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Menopause

Definition

Menopause is the time when the menstrual period ceases and the ovaries permanently stop releasing eggs. Menopause is considered complete when a woman has been without her period for a full year. Although menopause can occur anytime between ages 40 to 58, the average age is 51 years old.

Causes

Natural menopause is a gradual process. The ovaries begin producing lower amounts of estrogen and other steroid hormones prior to menopause during a phase called perimenopause.

When menopause occurs before the age of 40 it is called premature menopause. Premature menopause can occur naturally but may also be the result of several conditions, including:

  • Family history of premature menopause
  • Autoimmune diseases
  • X-chromosome abnormalities
  • Medical treatments (pelvic surgery, surgical removal of ovaries, chemotherapy , or pelvic radiation therapy)
  • Medications that lower estrogen levels
  • Smoking

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. As menopause is a natural process associated with aging, there are no risk factors. Risk factors for premature menopause include:

  • Family history of premature menopause

Symptoms

As menopause approaches, women often experience a number of physical and emotional symptoms including:

  • Irregular menstrual periods
  • Hot flashes and night sweats
  • Disturbed sleep patterns, insomnia
  • Anxiety
  • Significant mood changes
  • Depression
  • Dry skin
  • Irritability
  • Vaginal dryness and pain with sexual intercourse
  • Difficulty concentrating
  • Trouble remembering things
  • Diminished interest in sex
  • Frequent urination or leaking of urine
  • Headaches
  • Achy joints
  • Fatigue
  • Early morning awakening

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor may perform blood tests, a pelvic exam, and a Pap smear. Natural menopause is usually diagnosed when a woman has not had a menstrual period for 12 consecutive months.

Some women have had a hysterectomy before menopause, and they no longer have periods. For these women, if menopause is suspected but needs confirmation, the test considered most accurate for the diagnosis of menopause is the measurement of follicle stimulating hormone (FSH). High levels of FSH (greater than 40) may indicate menopause.

Treatment

Menopause is a natural part of life and does not necessarily require treatment. Symptoms and health risks associated with low estrogen can be treated. These include hot flashes, vaginal dryness, and osteoporosis (loss of bone mass).

Osteoporosis in Hip

Osteoporosis

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Hormone Replacement Therapy (HRT)

A number of different types of hormones are available. They include natural, synthetic, and plant-derived estrogens and progesterone; combinations of estrogen and progesterone; or the addition of small amounts of male hormones. Hormone preparations are available as tablets, gels, skin patches, vaginal rings, vaginal tablets, injections, and pellets inserted into the skin. There is now significant scientific evidence that the global health risks associated with combined estrogen and progestogen HRT on a long-term basis (>3-5 years) outweigh the benefits for many women. The average age of the women in these research studies is over 60 years old. Use of combined HRT at the time of menopause (around age 50) is believed to pose less risk. Furthermore, most of these studies used conjugated estrogens and medroxyprogesterone. Other evidence suggests that use of estradiol and natural progesterone may pose less risk.

Phytoestrogens

A high intake of phytoestrogens (or plant estrogens) may help menopausal women. They may reduce the risk for diseases associated with estrogen. Phytoestrogens are found in soybeans, black cohosh, whole grains, legumes, tempeh, and flax seed. They are also found in concentration in capsule form.

Healthful Diet

A healthful diet during menopause can improve a woman's sense of well-being. It may also reduce the risk of heart disease, osteoporosis, and certain cancers. The diet should be low in fat and high in fruits, vegetables, whole grains, calcium, and vitamin D.

Limit Caffeine and Alcohol

Cutting back on caffeine and alcohol may reduce symptoms of anxiety, insomnia, and loss of calcium.

Quit Smoking

Giving up smoking can reduce the risk of early menopause, heart disease, and osteoporosis.

Regular Exercise

Regular exercise may reduce hot flashes. Weight-bearing exercises such as walking, climbing stairs, and resistance exercises such as lifting weights help strengthen bones and decrease the risk of osteoporosis.

Stress Management

Stress management may help ease tension, anxiety, and possibly other menopausal symptoms. Deep breathing, massage, warm baths, and quiet music are examples of relaxation techniques.

Over-the-Counter Products

Moisturizers and lubricants are used to help vaginal dryness.

Nonhormonal Medications

Certain blood pressure medicines taken in lower doses than are used to treat high blood pressure have been somewhat helpful in relieving some menopausal symptoms such as hot flashes. These medicines include clonidine (Catapres) and methyldopa (Aldomet).

SSRI medications (serotonin reuptake inhibitors like Prozac , Paxil , and Effexor ) have been shown to have modest impact on hot flash severity scores. These medications should not be used if you are taking tamoxifen to reduce your risk of breast cancer recurrence.

Prevention

Menopause is a natural biologic event that does not need to be prevented. Quitting smoking could slightly delay the onset of menopause.

RESOURCES:

American College of Obstetricians and Gynecologists
www.acog.org

National Women's Health Resource Center
http://www.healthywomen.org

The North American Menopause Society
http://www.menopause.org

CANADIAN RESOURCES:

The Canadian Women's Health Network
http://www.cwhn.ca/indexeng.html

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm

References:

The North American Menopause Society website. Available at: http://www.menopause.org .

Planned Parenthood Federation of America, Inc. website. Available at: http://www.plannedparenthood.org .



Last reviewed February 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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