“All About Menopause and Perimenopause”

Menopause: What Is It? Menopause is the process a woman goes through that causes her periods to end. It's a turning point, not a disease, but it can have a big impact on a woman's well-being. Although menopause can bring physical discomfort from hot flashes, night sweats, and other symptoms, it can also be the start of a new and rewarding phase of a woman's life -- and a golden opportunity to guard against major health risks like heart disease and osteoporosis.

What Causes It? Age is the leading cause of menopause. It's the end of a woman's childbearing years, brought on by the ovaries gradually slowing down. Certain surgeries and medical treatments can also cause menopause. Those include surgical removal of the ovaries (bilateral oophorectomy), chemotherapy, and pelvic radiation therapy. Having a hysterectomy (surgical removal of the uterus) without removing the ovaries does not lead to menopause, although you will not have periods anymore.

When Does Menopause Start? On average, women in the U.S. are 51 at natural menopause, notes the National Institute on Aging. But menopause can start earlier or later. A few women start menopause as young as 40, and a very small percentage as late as 60. Women who smoke tend to go through menopause a few years earlier than nonsmokers. There is no proven way to predict menopause age. It's only after a woman has missed her periods for 12 straight months, without other obvious causes, that menopause can be confirmed. There are tests that can check your ovaries and spot a decrease in fertility.

Perimenopause: Natural menopause happens gradually. The ovaries don't abruptly stop working, they slow down over time. The transition to menopause is called perimenopause. Menopause is a milestone -- it's the day that marks 12 months in a row since a woman's last period. During perimenopause, it's still possible to get pregnant -- a woman's childbearing years are winding down, and although her periods may become more unpredictable, her ovaries are still working and she still may ovulate, though not always monthly.

What to Expect: Menopause isn't a one-size-fits-all event. It affects each woman differently. Some women reach natural menopause with little to no trouble. Others have severe symptoms. And when menopause starts suddenly as a result of surgery, chemotherapy, or radiation, the adjustment can be tough. Here is a look at menopausal symptoms that many women have, though the intensity can vary.

Signs: Period Changes - As menopause approaches, a woman's menstrual periods will likely change. But those changes can vary from woman to woman -- periods may get shorter or longer, heavier or lighter, with more or less time between periods. Such changes are normal, but the National Institute on Aging recommends seeing a doctor if your periods come very close together, if you have heavy bleeding or spotting, or if your periods last more than a week.

Symptom: Hot Flashes - Hot flashes (or hot flushes) are common. It’s a brief feeling of heat that may make the face and neck flushed and cause temporary red blotches to appear on the chest, back, and arms. Sweating and chills may follow. Hot flashes vary in intensity and typically last between 30 seconds and 10 minutes. Dressing in light layers, using a fan, getting regular exercise, avoiding spicy foods and heat, and managing stress may help you deal with hot flashes.

Symptom: Sleep Issues - Nighttime hot flashes can hamper sleep and cause night sweats. Try these sleep tips:

• Use a fan in your bedroom.
• Avoid heavy bedding.
• Choose light cotton or sheer materials for your nightclothes.
• Keep a damp cloth nearby to cool yourself quickly if you wake up feeling hot and sweaty.
• Keep pets out of your bedroom. They can give off heat.
• Talk to your doctor if your sleep problems don't stop or they bother you.

Symptom: Sex Problems - Less estrogen can lead to vaginal dryness, itching, and irritation, which may make intercourse uncomfortable or painful. Try using a water-based lubricant. Your desire may go up or down, but many things besides menopause -- including stress, medications, depression, poor sleep, and relationship problems -- affect sex drive. Talk to your doctor if you have sex problems -- don't settle for a so-so sex life. And remember, sexually transmitted diseases (STDs) don't end with menopause. You still need to use protection.

Manage Severe Symptoms: If menopause symptoms are a problem, talk with your doctor. She can help you weigh the pros and cons of treatment options such as hormone replacement therapy. Other treatments include low-dose birth control pills if you're perimenopausal; antidepressants, blood pressure drugs, or other medications to help with hot flashes; and vaginal estrogen cream. Your doctor may also have lifestyle tips about adjusting your diet, exercise, sleep, and stress management.

Hormone Replacement Therapy: Hormone replacement therapy can ease some menopausal symptoms. Various prescription products are available to treat hot flashes and vaginal symptoms. The FDA recommends taking the lowest dose that helps, and only for the shortest time because studies have linked long-term use of hormone replacement therapy to a greater risk of heart attacks, strokes, blood clots, and breast cancer.

Bioidentical Hormone Therapy: "Bioidentical hormone therapy" for menopausal symptoms can refer to FDA-approved prescription drugs. Or it can refer to custom-compounded hormones made at compounding pharmacies mixed according to a doctor’s instructions. These may have two or three types of estrogen, often mixed with other hormones. Some doctors claim that compounded bioidentical hormones are safer. The FDA's advice -- take the lowest dose for the shortest time -- applies to bioidentical hormone therapy. Custom-compounded bioidentical products aren't FDA approved.

Alternative Treatments: Interested in trying alternative or complementary treatments for menopause symptoms? According to the National Institutes of Health, there hasn't been a lot of well-designed research on this topic, so the research isn't firm enough to draw conclusions about treatments such as black cohosh, dong quai, red clover, and soy. Talk it over with your doctor, and tell him about any supplements you take so he can check on drug interactions.

Health Risks: With menopause comes a greater chance of heart disease (which is the No. 1 cause of death for U.S. women) and osteoporosis (thinning bones). Loss of hormones may play a role in heart disease after menopause, but hormone replacement therapy is not recommended to reduce the risk of heart disease or stroke. Of course, heart and bone health is important throughout a woman's life, but menopause means it's really time to step up and get serious about it if you haven't already.

Stay Healthy: Living a healthy lifestyle is important throughout a woman's life. And it's not too late to start at menopause. Get a checkup that includes measuring your blood pressure, cholesterol, and blood sugar and make appointments for vaccinations and routine screenings such as mammograms and bone density. Menopause is also a great time to upgrade your diet, physical activity, and stress management skills -- your doctor can give you pointers as you work together to plan for a healthy menopause.

Active Menopause Is a Must: One of the smartest things a woman can do as she transitions to menopause and afterward is to get regular physical activity. That includes aerobic exercise for her heart and weight-bearing exercise for her bones -- both of which may help ward off weight gain and provide a mood boost. Even if a woman hasn't been very active in her younger years, it's never too late to start. Menopause is a new beginning and the perfect time to weave more activity into your life.

A New Era: Western culture has long been obsessed with youth. But today's postmenopausal women are making the most of -- and even celebrating -- their new phase of life. Instead of looking back mournfully, Christiane Northrup, MD, recommends using it as a time to redefine yourself with positive thoughts, love yourself, explore what brings you pleasure, and revive (not retire) your sex life.

Reviewed by: Brunilda Nazario, MD on July 24, 2018

Sources:

Christiane Northrup, MD, Yarmouth, ME.
Cleveland Clinic's Women's Health Center.
FDA.
Hormone Health Network: “Bioidentical Hormones.”
Kryger, Meir, et al, editors: Principles and Practice of Sleep Medicine. Fourth Edition, Elsevier, 2005.
Kryger, Meir, et al, editors Sleep Medicine, Third Edition, Elsevier, 2000.
Mayo Clinic.
National Center for Complementary and Alternative Medicine.
National Institutes of Health.
National Institute on Aging.
National Women's Health Information Center.
North American Menopause Society.
Northrup, C. The Secret Pleasures of Menopause, Hay House, 2008.
U.S. Department of Health and Human Services Office on Women's Health.
Women's Health Initiative.
Wulf Utian, MD, PhD, consultant in women's health, Cleveland Clinic; executive director emeritus, North American Menopause Society.

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