What is it?
Menopause (MEN-oh-pawz) is a normal stage in a woman's life when her monthly period stops. It is also called the "change of life." A woman who has no periods for an entire year after the age of 45 is considered to be in menopause. After menopause, a woman is no longer fertile (able to become pregnant naturally). Going through menopause may take one to two years. Perimenopause (PER-i-men-oh-pawz) is the period of time leading up to menopause. Perimenopause can last from two to eight years. You can have many menopause-like symptoms during perimenopause. These symptoms, such as hot flashes, can be very bothersome for some women.
Causes Menopause starts when your ovaries (OH-var-ees) slowly stop making the female hormones estrogen (ES-troh-jen) and progesterone (proh-JES-te-rohn). Hormones are special chemicals that your body makes. Hormones act as messengers to help control how your body works. The hormones estrogen and progesterone help control your monthly periods. Menopause usually starts between the ages of 40 to 55. The average age that menopause starts is 51 years old. The age that menopause starts can be affected by:
- Cigarette smoking. Women who smoke may begin menopause about one year earlier than other women.
- Family history. Women often go through menopause at about the same age as their mothers did.
- Medical treatments. Some medical treatments, such as certain treatments for cancer, can cause menopause to start early.
- Surgery. Menopause may happen suddenly in women of any age if their ovaries are removed during surgery. This is called surgical menopause. A hysterectomy (his-te-REK-toh-mee) is a surgery where the uterus (womb) is removed. Sometimes one or both ovaries are also removed during a hysterectomy. If both ovaries are removed, menopause will start right away. Having a hysterectomy when just the uterus is removed will not usually cause menopause. This is because the ovaries are still inside the body and able to make hormones. However, monthly periods do stop after the uterus is removed during a hysterectomy. You can no longer get pregnant after having a hysterectomy.
Signs and Symptoms : The signs and symptoms of menopause can be different from woman to woman. The loss of female hormones may also cause other changes in your body. These changes and symptoms may include one or more of the following:
- Menstrual period changes. One of the first signs of menopause is a change in your monthly period. You may skip periods or your periods may come closer together. Your flow may be lighter or heavier than normal. Your periods may slowly decrease and then stop. This may happen quickly, but it usually happens over a year or two.
- Hot flashes. Hot flashes are brief periods of feeling very warm, flushed, and sweaty. Hot flashes can last from a few seconds to several minutes. They may happen many times during the day, and are common at night. Wear cotton clothing if night sweats are a problem. Layer your clothing so that you can easily remove some clothing and cool yourself during a hot flash.
- Mood changes. Mood changes are common during menopause. You may feel nervous, irritable (easily angered), or depressed (sad for a long time). You may also notice a decrease in your desire to have sex. Talk to your caregiver about any changes in your mood or sex drive that bother you. Talking to your partner or a close friend may also help.
- Breast changes. Your breasts may change shape or not be as full. You may have breast tenderness, especially during the early stages of menopause.
- Bone changes. After menopause starts, your bones lose calcium (a mineral needed for strong bones). This causes your bones to become thinner. Thin bones increase your chance of breaking a bone (bone fracture). This risk of bone fractures may increase as you age. Bone thinning may lead to osteoporosis (os-tee-oh-poh-ROH-sis) which is also called "brittle bone disease." You have a greater chance of getting osteoporosis if you smoke, drink too much alcohol, or have poor eating habits. Not exercising or using certain medicines (such as steroids or thyroid medicine) may also increase this risk.
- Hair changes. Your hair may become thinner or feel different. This may happen on your head and elsewhere on your body. You may get more hair on your face.
- Vaginal changes. The lining of your vagina (vah-JI-nah) may get thinner and less elastic (stretchy) because of hormone changes. You may also have vaginal dryness. This may cause you to have pain or discomfort during sexual intercourse (sex). Over-the-counter vaginal creams and lotions can help decrease vaginal dryness and make sex more comfortable. Only use creams and lotions that are made for vaginal use. Do not use petroleum jelly. Talk to your caregiver if over-the-counter products do not help. You may need an estrogen cream to put in and around your vagina. Estrogen cream may help decrease vaginal dryness and lower your risk of vaginal infections (in-FEK-shuns).
- Urinary changes. After menopause, you may be more likely to have urinary problems, such as urinary tract infections (UTIs). You may feel the urge to go to the bathroom more often. You may also feel pressure and a feeling that you need to urinate right away (urgency). You may start to wake up at night needing to urinate. You may sometimes leak urine.
- Other symptoms. You may feel like your heart is pounding at times (heart palpitations). Headaches, trouble sleeping, and tiredness are other symptoms you may have while going through menopause.
Wellness Recommendations :
- Regular weight-bearing physical exercise at least 30 minutes three or more times weekly can improve mood, decrease hot flashes, heart disease, diabetes, and help to prevent osteoporosis.
- Quit smoking. Aside from the risks of smoking with heart and lung disease and cancer, smoking has an anti-estrogenic effect in the body, which can worsen menopausal symptoms and osteoporosis.
- Try to keep to your ideal body weight.
- Find time to relax and enjoy life.
- Eat foods that low in fat and high in fiber, such as, fruits, whole grains, and vegetables.
Medical Care : There are other helpful treatments to treat your menopausal symptoms and to decrease the risk of other diseases.
- Talk to your caregiver about hormone replacement therapy medicine.
- Bone building medicine.
- Cholesterol-lowering medicine (if you have too much fat in your blood).
- High blood pressure medicine (if you have high blood pressure).
- High blood sugar medicine (if you have high blood sugar).
HOW TO TREAT YOUR SYMPTOMS :
Decrease your salt and sugar intake and avoid caffeine. Eating more soy products (tofu, tempeh, soy cheese, soy milk, and soy burgers) will also help. Eat foods that are high in calcium, such as milk and dairy products, nuts, seafood, and green leafy vegetables. Your doctor may suggest that you take a daily calcium pill. Avoid foods and drinks that may trigger hot flashes, like alcohol, coffee, tea, or spicy foods.
Herbs and Supplements:
Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.
- Black cohosh (Cimicifuga racemosa) may decrease menopausal symptoms. Black cohosh is a good source of natural estrogen.
- Ginseng (Panax ginseng) may improve menopausal symptoms, such as fatigue, insomnia, and depression.
- Calcium helps stop bone loss (osteoporosis). Take it with vitamin D.
- Dehydroepiandrosterone (DHEA) is a hormone that may help your body build bone. Even though DHEA is available over-the-counter, it should only be used with your doctor's knowledge and care. Your blood levels need to be watched. Taking hormones can be unsafe if your doctor is not aware you are taking them.
- Ipriflavone may help your body build bone. It should be taken with vitamin D.
- Lysine may help your body build bone. It should be taken with calcium.
- Magnesium may help your body build bone.
- Vitamin D prevents osteoporosis. Take vitamin D with calcium.
- Vitamin K, when used with hormone replacement therapy, may help your body build bone.
Ayurvedic medicine (a system of healing from India), herbalism, homeopathy, and TCM (Traditional Chinese Medicine which includes acupuncture and herbs) have all been used to treat menopause symptoms.
Recommended Screening Tests/Exams : Menopausal women should have regular check ups that include blood pressure screening, a Pap smear (test for cervical cancer), and mammogram (test for breast cancer). Blood may also be taken from an arm to check blood sugar and cholesterol. A bone densitometry (test for osteoporosis) and sigmoidoscopy (test for colon cancer) may also be done.
Other ways of treating your symptom s: Other ways to treat your symptoms are available to you.
Talk to your caregiver if:
- You would like medicine to treat menopause.
- Your symptoms have not gone away or improved by these self-help measures.
- You have spotting of blood between your monthly period.
- You have burning when you urinate.
- You have vaginal bleeding that lasts longer than what is normal for you.
- You have questions about what you have read in this document.
S EEK CARE IMMEDIATELY IF:
- You have a monthly period 6 months or more after your last period.
- You have heavy vaginal bleeding.
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.
1. Achat H, Kawachi I, Levine S et al: Social networks, stress and health-related quality of life. Qual Life Res 1998; 7(8):735-750.
2. Aisaka K, Uesato T, Miwa et al: Evaluation of vitamin K2 (menatetrenone) administration with hormone replacement therapy on prevention of osteoporosis in climacteric women. Ninth International Menopause Society World Congress on the Menopause, October 1999; 79-83.
3. American Thoracic Society: Cigarette smoking and health. Am J Respir Crit Care Med 1996; 153(2):861-865.
4. Braam AW, Beekman AT, van Tilburg TG et al: Religious involvement and depression in older Dutch citizens. Soc Psychiatr Epidemiol 1997; 32(5):284-291.
5. Bunker VW: The role of nutrition in osteoporosis. Br J Biomed Sci 1994; 51(3):228-240.
6. Burghardt M: Exercise at menopause: a critical difference. Medscape Womens Health 1999; 4(1):1.
7. Civitelli R, Villareal DT, Agnusdei D et al: Dietary l-lysine and calcium metabolism in humans. Nutrition 1992; 8(6):400-405.
8. Gennari C, Agnusdei D, Crepaldi G et al: Effect of ipriflavone-a synthetic derivative of natural isoflavones-on bone mass loss in the early years after menopause. J North Am Menopause Soc 1998; 5(1):9-15.
9. Harris TB, Savage PJ, Tell GS et al: Carrying the burden of cardiovascular risk in old age: associations of weight and weight change with prevalent cardiovascular disease, risk factors, and health status in the Cardiovascular Health Study. Am J Clin Nutr 1997; 66(4):837-844.
10. Jacobson JS, Troxel AB, Evans J et al: Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 2001; 19(10):2739-2745.
11. Kelley GA: Aerobic exercise and bone density at the hip in postmenopausal women: a meta-analysis. Prev Med 1998; 27(6):798-807.
12. Kouzis AC & Eaton WW: Absence of social networks, social support and health services utilization. Psychol Med 1998; 28(6):1301-1310.
13. Labrie F, Diamond P, Cusan L et al: Effect of 12-month DHEA replacement therapy on bone, vagina, and endometrium in post menopausal women. J Clin Endo Metab 1997; 82(10):3498-3505.
14. McBride JL, Arthur G, Brooks R et al: The relationship between a patient's spirituality and health experiences. Fam Med 1998; 30(2):122-126.
15. McKee DD & Chappel JN: Spirituality and medical practice. J Fam Pract 1992; 35(2):201, 205-208.
16. Ohta H, Komukai S, Makita K et al: Effects of 1-year ipriflavone treatment on lumbar bone mineral density and bone metabolic markers in postmenopausal women with low bone mass. Hormone Res 1999; 51(4):178-183.
17. Robinson-Whelen S, Kim C, MacCallum RC et al: Distinguishing optimism from pessimism in older adults: is it more important to be optimistic or not to be pessimistic? J Pers Soc Psychol 1997; 73(6):1345-1353.
18. Scioli A, Chamberlin CM, Samor CM et al: A prospective study of hope, optimism, and health. Psychol Rep 1997; 81(3 Pt 1):723-733.
19.Slaven L & Lee C: Mood and symptom reporting among middle-aged women: the relationship between menopausal status, hormone replacement therapy, and exercise participation. Health Psychol 1997; 16(3):203-208.
20. Spangler JG: Smoking and hormone-related disorders. Prim Care 1999; 26(3):499-511.
21. Stahelin HB: The impact of antioxidants on chronic disease in ageing and in old age. Int J Vitam Nutr Res 1999; 69(3):146-149.
22. Stahl W & Sies H: Antioxidant defense: vitamins E and C and carotenoids. Diabetes 1997; 46 Suppl 20:S14-18.
23. Stendig-Lindberg G, Tepper R & Leichter I: Trabecular bone density in a two year controlled trial of peroral magnesium in osteoporosis. Mag Res 1993; 6(2):155-163.
24. Tode T, Kikuchi Y, Hirata J et al: Effect of Korean red ginseng on psychological functions in patients with severe climacteric syndromes. Int J Gynecol Obstet 1999; 67:169-174.
25. Ullom-Minnich P: Prevention of osteoporosis and fractures. Am Fam Physician 1999; 60(1):194-202.
26. Ushiroyama T, Okamura S, Ikeda A et al: Efficacy of ipriflavone and 1- alpha vitamin D therapy for the cessation of vertebral bone loss. Int J Gynecol & Obst 1995; 48(3):283-288.
27. van de Weijer P & Barentsen R: Isoflavones from red clover (Promensil(R) significantly reduce menopausal hot flush symptoms compared with placebo. Maturitas 2002; 42(3):187-193.
28. Volpe SL, Taper LJ & Meacham S: The relationship between boron and magnesium status and bone mineral density in the human: a review. Magnes Res 1993; 6(3):291-296.
29. Washburn S, Burke GL, Morgan T et al: Effect of soy protein supplementation on serum lipoproteins, blood pressure, and menopausal symptoms in perimenopausal women. Menopause 1999; 6(1):7-13.
30. Willett WC: Long-term intake of dietary fiber and decreased risk of coronary heart disease among women. JAMA 1999; 281(21):1998-2004.
31. Yasuda N, Zimmerman SI, Hawkes W et al: Relation of social network characteristics to 5-year mortality among young-old versus old-old white women in an urban community. Am J Epidemiol 1997; 145(6):516-523.
Last Updated: 11/4/2014