Obstetrics and Gynecology

Menopause

Menopause is the stage in a woman's life when she stops having her monthly period. It is a normal part of aging that marks the end of a woman's reproductive years.

According to the American Congress of Obstetricians and Gynecologists (ACOG), the average age of menopause – defined as the absence of menstrual periods for one year – is 51. The normal age range is 45-55 years old.

While menopause is a natural biological process, not a medical illness, treatment is available for the symptoms of menopause that can disrupt a woman's life.

What causes menopause?

Menopause occurs when the ovaries begin to stop functioning. The ovaries are the reproductive glands that store and release eggs. They also produce the female hormones estrogen and progesterone that together control menstruation. At menopause, your ovaries produce much less of these hormones and they don't release eggs.

Additional causes of menopause include:

  • Surgical removal of ovaries. This may trigger severe symptoms because the hormone levels decrease all at once. Note: While a hysterectomy (removal of the uterus) ends a woman's monthly period, it will not cause menopause unless ovaries are also removed.
  • Chemotherapy and radiation therapy
  • Primary ovarian insufficiency. When the ovaries fail to produce normal levels of reproductive hormones.

What are the stages of menopause?

Menopause is commonly divided into two stages:

Perimenopause. When a woman first starts to experience menopausal signs and symptoms like hot flashes, but is still having her period. Perimenopause may last four to five years or longer

Postmenopause. When 12 months have passed since your last period, you've reached menopause. The years that follow are called postmenopause.

What are the symptoms of menopause?

Symptoms of menopause brought on by changes in estrogen may include:

  • Irregular periods and changes in flow
  • Hot flashes (sudden feeling of warmth that spreads over the upper body)
  • Vaginal dryness and painful intercourse
  • Night sweats
  • Sleeplessness
  • Mood swings
  • Increased abdominal fat
  • Bladder irritability and worsening of bladder control (incontinence)
  • Vaginal infections

What are the risks of menopause?

The reduction of estrogen in the body after menopause increases a woman's risk of:

Osteoporosis. Occurs when the inside of your bones become less dense, making them more fragile and likely to fracture. Estrogen signals cells in the bones to stop breaking down, preserving bone mass.

Coronary artery disease. Narrowing or blockage of arteries that surround the heart muscle, caused by plaque buildup associated with high levels of cholesterol. Estrogen helps maintain healthy levels of cholesterol in the blood.

How is menopause diagnosed?

Menopause is often apparent based on a woman's symptoms. Talk with your doctor about any signs or symptoms you are experiencing. Additional evaluation may include:

  • Blood and urine tests. To measure changes in hormone levels
  • A pelvic exam. To check for changes in the vaginal lining caused by declining estrogen levels
  • A bone density test. To screen for low bone density levels that occur with osteoporosis

How is menopause treated?

Treatment is focused on relieving the symptoms that come with menopause. Options include:

Hormone therapy. Using estrogen to relieve hot flashes, vaginal dryness, and slow bone loss. Talk with your doctor about the risks and benefits of hormone therapy.

Other medications. To reduce hot flashes and prevent or treat osteoporosis.

Vaginal estrogen. Administered locally to relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.

Healthy lifestyle habits can also help prevent or reduce the symptoms of menopause, including:

  • Regular exercise
  • Plenty of sleep
  • Strong pelvic floor muscles through Kegel exercises
  • A healthy, balanced diet, including calcium and vitamin D supplements as needed
  • Don't smoke
  • Regular checkups