Frequently Asked Questions About Menopause
From the National Women’s Health Information Center
What is menopause?
Menopause is only one of several stages in the reproductive life of a woman. The whole menopause transition is divided into four main stages known as:
Premenopause – refers to the entirety of a woman's life from her first to her last regular menstrual period. It is best defined as a time of "normal" reproductive function in a woman.
Perimenopause – means "around menopause" and is a transitional stage of two to ten years before complete cessation of the menstrual period and is usually experienced by women from 35 to 50 years of age. This stage of menopause is characterized by hormone fluctuations, which cause the typical menopause symptoms, such as hot flashes.
Menopause – represents the end stage of a natural transition in a woman's reproductive life. Menopause is the point at which estrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs and a woman is no longer able to get pregnant naturally.
Postmenopause – refers to a woman's time of life after menopause has occurred. It is generally believed that the postmenopausal phase begins when 12 full months have passed since the last menstrual period. From here a woman will be postmenopausal for the rest of her life.
Some women go through menopause before the age of 40. This is called premature menopause. It can happen naturally or as a result of certain medical treatments.
What are the symptoms of menopause?
Every woman's period will stop at menopause. Some women have no other symptoms. But many women notice changes in body, mind, and mood at this stage of life. We don’t always know if these changes are related to menopause, aging, or both. Some changes you might notice include:
What is premature menopause?
- Changes in your period. The time between periods and the flow from month to month may be different.
- Abnormal bleeding or "spotting." This is common as you near menopause. But if your periods have stopped for 12 months in a row, and you still have "spotting," you should talk to your doctor to rule out serious causes, like cancer.
- Night sweats. Hot flashes that occur while a woman is sleeping and cause her to perspire. They can make it hard to get a good night’s sleep.
Sleeping problems. Lack of sleep can affect your mood, health, and ability to cope with everyday stress.
- Vaginal changes. The vagina may become dry and thin, and sex and vaginal exams may be painful. You also might get more vaginal infections.
Emotional changes. May include mood swings, sadness, tearfulness, and irritability. Although menopause does not cause depression, women are at a higher risk of depression in the years leading up to menopause. Some researchers think that the decrease in estrogen levels plays a role in the onset of depression in some women. Also, lack of sleep can strain a woman’s emotional health.
- Thinning of your bones. This may lead to loss of height and bone breaks (osteoporosis).
- Problems with memory and staying focused. You may notice you are more forgetful or have trouble concentrating.
- Sex drive decreases. You may have less interest in sex and changes in sexual response.
- Weight fluctuation. Weight gain or increase in body fat around your waist.
- Hair loss or thinning. Hair thinning or loss is a problem for some women.
Some women go through menopause before the age of 40. This is called premature menopause. It can happen naturally or as a result of certain medical treatments. Women who enter menopause early get symptoms similar to those of natural menopause, like hot flashes, emotional problems, vaginal dryness, and decreased sex drive. For some women with early menopause, these symptoms are severe. Also, women who have early menopause tend to get weaker bones faster than women who enter menopause later in life. This raises their chances of getting osteoporosis and breaking a bone. Premature menopause can happen for the following reasons:
- Chromosome defects. Defects in the chromosomes can cause premature menopause. For example, women with Turner's syndrome are born without a second X chromosome or born without part of the chromosome. The ovaries don't form normally, and early menopause results.
- Genetics. Women with a family history of premature menopause are more likely to have early menopause themselves.
- Autoimmune diseases. The body's immune system, which normally fights off diseases, mistakenly attacks a part of its own reproductive system. This hurts the ovaries and prevents them from making female hormones. Thyroid disease and rheumatoid arthritis are two diseases in which this can happen.
- Surgery to remove the ovaries. Surgical removal of both ovaries, also called a bilateral oophorectomy, puts a woman into menopause right away. She will no longer have periods, and hormones decline rapidly. She may have menopausal symptoms right away, like hot flashes and diminished sexual desire. Women who have a hysterectomy, but have their ovaries left in place, will not have induced menopause because their ovaries will continue to make hormones. But because their uterus is removed, they no longer have their periods and cannot get pregnant. They might have hot flashes since the surgery can sometimes disturb the blood supply to the ovaries. Later on, they might have natural menopause a year or two earlier than expected.
Chemotherapy or pelvic radiation treatments for cancer. Cancer chemotherapy or pelvic radiation therapy for reproductive system cancers can cause ovarian damage. Women may stop getting their periods, have fertility problems, or lose their fertility. This can happen right away or take several months. With cancer treatment, the chances of going into menopause depend on the type of chemotherapy used, how much was used, and the age of the woman when she gets treatment. The younger a woman is, the less likely she will go into menopause.
To find out if you have premature menopause, your doctor will ask you if you've had changes typical of menopause, like hot flashes, irregular periods, sleep problems and vaginal dryness. Normally, menopause is confirmed when a woman hasn't had her period for 12 months in a row.
However, with certain types of premature menopause, these signs may not be enough for a diagnosis. A blood test that measures follicle-stimulating hormone (FSH) can be done. Your ovaries use this hormone to make estrogen. FSH levels rise when the ovaries stop making estrogen. When FSH levels are higher than normal, you've reached menopause. However, your estrogen levels vary daily, so you may need this test more than once to know for sure.
You may also have a test for levels of estradiol (a type of estrogen) and luteinizing hormone (LH). Estradiol levels fall when the ovaries fail. Levels lower than normal are a sign of menopause. LH is a hormone that triggers ovulation. If you test above normal levels, you've gone through menopause.
How do I manage my symptoms?
Since we're always learning more about menopause treatment options and hormone therapy, it can be confusing to figure out how to treat or manage menopausal symptoms. It is important for you to have a doctor that you trust, so you can have an open talk about your concerns and your treatment options. Then you can make informed decisions about your health that you feel good about. If you feel that you have talked openly with your doctor and still don't feel satisfied, you should think about getting a second opinion.
Make sure the doctor knows your medical history and your family medical history. This includes whether you are at risk for heart disease, osteoporosis, and breast cancer. Remember that your decision is never final. You can, and should review it with your doctor during a checkup. Your needs may change, and so might what we know about menopause.
Hormone therapy (HT) – To help control the symptoms of menopause, some women can take hormones, called menopausal hormone therapy (MHT). MHT used to be called hormone replacement therapy or HRT. The use of MHT has been debated a great deal since the Women's Health Initiative (WHI) Hormone Study findings were released in 2002. Before this study, it was thought that MHT could ward off heart disease, osteoporosis, and cancer, while improving women's quality of life. Findings emerged from clinical trials that showed this was not so. In fact, long-term use of MHT poses some serious risks. New results from the WHI confirmed that using MHT does not protect against coronary heart disease (CHD, called heart disease here). There is good news, however: The results also suggest that short-term use of MHT does not increase heart disease risk in women who begin MHT within 10 years of onset of menopause. But, it appears that the longer a woman waits to begin MHT after the onset of menopause, the greater her risk of developing heart disease. More research is needed to fully understand this issue. Still, a woman has options when it comes to managing the symptoms of menopause.
During perimenopause, some doctors suggest birth control pills to help with very heavy, frequent, or unpredictable menstrual periods. These pills might also help with symptoms like hot flashes, as well as prevent pregnancy. As you get closer to menopause, you might be bothered more by symptoms like hot flashes, night sweats, or vaginal dryness. Your doctor might then suggest starting MHT. A woman whose uterus has been removed can use estrogen alone to control her symptoms. But a woman who still has a uterus must take progesterone or a progestin (a man-made progesterone) along with the estrogen. These hormones will probably help with menopause symptoms and prevent the bone loss that can happen at menopause. However, there is a chance your symptoms will come back when you stop MHT.
Once a woman reaches menopause, MHT currently is recommended only as a short-term treatment of moderate to severe symptoms such as hot flashes or night sweats. Women who have problems with vaginal dryness can try lower dose estrogen products, such as vaginal creams, rings, and tablets. Long-term use of MHT is no longer advised, and doctors very rarely prescribe MHT to prevent certain chronic diseases, like osteoporosis. Postmenopausal women should not take MHT as they grow older to prevent problems like heart disease. A woman should talk about the benefits and risks of using MHT with her doctor to decide if MHT is right for her.
HT can help with menopause by:
- Reducing hot flashes
- Treating vaginal dryness
- Slowing bone loss
- Improving sleep
- Easing mood swings and mild depressive symptoms (MHT alone is not effective in treating depression)
For some women, HT may increase their chance of:
Who should not take HT?
- Blood clots
- Heart attack
- Breast cancer
- Gall bladder disease
- think they are pregnant
- have problems with vaginal bleeding
- have had certain kinds of cancers (such as breast and uterine cancer)
- have had a stroke or heart attack
- have had blood clots
- have liver disease
- have heart disease
HT can also cause these side effects:
What about "natural" treatments for menopause?
- Vaginal bleeding
- Breast tenderness or swelling
- Mood changes
Some women decide to take herbal or other plant-based products to help relieve hot flashes. But there is not enough evidence to know if treatments like these are helpful. Tell your doctor if you are taking any of these treatments. They may have side effects or make another drug not work as well. Some of the most common ones are:
Soy. This contains phytoestrogens (estrogen-like substances from a plant). Some research has shown that soy food products can help with mild hot flashes. Other research suggests that women who have been diagnosed with estrogen-dependent breast cancer should be cautious with their soy intake. Eating large amounts of soy products could be harmful for women with this type of breast cancer.
Other sources of phytoestrogens. The active ingredients in most dietary supplements for menopause are phytoestrogens — chemicals found in plants that may act like the estrogen produced naturally in the body. These include herbs, such as black cohosh, wild yam, dong quai, and valerian root.
Bioidentical hormone therapy. Bioidentical hormones are custom-mixed formulas containing various hormones that are chemically identical to those naturally made by your body. These over-the-counter products are marketed as being tailored to a woman's individual hormone needs. There are two main types of bioidentical hormones:
- Those that are FDA-approved and commercially available with a prescription
- Those that are mixed on an individual basis for women in compounding pharmacies, which are NOT FDA-approved