What Is Menopause?

Menopause is a normal part of life, just like puberty. It is the time of your last menstrual period. You may notice changes in your body before and after menopause. The transition usually has three parts:perimenopause, menopause, and postmenopause.

Changes usually begin with perimenopause. This can begin several years before your last menstrual period. Changing levels of estrogen and progesterone, which are two female hormones made in your ovaries, might lead to symptoms. Menopause comes next, the end of your menstrual periods. After a full year without a period, you can say you have been “through menopause,” and perimenopause is over. Postmenopause follows perimenopause and lasts the rest of your life.

The average age of a woman having her last period, menopause, is 51. But, some women have their last period in their forties, and some have it later in their fifties.

Smoking can lead to early menopause. So can some types of operations. For example, surgery to remove your uterus (called a hysterectomy) will make your periods stop, and that’s menopause. But you might not have menopause symptoms like hot flashes right then because if your ovaries are untouched, they still make hormones. In time, when your ovaries start to make less estrogen, menopause symptoms could start. But, sometimes both ovaries are removed (called an oophorectomy), usually along with your uterus. In this case, menopause symptoms can start right away, no matter what age you are, because your body has lost its main supply of estrogen.

What Are the Signs of Menopause?

Women may have different signs or symptoms at menopause. That’s because estrogen is used by many parts of your body. As you have less estrogen, you could have various symptoms. Here are the most common changes you might notice at midlife. Some may be part of aging rather than directly related to menopause.

Change in your period. This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed less than usual or more. These are all normal changes, but to make sure there isn’t a problem, see your doctor if:

• Your periods come very close together
• You have heavy bleeding
• You have spotting
• Your periods last more than a week
• Your periods resume after no bleeding for more than a year

Hot flashes. Many women have hot flashes, which can last a few years after menopause. They may be related to changing estrogen levels. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Flashes can be very mild or strong enough to wake you from your sleep (called night sweats). Most hot flashes last between 30 seconds and 10 minutes.

Vaginal health and bladder control. Your vagina may get drier. This could make sexual intercourse uncomfortable. Or, you could have other health problems, such as vaginal or bladder infections. Some women also find it hard to hold their urine long enough to get to the bathroom. This loss of bladder control is called incontinence. You may have a sudden urge to urinate, or urine may leak during exercise, sneezing, or laughing.

Sleep. Around midlife, some women start having trouble getting a good night’s sleep. Maybe you can’t fall asleep easily, or you wake too early. Night sweats might wake you up. You might have trouble falling back to sleep if you wake up during the night.

Sex. You may find that your feelings about sex are changing. You could be less interested. Or, you could feel freer and sexier after menopause. After 1 full year without a period, you can no longer become pregnant. But remember, you could still be at risk for sexually transmitted diseases (STDs), such as gonorrhea or even HIV/AIDS. You increase your risk for an STD if you are having sex with more than one person or with someone who is having sex with others. If so, make sure your partner uses a condom each time you have sex.

Mood changes. You might find yourself more moody or irritable around the time of menopause. Scientists don’t know why this happens. It’s possible that stress, family changes such as growing children or aging parents, a history of depression, or feeling tired could be causing these mood changes.

Your body seems different. Your waist could get larger. You could lose muscle and gain fat. Your skin could get thinner. You might have memory problems, and your joints and muscles could feel stiff and achy. Are these a result of having less estrogen or just related to growing older? Experts don’t know the answer.

What About My Heart and Bones?

Two common health problems can start to happen at menopause, and you might not even notice.

Osteoporosis. Day in and day out, your body is busy breaking down old bone and replacing it with new healthy bone. Estrogen helps control bone loss, and losing estrogen around the time of menopause causes women to lose more bone than is replaced. In time, bones can become weak and break easily. This condition is calledosteoporosis. Talk to your doctor to see if you should have a bone density test to find out if you are at risk. Your doctor can also suggest ways to prevent or treat osteoporosis.

Heart disease. After menopause, women are more likely to have heart disease. Changes in estrogen levels may be part of the cause. But, so is getting older. As you age, you may gain weight and develop other problems, like high blood pressure. These could put you at greater risk for heart disease. Be sure to have your blood pressure and levels of triglycerides, fasting blood glucose, and cholesterol, including LDL and HDL, checked regularly. Talk to your healthcare provider to find out what you should do to protect your heart.

How Can I Stay Healthy After Menopause?

Staying healthy after menopause may mean making some changes in the way you live.

• Don’t smoke. If you do use any type of tobacco, stop—it’s never too late to benefit from quitting smoking.
• Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals.
• Make sure you get enough calcium and vitamin D—in your diet or with vitamin/mineral supplements if recommended by your doctor.
• Learn what your healthy weight is, and try to stay there.
• Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health.

Other things to remember:

• Take medicine if your doctor prescribes it for you, especially if it is for health problems you cannot see or feel—for example, high blood pressure, high cholesterol, or osteoporosis.
• Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort.
• Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed.

Menopause is not a disease that has to be treated. But you might need help if symptoms like hot flashes bother you. Here are some ideas that have helped some women:

• Try to keep track of when hot flashes happen—a diary can help. You might be able to use this information to find out what triggers your flashes and then avoid those triggers.
• When a hot flash starts, try to go somewhere cool.
• If night sweats wake you, sleep in a cool room or with a fan on.
• Dress in layers that you can take off if you get too warm.
• Use sheets and clothing that let your skin “breathe.”
• Have a cold drink (water or juice) when a flash is starting.

You could also talk to your doctor about whether there are any medicines to manage hot flashes. A few drugs that are approved for other uses (for example, certain antidepressants) seem to be helpful to some women.

What About Those Lost Hormones?

These days you hear a lot about whether or not you should use hormones to help relieve some menopause symptoms. It’s hard to know what to do, although there is some information to help you.

During perimenopause, some doctors suggest birth control pills to help with very heavy, frequent, or unpredictable menstrual periods. These pills might also help with symptoms like hot flashes, as well as prevent pregnancy.

If you are bothered by symptoms like hot flashes, night sweats, or vaginal dryness, your doctor might suggest taking estrogen (as well as progesterone, if you still have a uterus). This is known asmenopausal hormone therapy (MHT). Some people still call it hormone replacement therapy or HRT. Taking these hormones will probably help with menopause symptoms. It also can prevent the bone loss that can happen at menopause.

Menopausal hormone therapy has risks. That is why the U.S. Food and Drug Administration suggests that women who want to try MHT to manage their hot flashes or vaginal dryness use the lowest dose that works for the shortest time it’s needed.

Do Phytoestrogens Help?

Phytoestrogens are estrogen-like substances found in some cereals, vegetables, legumes (including soy), and herbs. They might work in the body like a weak form of estrogen. Researchers are trying to discover whether phytoestrogens relieve some symptoms of menopause and if they might also carry some risks. Be sure to tell your doctor if you decide to try eating a lot more foods that contain phytoestrogens or to try using an herbal supplement. Any food or over-the-counter product that you use for its drug-like effects could change how other prescribed drugs work or cause an overdose.

What treatments help?

Acupuncture

Studies showed no difference in low mood in women who received acupuncture compared with those who received sham acupuncture.

Cognitive behavioural therapy (CBT)

The good news is that the guidelines recommend that CBT should be considered as there is good evidence that it can alleviate low mood and anxiety which arise as a result of the menopause.

Herbal treatments

Guidelines recommend that you look for the THR logo standing for traditional herbal medicines. These products have been approved and you can be sure that the product has the correct dosage, is of high quality and has suitable product information. The guidelines also recommend that many available herbal medicines have unpredictable dose and purity and some herbal medicines have significant drug interactions.

Black Cohosh:

This North American traditional herb does have evidence that it helps vaso-motor symptoms when compared to placebo although not as good as HRT. Black Cohosh did not help with anxiety or low mood. There is a recommendation from the guideline however that black Cohosh can interact with other medicines and its results should be interpreted with caution and that there were unknown risks regarding the safety profile of these drugs.

Chinese herbal medicine:

There was no evidence that Chinese herbal medicine had any benefit in menopausal symptoms and again there were cautions about safety profiles and interactions. Other herbal treatments including Ginseng,had no evidence for benefit in reducing anxiety or low mood.

St John’s Wort:

Again the good news is that St John’s Wort was shown to have benefit in relieving vasomotor symptoms particularly in women with a history of, or at high risk of breast cancer, although there was no evidence that St John’s Wort had any impact on reducing anxiety or low mood. St John’s Wort however does interact with other drugs, in particular with Tamoxifen and so cannot be used in patients with breast cancer who are taking Tamoxifen. There are other significant drug interactions associated with St John’s Wort which again make it a drug the guideline committee have concerns about, including its reliability regarding dose effectiveness and safety profiles.

In the past alternative products have not been subject to the strict regulations, which apply to drugs.

Recently the regulatory authorities have developed a system, called the Traditional Herbal Medicine Scheme (THR). Products that have been approved by this system have a THR logo on their packs and this means that the product has the correct dosage, is of high quality and has suitable product information (drug interactions and side effects) included in the pack. Only select products that have the THR logo on their packs or seek advice from qualified healthcare professionals.

This and other changes have resulted in more confidence about products bought over the counter, however you must still be careful, as ‘natural’ doesn’t necessarily mean ‘safe’. Some products had been found to contain contaminants and some Chinese medicines had been found to contain small amounts of active drugs. Cases of kidney toxicity have been reported. Consequently, if you have any doubts, ask a qualified healthcare professional.