Overview
Menopause is the time when a woman's menstrual periods stop and her ovaries stop releasing eggs. A woman is considered menopausal once she has gone a year without having a menstrual period. Therefore, the exact time of a woman's final menstrual period can only be pinpointed by counting backwards after the fact.
Although most women go through menopause around age 50, normal menopause can happen any time between the age of 40 and 50. The last periods are usually more irregular and have less blood flow. However, some women's periods don't change at all.
Along with normal or natural menopause, there is also premature menopause. Premature menopause occurs before the age of 35 and can be caused by a variety of things, such as removal of the ovaries, autoimmune disorders, endocrinological reasons, or cancer therapy. Medical interventions, such as a hysterectomy (when the uterus is removed), may also prevent menstruation. If the ovaries are removed as well, production of the hormones estrogen and progesterone are stopped, causing the symptoms of menopause.
Causes
Menopause is a normal part of the aging process. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) are secreted by the pituitary gland as part of the normal menstrual cycle. They stimulate the ovary to produce estrogen and progesterone and to release an egg. As a woman ages, her ovaries don't respond to FSH or LH as strongly as they used to. Over time, less and less estrogen and progesterone are produced and the woman stops releasing eggs.
Premature menopause can be genetic or it can be caused by autoimmune diseases. These diseases produce antibodies that can damage the ovaries. Surgical removal of the ovaries causes artificial menopause, as does chemotherapy or radiation therapy to the pelvis to treat cancer.
Symptoms
Before her periods stop completely, a woman might experience a variety of unpleasant symptoms, including hot flashes, irritability, night sweats, loss of bladder control, urinary infection, vaginal dryness, and pain during intercourse. About 75% of women have hot flashes. During a hot flash, the woman's head and neck will become red and warm, and she may perspire a lot. A hot flash lasts from 30 seconds to 5 minutes and may be followed by a chill. Hot flashes usually go away after a year.
Low estrogen levels may cause a woman to feel irritable, tired, and nervous. She might also have trouble sleeping, have headaches, feel dizzy, or have a rapid or irregular heartbeat. Lack of estrogen makes the skin of the vagina thinner, causing vaginal itching or burning or pain during intercourse. Menopause can also cause poor bladder control and, occasionally, aching muscles and joints.
Post-menopausal women are more likely to have osteoporosis, which is a thinning of the bones. Women with osteoporosis break their wrists, hips, and backbones easily. Older women may not even have to fall in order to break a bone. A woman loses 3% to 5% of her bone mass every year during the first five years after menopause. After five years, she loses from 1% to 2% of bone mass yearly. Smoking, heavy drinking, lack of exercise, and not getting enough calcium in the diet can increase a woman's risk of bone loss.
Treatment
Hormone therapy (HT) uses the hormones estrogen or progestin, alone or together, to manage the symptoms of menopause.
Estrogen can be taken as a pill, applied as a skin patch, inserted as a vaginal ring, or applied as a vaginal cream. All forms help relieve the symptoms of menopause. One of the effects of estrogen is to help prevent the vaginal walls from thinning and becoming dry and susceptible to infection or to pain during intercourse. Since estrogen has side effects and long-term risks, it's important for a woman and her doctor to weigh the benefits and the risks of taking estrogen.
In a natural menstrual cycle, a woman's body produces progesterone just before her menstrual period. Women who are past menopause and take estrogen increase their risk of developing endometrial cancer, which is a cancer of the lining of the uterus, from 1 in 1,000 to 4 in 1,000. If progesterone is taken along with the estrogen, the risk of developing endometrial cancer is almost eliminated. If a woman notices abnormal bleeding from the vagina, she should tell her doctor. The doctor may take a biopsy, which is a sample of tissue, from the wall of the uterus to check the endometrial lining.
The terms "natural" and "synthetic" are often used to describe the different types of estrogens and progestins. These terms can be misleading because they can be used to mean different things. Sometimes the term "natural" is used to describe the chemical structure of the hormone (exactly the same as the hormones normally produced by the human body), but other times it's used to describe where the hormone comes from (e.g., from plants or animals). What's most important is not whether the hormone is natural or synthetic, but whether you're receiving the medication, dose, and dosage form that are most appropriate for you.
Hormone therapy can be taken daily or in cycles. With cyclic therapy, hormones are taken on certain days of the month and women will have bleeding, similar to a light period, every month. With continuous or daily therapy, hormones are taken every day. There is no monthly bleeding, but women may have spotting (small amounts of irregular bleeding) during the first three to six months of continuous therapy. Talk to your doctor about which method would be best for you.
Women who have taken estrogen for more than five years may have a greater risk of developing breast cancer. An individual risk-benefit assessment and regular monitoring are required. In general, estrogen should not be taken if a woman has, or has ever had, breast cancer, advanced endometrial cancer, or abnormal vaginal bleeding.
For women who cannot take hormones, or those who prefer alternatives, there are other treatment options for menopause symptoms, including clonidine, certain antidepressants, and herbal remedies, such as Black Cohosh. If you're thinking of starting an herbal remedy, speak to your doctor or pharmacist first.
To prevent the bone loss that comes with menopause, women should reduce their alcohol consumption and cigarette use, and make sure to include calcium-rich foods, such as cheese, milk, and other dairy products, in their diets. Exercise and resistance training, also called weight training or strength training, helps prevent osteoporosis and control weight.
Other tips:
A doctor will make a diagnosis based on a woman's symptoms, past medical history, a physical exam, and laboratory tests of hormone levels.
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