Menopause

Menopause is a natural process where a woman's menstrual periods permanently stop. Doctors consider someone to be in menopause after they haven't had a period, or any vaginal bleeding or spotting, for a full year. This usually happens between the ages of 40 and 55, with the average age being around 51 in the United States.

While menopause itself is a normal part of aging, the physical and emotional changes that come with it can sometimes be challenging. Common physical symptoms include hot flashes. These can disrupt sleep patterns and lower energy levels. Emotional symptoms can also affect mood. Fortunately, there are various ways to manage these symptoms, ranging from making healthy lifestyle choices to using hormone therapy. These options can help improve quality of life during this transition.

Menopause usually happens gradually. The time leading up to menopause is called perimenopause. During perimenopause, your ovaries make varying amounts of hormones. This period can last anywhere from two to eight years, with an average of around four years. These hormone shifts can cause a range of symptoms.

Common Symptoms of Perimenopause:

• Irregular periods: This is very common. Your menstrual cycle might become unpredictable, skipping months or having periods closer together than usual. Eventually, periods will get further apart until they stop completely.
• Vaginal dryness: The changing hormones can make the vagina feel dry and uncomfortable.
• Hot flashes: These are sudden feelings of warmth, often accompanied by sweating.
• Night sweats: Hot flashes that happen while you're sleeping.
• Sleep problems: Difficulty falling asleep or staying asleep.
• Mood changes: You might experience changes in your mood, such as feeling more irritable or anxious.
• Brain fog: Sometimes, people experience difficulty concentrating, remembering things, or finding the right words.

Understanding Irregular Periods:

It's normal for periods to be irregular during perimenopause. Skipping a period or having shortened or lengthened cycles is common and expected. Sometimes, periods will skip a month and then return to a regular cycle for a while. As menopause nears, periods will become further apart before they stop completely.

Pregnancy:

It's still possible to get pregnant during perimenopause. If you've missed a period and are unsure if it's related to menopause, it's a good idea to take a pregnancy test.

Healthcare:

Regular check-ups with your healthcare provider are crucial before, during, and after menopause. This is important for general well-being and for addressing any medical concerns. If you experience vaginal bleeding after menopause, see your doctor immediately.

Regular checkups with your doctor are important throughout your life, especially during and after menopause. This includes routine wellness visits, as well as addressing any health concerns that arise. If you experience any vaginal bleeding after menopause, see a doctor right away. This is crucial for getting prompt and appropriate medical attention.

Menopause: Understanding the Different Causes

Menopause is a natural process that marks the end of a person's menstrual cycles. It typically happens around age 51, but there are several ways it can start earlier. Here are the main causes:

1. Natural Hormone Decline:

As women enter their late 30s, their ovaries gradually produce less of the hormones estrogen and progesterone, which regulate menstruation. These lower hormone levels can make it harder to get pregnant. During the 40s, menstrual cycles often become irregular—periods may be longer or shorter, heavier or lighter, and less frequent. Eventually, the ovaries stop releasing eggs, and menstruation stops entirely. This gradual process typically leads to the cessation of periods around age 51.

2. Surgical Removal of the Ovaries (Oophorectomy):

The ovaries are responsible for producing hormones like estrogen and progesterone, which control the menstrual cycle. If the ovaries are surgically removed (oophorectomy), menopause happens immediately. This sudden drop in hormones can lead to more intense symptoms, such as hot flashes, compared to the gradual decline in natural menopause.

3. Cancer Treatments (Chemotherapy and Radiation):

Cancer treatments like chemotherapy and radiation can also trigger menopause. Hot flashes and other menopausal symptoms are possible during or shortly after these treatments. Importantly, in some cases, menstrual periods may return after chemotherapy. If this happens, it's crucial to continue using birth control if pregnancy is not desired. Radiation therapy to specific areas like the pelvis, abdomen, or lower spine is more likely to cause menopause. Radiation to other parts of the body, such as the breasts, head, or neck, usually does not affect menopause.

4. Primary Ovarian Insufficiency (Premature Menopause):

In some cases, menopause occurs before age 40. This is known as premature menopause, and it's caused by the ovaries not producing sufficient amounts of hormones, medically termed primary ovarian insufficiency. This can result from genetic factors or autoimmune diseases. In many cases, the exact cause of premature menopause isn't identified. In these instances, hormone therapy is often recommended, ideally extending until the typical age of menopause, to support the health of the brain, heart, and bones.

It's essential to remember that each person's experience with menopause can vary. If you have concerns about menopause or its symptoms, consulting a healthcare professional is highly recommended. They can provide personalized guidance and support.

Women experience menopause. The primary cause of menopause is simply getting older.

Other things that can lead to menopause include:

• Having surgery to remove the ovaries: This procedure often stops the ovaries from producing hormones, triggering menopause.
• Some cancer treatments: Certain treatments, like chemotherapy or radiation therapy, can sometimes cause the body to stop producing the hormones needed for a woman's monthly cycle, and therefore, lead to menopause.

After menopause, some health risks increase for women. Here are a few examples:

1. Heart and Blood Vessel Problems (Cardiovascular Disease): As estrogen levels decrease after menopause, the risk of heart disease goes up. Heart disease is a major cause of death for women, just like it is for men. This happens because the changes in hormone levels can affect cholesterol levels and blood pressure, making the heart work harder. Taking steps to maintain a healthy weight, eating a balanced diet, and getting regular exercise are important for lowering this risk.

2. Weak Bones (Osteoporosis): Menopause can lead to weaker, more brittle bones, a condition called osteoporosis. This is because women lose bone density more quickly in the years following menopause. This increased risk of fractures means bones, like those in the spine, hips, and wrists, are more likely to break. Getting enough calcium and vitamin D, along with regular weight-bearing exercise, can help build and maintain strong bones.

3. Bladder Control Problems (Urinary Incontinence): The tissues in the vagina and urethra (the tube that carries urine out of the body) change during menopause. This can lead to problems with bladder control. There are different types of incontinence. Urge incontinence means you feel a sudden, strong need to urinate and lose urine before you can make it to the bathroom. Stress incontinence means you lose urine when you cough, laugh, or lift something heavy. These changes can also increase the chance of urinary tract infections (UTIs). Kegel exercises can strengthen the pelvic floor muscles, which can help with bladder control.

4. Sexual Health Issues: Menopause often causes the vagina to become drier and less elastic. This can make sex uncomfortable, and there might be some light bleeding. The decreased lubrication and feeling in the area can also affect sexual desire (libido). Using vaginal moisturizers or lubricants can help alleviate discomfort and increase comfort during sex.

5. Weight Gain: Many women gain weight during and after menopause. This is often due to a slowing of metabolism (the process of burning calories). Maintaining a healthy diet and regular exercise are crucial for managing weight during this time. It's important to remember that everyone's experience with menopause is different, and these are just some common concerns. Consulting a doctor is always recommended for personalized advice.

Many people recognize menopause by its symptoms. If you're concerned about changes in your periods or experiencing hot flashes, it's important to talk to your doctor.

Doctors usually don't need tests to diagnose menopause. However, sometimes they might suggest blood tests to check hormone levels. These tests measure:

• Follicle-stimulating hormone (FSH) and estrogen (estradiol): During menopause, FSH levels typically rise and estrogen levels fall. But, because hormone levels fluctuate during the perimenopause stage (the time leading up to menopause), these tests can be tricky for figuring out if you're actually in menopause. Perimenopause can last for several years, and hormone levels can go up and down a lot during this time. This makes it difficult to precisely pinpoint the start of menopause based on these tests alone.

• Thyroid-stimulating hormone (TSH): An overactive thyroid (hyperthyroidism) can cause symptoms similar to menopause symptoms, like hot flashes and irregular periods. So, checking TSH levels helps rule out thyroid problems as the cause of your symptoms.

You can buy home tests to check your FSH levels in your urine without a doctor's prescription. These tests will tell you if your FSH levels are higher than normal. A higher FSH level might suggest you're in perimenopause or menopause.

However, FSH levels naturally rise and fall during your menstrual cycle. This means that home FSH tests aren't very reliable for determining if you're actually in menopause. The results might be misleading because of these natural fluctuations. A doctor's evaluation, including a discussion of your symptoms and medical history, is usually the best way to understand your situation and determine if you are going through menopause.

Managing Menopause Symptoms: Treatment Options

Menopause doesn't require treatment in all cases. However, treatments are available to help manage the symptoms and address any related health issues that may arise with aging. These treatments are designed to alleviate discomfort and prevent or manage complications.

Here are some common treatment options:

1. Hormone Therapy:

Estrogen therapy is often the most effective treatment for hot flashes, a common symptom of menopause. It can also help with other menopausal symptoms and slow the rate of bone loss. Doctors typically recommend the lowest dose of estrogen for the shortest time needed to manage symptoms. This approach is generally best for women under 60 and within 10 years of experiencing menopause.

If you still have your uterus, you'll need to take both estrogen and progestin. Estrogen alone is sufficient if you've had a hysterectomy (removal of the uterus). Estrogen helps maintain bone density.

While long-term hormone therapy use might slightly increase the risk of heart disease and breast cancer, starting hormone therapy close to the time of menopause can be beneficial for some women. It's crucial to discuss the potential risks and benefits with your doctor to determine if hormone therapy is right for you.

2. Vaginal Estrogen:

For vaginal dryness, a low dose of estrogen applied directly to the vagina (as a cream, tablet, or ring) can be effective. This delivers a small amount of estrogen directly to the vaginal tissues, easing dryness, discomfort during intercourse, and some urinary problems.

3. Prasterone (Intrarosa):

Prasterone (Intrarosa) is a vaginal treatment that uses a man-made form of the hormone dehydroepiandrosterone (DHEA). It can help with vaginal dryness and pain during sex.

4. Gabapentin (Gralise, Neurontin):

Gabapentin, a medication typically used to treat seizures, can also help reduce hot flashes. It's a good option for women who can't or don't want to use estrogen therapy, or those experiencing nighttime hot flashes.

5. Fezolinetant (Veozah):

Fezolinetant is a non-hormonal medication that targets a specific pathway in the brain to help regulate body temperature and reduce hot flashes. While effective, it can cause side effects like abdominal pain, liver problems, and worsen sleep issues.

6. Oxybutynin (Oxytrol):

Oxybutynin is used to treat an overactive bladder and urinary incontinence. It may also help with some menopausal symptoms. However, in older adults, it might be linked to cognitive decline.

7. Medications for Osteoporosis:

If you're at risk for or have osteoporosis (thinning of the bones), your doctor might prescribe medications to help slow bone loss and reduce the risk of fractures. Vitamin D supplements are often recommended alongside these medications to strengthen bones.

8. Ospemifene (Osphena):

Ospemifene is a medication taken orally that helps treat painful intercourse due to thinning vaginal tissue. However, this medication is not suitable for those with or at high risk of breast cancer.

Important Considerations:

Before starting any treatment, discuss your options with your doctor. Weigh the potential benefits against the risks of each treatment, as individual needs and preferences can vary. It's also important to review your choices annually, as your needs and treatment options may evolve over time.