot flashes can cause a lack of sleep, often waking a woman from a deep sleep. A lack of sleep may be one of the biggest problems you face as you approach menopause. Too little sleep can affect your mood, health and ability to cope with daily activities. Some women have less rapid eye movement know as REM sleep. This is the stage of sleep when you dream. REM sleep makes up about 20 percent of an adult’s normal sleep cycle. Without it, you may wake up without feeling rested. Some women approaching menopause may find it takes longer to get to sleep.
Vaginal and Urinary Tract Changes
Loss of estrogen causes changes in the vagina. Its lining may become thin and dry. These changes can cause pain during sexual intercourse. They also can make the vagina more prone to infection, which can cause burning and itching.
The urinary tract also changes with age. The urethra (the tube that carries urine from the bladder) can become dry, inflamed or irritated. Some women may need to urinate more often. Women may have an increased risk of bladder infections after menopause.
Bone and Other Body Changes
Bone loss is a normal part of aging. At menopause, the rate of bone loss increases. Osteoporosis, a result of this bone loss, increases the risk of fractured bones in older women. The bones of the hip, wrist, and spine are affected most often.
The estrogen produced by women’s ovaries before menopause protects them from heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. The risk of heart attack and stroke then increases.
Emotional Changes
Menopause does not cause sudden mood swings or depression. However, the change in hormone levels may make you feel nervous, irritable or very tired. These feelings may be linked to other symptoms of menopause such as lack of sleep.
If you are under a lot of stress, the changes of menopause may be harder to manage. Many women in midlife are going through major life changes anyway. There may be stress in the family as time passes and roles change. There may be stress related to money or your job. Some women may be watching children leave home and are learning to deal with the “empty nest.” Some are saddened that they can no longer have children. More often, women find themselves part of the “sandwich generation,” becoming caretakers for their children, grandchildren and their aging parents. If you find it hard to cope, talk about your feelings with your partner, a close friend, a counselor or your doctor.
Sexuality
Menopause does not have to affect your ability to enjoy sex. Although the lack of estrogen may make the vagina dry, vaginal lubricants can help moisten the vagina and make sex more comfortable. There are a number of over-the-counter lubricants available. If you don’t like one product, try another.
Regular sex may help the vagina keep its natural elasticity. If you have been having sex on a regular basis, you may not notice any major changes during menopause. If you have not been sexually active for a while, you may want to talk with your partner and perhaps your doctor about ways to make sex more comfortable.
Some women find that they have less interest in sex around and after menopause. Lower hormone levels may decrease the sex drive. It may affect your ability to have an orgasm or it may take longer for you to reach orgasm.
You are not completely free of the risk of pregnancy until one year after your last period. Until this time, if you do not wish to become pregnant, it is important to use a method of birth control. Keep in mind you still need to prevent sexually transmitted diseases. If you are at risk for sexually transmitted diseases, use a latex condom.
Men too may find that their sex drive decreases as they age. It may take an older man longer to achieve an erection and ejaculate or he may have problems with impotence. Impotence usually is caused by physical or medical problems or it may be caused by medications. In many cases, impotence can be treated with success.
Talk with your partner about how you feel. Communication is key during this time of changes. This may be a good time to experiment with your sex life. You and your partner may want to try different positions or engage in longer foreplay. There are many “how-to” books and videos available as guides.
The Gynecologic Visit
Routine visits to your doctor for breast, pelvic and rectal exams are recommended for all women. Your doctor will do a Pap test to check for cancer of the cervix. Between visits you should perform a breast self-exam once a month.
Depending on your age, your doctor may recommend that you have a mammogram. You will also be asked about your general health and medical history. If you have problems at any time, contact your doctor. Don’t wait until your next checkup.
Hormone Therapy
Hormone therapy (HT) can help relieve the symptoms of menopause. It replaces female hormones no longer made by the ovaries. Depending on your situation, you may begin HT before menopause. If you are taking birth control pills, they will be stopped when you begin treatment.
For women with a uterus, estrogen usually is given along with progestin—a synthetic version of the hormone progesterone. This helps reduce the risk of cancer of the lining of the uterus that occurs when estrogen is used alone. The progestin may be taken every day with estrogen or estrogen may be taken on some days and the progestin added on others.
Hormone treatment is most often prescribed in the form of pills, injections, vaginal rings or patches placed on the skin. Estrogen creams and tablets used in the vagina can treat dryness but do not work well against other symptoms.
Benefits
Many of the symptoms of menopause can be eased by taking estrogen. Estrogen is used to treat hot flashes, the main symptom of menopause. It also relieves vaginal dryness. Estrogen also can help to relieve some changes that can cause problems in the urinary tract.
Estrogen protects against bone loss. Hormone therapy slows bone loss after menopause and helps prevent osteoporosis. Estrogen also can help reduce the risk of colon cancer.
Risks
Like any treatment, hormone therapy is not free of risk. In women with a uterus, using estrogen alone can increase the risk of endometrial cancer because estrogen causes the lining of the uterus to grow. Taking a progestin will help reduce the risk of uterine problems. The drawback of using a progestin is that menopausal women may start bleeding again. Although bleeding may occur only for a short time, many women don’t want to go through having menstrual periods again.
There is an increased risk of breast cancer in women who use combined hormone therapy. The increased risk appears to be small, but increases depending on how long a woman takes hormone therapy. Hormone therapy also modestly increases the risk of heart attack, stroke and blood clots.
Other Therapies
Women also can take selective estrogen receptor modulators (SERMs) to help prevent some of the bone problems that can occur during menopause. SERMs are a type of medication that strengthen tissues of the bones. Because SERMs target specific areas, they can treat only the areas that need to be treated.
Some types of SERMs can help prevent bone loss that occurs during menopause. SERMs also decrease total cholesterol and “bad” cholesterol (LDL) levels. However, they do not increase “good” cholesterol (HDL) levels. Yet, SERMs still may help reduce the risk of heart disease.
SERMs may be a good choice for women who need protection from osteoporosis, but can’t or don’t want to take HT. This may include:
- Women at the risk of breast cancer
- Women who can’t tolerate the side effects of HT
- Women who don’t need relief from symptoms of menopause
SERMs do not relieve hot flashes. In fact, SERMs may make them worse.
If a woman does not take hormone therapy or SERM’s, there are some other options for preventing bone loss. A medication called calcitonin slows the breakdown of bone. It can be given by injection or nasal spray. Other medications used to slow bone breakdown are bisphosphonates. Bisphosphonates are used to increase bone density and reduce the risk of fractures. Parathyroid hormone also is used for this purpose.
Staying Healthy
Good Nutrition
Eating a balanced diet will help you stay healthy before, during and after menopause. It’s important to eat a variety of foods to make sure you get all the essential nutrients. Choose a low-fat, low-cholesterol diet. Also, be sure to include enough calcium in your diet to help maintain strong bones. Women older than 50 years should be getting 1,000 mg of calcium each day if they are taking hormone therapy and 1,500 mg each day if they are not. It is hard to get enough calcium from eating dairy products and certain vegetables so you should consider using calcium supplements. Ask your pharmacist about a supplement to slow bone loss.
Calcium cannot be absorbed without vitamin D. Milk that is fortified with vitamin D is one of the best sources. Another is sunlight. You also can use vitamin D supplements. A woman should take the recommended daily amount of vitamin D which is 400 to 800 international units.
Exercise
Exercise is very important, especially as you get older. Regular exercise slows down bone loss and improves your overall health. Follow a program of regular weight-bearing exercise such as walking and aerobic exercises.
Finally . . .
Menopause is a natural event. Today, women can expect to live one third of their lives after menopause. The physical changes that occur around menopause should not prevent you from enjoying this time of your life. To function at your best, you should:
Exercise regularly.
Eat a balanced diet that contains enough calcium.
Visit your doctor for routine checkups.
