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Menopause, sometimes referred to as “the change of life” is the time in a woman’s life when she stops menstruation. Since menopause is a natural occurrence in the female body, all women experience menopause at some point in their lives, typically between the ages of 45 and 55 (median age 51). Menopause is considered to have arrived when a woman has not had a menstrual period for 12 consecutive months (without any other identifiable physiological or biological cause) and is brought on by a decrease in the ovarian production of estrogen and progesterone.
According to the American Congress of Obstetricians and Gynecologists (ACOG), while life expectancy has increased over the years, the age of menopause has not changed during the past few centuries. ACOG reports that no link has been found between the age of natural menopause and use of oral contraceptives, socio-economic or marital status, race, or age at menarche. Cigarette smoking (even former cigarette smoking) can cause a woman to reach menopause two years prior to women who never smoked.
Perimenopause, meaning “around menopause,” is the period of time that leads up to the last menstruation and menopause. Perimenopause typically starts when women are in their 40s but may happen as early as the 30s. During this time, women may experience menstrual irregularities, menstruation without ovulation (release of the egg), and symptoms similar to those of menopause (hot flashes, vaginal dryness, etc.)
A report about menopause released by ACOG in 2011, the most recent year for which data are available, stated that an estimated 6,000 US women reach menopause every day. Due to America’s aging population, the number of women who will be older than 55 is estimated to be 46 million by the year 2020.
ACOG also noted that with increasing life expectancy, many women will spend up to 40% of their lives in the postmenopausal stage. Half of all women who reach age 50 will live to be at least age 80.
Menopause is a natural stage of the female body brought on by the ovaries’ decreased production of estrogen and progesterone. As estrogen and progesterone levels decrease, the woman no longer ovulates (her ovaries stop making and releasing eggs) and menstruation ceases.
Menopause is a natural phenomenon, but as your hormones fluctuate you can be at risk of developing other conditions. Therefore it is vital to work closely with your gynecologist so he or she can help you navigate safely through “the change.”
The following conditions may arise as complications of menopause:
Menopause is often self-diagnosed as it is a natural occurrence of the female body and women who are approaching the menopausal age are expecting the change to occur and are familiar with the symptoms.
Gynecologists or general practitioners can also help to determine whether your symptoms are a result of menopause or another condition. Factors he or she may take into account include:
Some women may experience only a few symptoms of menopause while others experience many.
Symptoms of menopause may include:
Menopause is a natural, unavoidable process. Perimenopause, the time leading up to menopause, may last anywhere from a few months to 10 years, with 4 years being the average duration. Women typically experience menopausal symptoms for 4 or 5 years, though many symptoms may stop sooner or last into the postmenopausal phase. Symptoms such as hot flashes and mood changes are most severe from ages 53 to 65.
Because the symptoms can last for several years, it is best to do everything you can to make the time as comfortable as possible. This can be done through medications, alternative treatments, and lifestyle changes.
Though menopause symptoms may be disruptive and last several years, there are lifestyle changes you can make that add immeasurably to your quality of life during “the change”:
Since menopause is not an illness but a natural, unavoidable, event, there is no screening done for menopause.
Approximately 55% of women going through menopause don’t do anything at all to treat symptoms. In a woman’s reproductive years, the ovaries produce estrogen and progesterone during the ovulatory cycle to prepare the uterus for a possible pregnancy. During menopause, the ovarian production of both of these hormones essentially ceases. Estrogen helps maintain good bone density, regulates body temperature, and helps maintain vaginal lubrication and elasticity. When estrogen and progesterone levels drop, many women experience symptoms that can be bothersome, like hot flashes, night sweats, palpitations, sexual problems, forgetfulness, and more. Many women benefit from increasing their hormone levels with a form of treatment called hormone replacement therapy (HRT) that helps reduce and manage menopausal symptoms.
Hormone replacement therapy can use either estrogen, progestin (a form of progesterone designed to protect against endometrial cancer), or a combination of the two, and can come in a variety of delivery modes. ACOG and the U.S. Preventative Services Task Force both advise against long-term hormone therapy to prevent diseases. Hormone treatment may help prevent osteoporosis, but long-term hormone treatment increases your risk of blood clots, heart attacks, stroke, and other problems. One study published in the April 4th 2007 issue of JAMA found that women who begin hormone therapy early, within 10 years of menopause, seem to have less of a risk of heart disease than women who wait until they are older to start taking the medication. A second study published in JAMA in 2008, researchers found that the risks of hormone therapy outweigh the benefits. If you do elect to take hormone therapy, ACOG recommends using the lowest dose that works for only as long as you need it.
Estrogen-only medications are prescribed to raise estrogen levels in post-menopausal women without uteruses and women who have undergone a bilateral oophorectomy (both ovaries removed). Women with uteruses should not take estrogen-only medications due to the risk of estrogen overgrowth, which could lead to the development of certain cancers including endometrial cancer. Estrogen-only medication can treat many symptoms of menopause, but it has been proven to be most effective in reducing hot flashes and night sweats. Local estrogen vaginal creams are most effective in treating vaginal dryness and discomfort. Patients taking estrogen observe a 65-90% decrease in the severity of hot flashes due to treatment. One recent study suggests that early, short-term estrogen treatment without progestin can protect you from heart disease later in life—but this is still new, and needs more research. Women with uteruses are recommended to take an estrogen-progesterone combination medication, which puts them at a lower risk for endometrial cancer.
According to the FDA, common side effects of estrogen-only therapy include:
Rarer, more serious side effects include:
Progestin-only medications. Progestogen-only medications initially underwent clinical studies for menopause treatment as a possibly lower risk alternative to estrogen-only medications. However, studies have not found progestogen-only treatment to be effective for treating menopause symptoms. Progestogen-only treatments can be combined with estrogen-only treatments to lower the risk of endometrial cancer.
Common side effects for progestin-only medications include:
Estrogen-Progestin medications combine both estrogen and progesterone in a single dose. These lower the risk of endometrial cancer but may increase the risk of breast cancer.
According to the FDA, the most common side effects of estrogen-progestin medicines include:
Talk to your doctor about which type of hormone replacement therapy is right for you.
Do not take HRT if you:
There are ways to treat the symptoms of menopause without hormone replacement therapy. These include:
Herbal Medicines. Research has shown that several herbal medicines may be useful in treating many menopausal symptoms. Before taking natural or herbal products, discuss with your doctor, who will be able to notify you of any health risks and potential interactions with medications. Because natural products used for menopausal symptoms can have side effects and can interact with other botanicals or supplements or with medications, research in this area is addressing safety as well as efficacy. Some findings from this research are highlighted below.
Dietary supplements. Certain dietary supplements can help to restore deficiencies that may occur as a result of decreased estrogen and progesterone production. These include:
Bioidentical Hormone Replacement Therapy or BHRT, is a marketing term that is not recognized by the FDA. It is a term used to describe medications that are prepared in specialized pharmacies. BHRT may contain any variation of hormones including estrone, estradiol, estriol, progesterone, and testosterone. Compounded bioidentical hormones are often marketed as natural and safe alternatives to conventional hormone therapy prescription medications. However, compounded formulas are often inconsistent and can vary depending on the batch or the pharmacist. While FDA-approved hormone preparations have been tested for efficacy, purity, safety, and potency, there is a lack of scientific evidence surrounding BHRT and the safety and efficacy of these compounds. As a result, compounded bioidentical hormones are not approved by the FDA. For additional information, see the FDA publication Bio-Identicals: Sorting Myths from Facts
Acupuncture. Studies have shown that acupuncture, which aims to restore the bodily flow of energy through the insertion of needles into acupuncture points around the body, can help to reduce the severity of hot flashes and night sweats. Research on the efficacy of acupuncture as a menopause treatment is limited, and patients should talk to their general practitioners before beginning treatment.
Apart from hormone therapy and alternative treatments, there are many lifestyle changes you can make to help alleviate your menopause symptoms:
The North American Menopause Society, a leading source of information about menopause for 25 years, has developed a competency examination to set essential standards for health providers in order to assure high-quality care for women at menopause and beyond. All licensed healthcare providers are eligible to sit for this examination. Those who pass have demonstrated their expertise in the field and are awarded the credential of NCMP or NAMS Certified Menopause Practitioner. To find an NCMP in your area, click here. When you arrive at the site, type in your zip code and click “Search Now”.
Here are some questions to ask:
September is Menopause Awareness Month (MAM). According to the website, MAM’s goal is to educate people about menopause and “shine light on innovations in menopausal science and technology”.
For more information about menopause, visit:
The North American Menopause Society, a leading source of information and support for 25 years.
Red Hot Mamas, the nation’s largest menopause education program providing mid-life women’s health information and support, was founded in 1991. Red Hot Mamas programs have been offered in over 200 hospitals and physician practices in the US and Canada.
The National Institute on Aging, the National Institutes of Health, has reliable information on all aspects of menopause
The American Congress of Obstetricians and Gynecologists has a section devoted to information about menopause.
The Menopause Makeover has suggestions for meals, a 8-step plan for well-being during menopause, and a list of health calculators.
Menopause Mondays is a weekly e-newsletter with breaking news and advice.
For more information about post-menopausal hormone therapy, visit this page on the National Institutes for Health site.
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