Menopause

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is menopause?

Menopause is when menstruation stops permanently. It is defined medically as the absence of menstrual periods for 12 consecutive months.

Menopause can occur naturally, due to age, or it can be induced. This can occur due to surgical removal of the ovaries (oophorectomy) or from damage to the ovaries caused by chemotherapy, radiation or other factors.

The average age of natural menopause is 51. During menopause, estrogen production, the menstrual cycle, and egg maturation stop.

Perimenopause, the years leading up to menopause, usually occurs between ages 45 and 55. During this time, estrogen production declines. The drop in estrogen most commonly occurs over a period of 1 to 5 years. Surgical removal of the ovaries causes a more sudden decline in circulating hormones.

Perimenopause differs from person to person. In some cases, menstruation occurs regularly until periods suddenly stop. Others may see changes in the amount of menstrual flow or the length of time between periods. Still others have missed periods or bleeding between periods.

The symptoms of perimenopause and menopause are different for every individual. The most common symptom is hot flashes, but several other symptoms can occur. Perimenopause can cause sleep problems due to sweating or insomnia. Lack of sleep can affect mood, physical health, and the ability to function at home or work.

Vaginal and urinary tract changes can also occur. The vaginal lining gets thinner and drier. The lining of the urinary tract also becomes thinner, and tissue supporting the bladder may weaken. These changes can cause stress incontinence—urine leaking with sneezing, lifting, or other exertion.

Menopause symptoms can occur frequently or only occasionally. Some people do not experience any symptoms of menopause, while others have sweats, hot flashes, and emotional distress. The symptoms may range in intensity from mild to severe. Treatment options to manage the symptoms of menopause include hormone therapy, medications, and self-care.

Seek prompt medical care if you are being treated for menopause symptoms but they recur or are persistent or severe, interfering with your life or productivity.

What are the symptoms of menopause?

Menopause causes a reduction in the production of the female hormones that can result in a number of symptoms. The symptoms can vary in intensity among individuals.

Common symptoms of menopause

You may experience menopause symptoms daily or only occasionally. Any of these menopause symptoms can be severe:

  • Difficulty sleeping

  • Flushing of the skin

  • Hot flashes. Up to 75% of women have hot flashes as they approach menopause. The flashes—a sudden flushed feeling that usually begins near the chest and spreads to the neck, face, and arms—usually last 3 to 4 minutes. 

  • Pounding or racing of the heart

  • Sleep sweats, which are hot flashes that occur during sleep

Other symptoms of menopause

Other symptoms that may occur with menopause include:

  • Aches and pains in the joints

  • Anxiety

  • Depression

  • Difficulty with memory

  • Dry vagina and outer genitalia

  • Headache

  • Inability to control urination (urinary incontinence)

  • Infections of the vagina

  • Insomnia or other sleep problems

  • Irregular heart rate

  • Irritability and mood change

  • Pain during sexual intercourse

  • Reduced interest in sex

  • Reduced sexual response

  • Weight gain

Symptoms that might indicate a serious condition

Menopause alone is not a serious condition. Seek prompt medical care if you are being treated for symptoms of menopause but these recur or cause you concern.

What causes menopause?

Menopause is caused by the decreased production of the female hormones estrogen and progesterone. As a result, the frequency of the menstrual cycle begins slowing down, eventually stopping completely. Surgical removal of the ovaries causes induced menopause and a more sudden decline in circulating hormones.

What are the diet and nutrition tips for menopause?

The decline in estrogen levels and increase in age with menopause naturally increases the risk of certain health conditions, including heart disease and osteoporosis. A healthy, nutritious diet is an important step in lowering this risk and managing the symptoms of menopause, such as insomnia and hot flashes.

Nutrition for menopause includes:

  • Calcium-rich foods, including dairy, soy products, and dark, leafy green vegetables like broccoli

  • Potassium-rich foods, including bananas, soy beans, and potatoes

  • Fiber-rich foods, including whole grains, oatmeal, and beans 

  • Fresh fruits and vegetables, which are full of antioxidants to prevent and reduce inflammation

     

  • Lean sources of protein, including chicken, fish, ancient grains, and beans

To lower the chance of developing osteoporosis, doctors recommended a daily intake of 1,000 milligrams (mg) or more of calcium before and during menopause. Post-menopause, the recommendation is 1,200 mg daily. If it is too difficult to get enough calcium from the food you eat, talk with your doctor about taking calcium supplements.

Vitamin D helps the body absorb calcium. The recommendation is 800 international units (IU) per day after menopause. You can take calcium and vitamin D separately or in a combination product.

Learn more about what to eat during menopause. Ask your healthcare provider for guidance before making significant changes to your diet.

How do doctors diagnose menopause?

Menopause is when periods stop for 12 months, so healthcare providers diagnose menopause based on your last menstrual period.

Asymptomatic vs. symptomatic menopause

Doctors may diagnose asymptomatic menopause, which is menopause without accompanying symptoms. Conversely, they may diagnose certain symptoms as being attributed to menopause when no other cause is identified. Menopausal symptoms may include:

  • Headache 

  • Hot flashes and flushing 

  • Insomnia 

  • Lack of concentration

  • Painful sex

  • Vaginal dryness

The average age of natural menopause is 51, but it is common for people to experience these symptoms in the years leading up to menopause. This time is known as perimenopause.

Hot flashes and sleep sweats are a tell-tale sign of perimenopause and menopause, but there are other possible causes of these symptoms, including thyroid disorders and endocrine problems. Sleeplessness, trouble concentrating, and headache can be symptoms of many different conditions.

Menopause tests

If you are younger than 45 and experiencing symptoms commonly associated with menopause or perimenopause, your doctor may order or perform tests. These include:

  • Blood tests to check your hormone levels, including estrogen, progesterone and thyroid hormone

  • Bone density test to get a baseline and determine your risk of osteoporosis 

  • Pelvic exam to check the health of the vagina and outer genitalia

Questions your doctor may ask

To aid in the diagnosis and rule out other possible causes, your doctor or licensed healthcare practitioner may ask you several questions related to your symptoms and medical history, including:

  • Are your periods irregular?

  • When was your last period?

  • Is there any possibility you could be pregnant?

  • How long have you been experiencing hot flashes (or other symptoms)?

  • How often do they occur?

  • When do your symptoms occur?

  • Are they interfering with your enjoyment of life?

  • Do you notice your symptoms worsening or improving under certain circumstances?

  • Do you have a family history of breast cancer?

  • Do you have a family history of cardiovascular disease?

Once your doctor determines you are menopausal, you can work together to discuss treatment options, including hormone replacement therapy.

How is menopause treated?

Treatment for menopause is not always necessary. Some people with menopause may not have any troubling symptoms, but if symptoms do occur, there are several treatment options for reducing or eliminating them.

Your healthcare provider will assess the best treatment options for you based on your age, the severity of your symptoms, and your individual risk of cardiovascular disease, blood clots, breast cancer, and stroke.

Hormone replacement therapy

Doctors may recommend hormone therapy for the short-term relief of symptoms. This typically involves estrogen or, more commonly, estrogen plus a progestin. Hormone replacement therapy (HRT) is available in pill form or as a skin patch, cream, or vaginal suppository.

HRT can relieve vaginal dryness, reduce or end hot flashes, and help bladder symptoms. However, oral HRT slightly increases the risk of blood clots and breast cancer. Other forms of HRT are associated with less risk, including vaginal creams and suppositories.

Vaginal creams that contain estrogen can help with vaginal dryness. If dryness if making sex painful, vaginal creams and a water-based lubricant can make sexual intercourse more comfortable. Estrogen-containing vaginal creams may also improve bladder control (urinary incontinence).

The decision to take HRT is personal, but one to make with your healthcare provider. Together, you can decide whether the benefits will outweigh the risks for you based on your medical history and other conditions you may have. For example, if you fall in a low-risk category for blood clots and breast cancer, and your menopause symptoms are interfering with your quality of life, HRT is likely to be beneficial and safe.

Your healthcare provider may use the following evidence-based guidelines for hormone replacement therapy:

  • Do not prescribe for longer than five years.

  • Do not prescribe for people who began menopause several years ago. This does not apply to estrogen creams, which can be used at any stage of menopause.

  • Prescribe as low a dose as possible for symptom relief or use estrogen cream.

  • Prescribe only for individuals who recently started menopause.

Learn more about talking with your doctor about HRT for menopause.

Other menopause treatment options

Antidepressants and anti-anxiety drugs can reduce menopause symptoms related to mood and hot flashes. Medications include:

  • Bupropion (Wellbutrin)

  • Catapres (Clonidine)

  • Fluoxetine (Prozac)

  • Paroxetine (Paxil)

  • Venlafaxine (Effexor)

Self-care and home remedies for menopause symptoms

Besides hormone replacement and medication, simple self-care and other strategies can help relieve menopausal symptoms. Tips include:

  • Dress in layers and wear loose clothing.

  • Drink plenty of water.

  • Do weight-bearing exercise for 30 to 60 minutes a day most days of the week, to strengthen bones.

  • Limit caffeine and alcohol, which can intensify hot flashes and cause insomnia.

  • Eat a balanced diet that includes fruits, vegetables and protein. 

  • Get 1,000 to 1,200 milligrams (mg) of calcium and 400 to 800 IU of vitamin D daily.

  • Maintain a healthy body mass index for you. Focus on reducing fat in the belly area, as this is linked to increased risk of heart disease and some types of cancer, including breast cancer.

Complementary treatments

Alternative treatments that may help minimize menopause-related symptoms include:

Nutritional dietary supplements

Some people find symptom relief with dietary and herbal supplements. However, doctors do not recommend certain non-hormonal products, such as soy and black cohosh, because they do not undergo the same rigorous safety and effectiveness studies as do FDA-approved drugs. If you have interest in using these products, talk with your doctor or other healthcare professional about the benefits and potential risks.

How does menopause affect quality of life?

Menopause is a welcome and positive stage of life for many people. Menstrual periods stop and, if you are sexually active, you no longer require birth control methods. However, the body changes that occur before, during and after menopause can present challenges.

Menopause symptoms may be severe. Hot flashes and sleep sweats can occur as often as once per hour or as infrequently as a few times a month. Hot flashes can happen any time of the day or night and may continue to occur for as long as five years (or more) after menopause, as your body adjusts to the lower production of estrogen and progesterone.

Mood disorders are more likely with menopause, which can affect quality of sleep and mental health. The loss in estrogen levels can also increase the risk of certain health conditions, such as osteoporosis. Your treatment plan may include medications and supplements to minimize these risks.

For some people, the effect of hormone levels on sexual health is one of the most significant aspects of menopause, both physically and emotionally. Loss of sex drive can cause stress in relationships and make intimacy more difficult. Talk honestly with your doctor about your symptoms so you can discuss treatment plans that address sexual health.

Self-care tips for menopause

The following strategies may improve some symptoms of menopause:

  • Avoid spicy foods and other triggers of hot flashes.

  • Get physically active most days of the week.

  • Consume soy products, which have properties that may reduce hot flashes.

  • Take the recommended amount of vitamin D and calcium for people in menopause.

  • Meditate or take deep breaths when you feel a hot flash coming.

  • Practice daily Kegel exercises to strengthen vaginal muscles, which helps with orgasm and stress incontinence.

  • Use vaginal lubricants during sexual intercourse.

What are the potential complications of menopause?

Complications of menopause include:

  • High cholesterol (hypercholesterolemia)

  • Increased risk of heart disease

  • Low bone density (osteoporosis, which is thinning and weakening of the bones)

The risks of heart disease and stroke can increase after menopause due to the reduction in estrogen. Natural estrogen levels help protect the heart and blood vessels by decreasing the LDL ("bad") cholesterol and increasing the HDL ("good") cholesterol in the blood.

Hormone replacement therapy (HRT) can help relieve menopausal symptoms, but studies have not shown it to prevent heart disease. HRT also raises the risk of breast cancer slightly.

The reduction in estrogen also can trigger more rapid bone loss. When the loss becomes excessive, leading to low bone density (osteoporosis), the chance of fractures increases.

You can help minimize health risks associated with menopause by eating whole, nutritious food; exercising regularly; maintaining a healthy weight; and not smoking. If you have risk factors for heart disease and stroke, such as high blood pressure or diabetes, follow your treatment plan to minimize their impact on your health and wellness.

You can help prevent osteoporosis by taking calcium supplements and exercising regularly with weights or resistance bands. If your bone density is low or you have a family history of osteoporosis, your doctor may talk with you about medications that can help slow bone loss to reduce your risk of fractures.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Nov 7
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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