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Menopause is the point in a woman's life when
she has not had her period for 1 year. It marks the end
of the childbearing years. It's sometimes called "the change of life."
For most women, menopause happens around age 50. But every woman's body
has its own time line. Some women stop having periods in their mid-40s. Others
continue well into their 50s.
is the process of change that leads up to menopause. It can start as early as
your late 30s or as late as your early 50s. How long perimenopause lasts
varies, but it usually lasts from 2 to 8 years. You may have irregular periods
or other symptoms during this time.
Menopause is a natural part of
growing older. You don't need treatment for it unless your symptoms bother you.
But it's a good idea to learn all you can about menopause. Knowing what to
expect can help you stay as healthy as possible during this new phase of your
Normal changes in your
reproductive and hormone systems cause menopause. As your egg supply ages, your
body begins to
ovulate less often. During this time, your
hormone levels go up and down unevenly (fluctuate),
causing changes in your periods and other symptoms. In time,
progesterone levels drop enough that the menstrual
Some medical treatments can cause your periods to
stop before age 40. Having your ovaries removed, having
radiation therapy, or having
chemotherapy can trigger early menopause.
Common symptoms include:
Some women have only a few mild symptoms. Others have
severe symptoms that disrupt their sleep and daily lives.
Symptoms tend to last or get worse the first year or more after
menopause. Over time, hormones even out at low levels, and many symptoms
improve or go away.
need to be tested to see if you have started perimenopause or reached
menopause. You and your doctor will most likely be able to tell based on
irregular periods and other symptoms.
If you have heavy,
irregular periods, your doctor may want to do tests to rule out a serious cause
of the bleeding. Heavy bleeding may be a normal sign of perimenopause. But it
can also be caused by infection, disease, or a pregnancy problem.
You may not need to see your doctor about menopause symptoms. But it is
important to keep up your annual physical exams. Your risks for heart disease,
cancer, and bone thinning (osteoporosis) increase after menopause.
At your yearly visits, your doctor can check your overall health and recommend
testing as needed.
Menopause is a natural part
of growing older. You don't need treatment for it unless your symptoms bother
you. But if your symptoms are upsetting or uncomfortable, you don't have to
suffer through them. There are treatments that can help.
step is to have a healthy lifestyle. This can help reduce symptoms and also
lower your risk of heart disease and other long-term problems related to
If lifestyle changes aren't enough to relieve your
symptoms, you can try other measures, such as breathing exercises and yoga.
If you have severe symptoms, you may want to ask your
doctor about prescription medicines. Choices include:
All medicines for menopause symptoms have possible risks
or side effects. A very small number of women develop serious health problems
when taking hormone therapy. Be sure to talk to your doctor about your possible
health risks before you start a treatment for menopause symptoms.
Remember, it is still possible to become pregnant until you reach
menopause. To prevent an unwanted pregnancy, keep using birth control until you
have not had a period for 1 full year.
Health Tools help you make wise health decisions or take action to improve your health.
Learning about menopause:
Living with symptoms of perimenopause and menopause:
Menopause is a natural part of aging. As you age, the number and quality of
your eggs decline,
hormone levels fluctuate, and your menstrual cycle
becomes less predictable until it finally stops completely.
lifestyle choices and medical treatments can cause or are linked to an earlier
The first sign that you are nearing menopause is a change in your menstrual periods. They may become less frequent. And they may be lighter or heavier than you're used to.
Menopause symptoms range from mild (or none) to severe. They include:
These symptoms usually go away after 1 or 2 years. But some women have them for several years longer.
Other conditions can cause similar symptoms. Examples include
pregnancy; a significant change in weight; depression; anxiety; or
uterine, thyroid, or pituitary problems.
Menopause caused by surgery,
radiation therapy can cause more severe symptoms than
usual. Preexisting conditions such as
anxiety, sleep problems, or irritability can also make symptoms worse.
After you stop having menstrual periods, you may get other symptoms, including:
In your late 30s, your
egg supply begins to decline in number and quality. As a result, your
hormone production changes. You may notice a shortened menstrual cycle and some
premenstrual syndrome (PMS) symptoms that you didn't
Gradually, your periods become irregular. This can
start as early as your late 30s or as late as your early 50s. It continues for
2 to 8 years before menstrual cycles end.
During this time, your ovaries are
sometimes producing too much
progesterone and at other times too little. Your
progesterone is likely to fluctuate more than before. This can lead to
heavy menstrual bleeding. (If you have heavy or
unexpected vaginal bleeding, see your doctor to be sure it isn't caused by a
more serious condition.)
About 6 months to a year before your
periods stop, your estrogen starts to drop. When it drops past a certain point,
your menstrual cycles stop. After a year of no menstrual periods, you are said
to have "reached menopause."
During the next year or so, estrogen levels keep going down. This lowers your risk for certain types of cancers (estrogen is linked to some types of cancerous cell growth). But low estrogen
also creates some health concerns, such as:
Although the reasons aren't well understood,
a woman's risk of heart disease increases after menopause. Because heart
disease is the number one killer of women, consider your heart risk factors
when making lifestyle and treatment decisions.
Call your doctor if you have:
The following health professionals can
help you manage menopause symptoms and evaluate menstrual period
Your age, your history of
menstrual periods, your symptoms, and the results of your
pelvic exam will tell your doctor whether you are near or at menopause. If possible, bring a calendar or journal
of your periods and symptoms.
If you have severe symptoms, if your doctor suspects another medical condition,
or if you have a medical condition that makes a diagnosis difficult, your
doctor may do one or more of the following blood tests:
If you have had no menstrual periods for 1 year, this is a good time to have a full
physical exam, with particular focus on your heart health and risk factors for
Menopause is a natural part of aging. But symptoms can be
difficult for some women.
If you have
trouble sleeping, mood swings,
hot flashes, cloudy thinking,
heavy menstrual periods, or other symptoms,
treatment can help you get through this time more comfortably.
Treatment for menopause symptoms may include:
A healthy lifestyle can help you manage menopause symptoms. It can also help lower your risk for heart disease,
osteoporosis, and other long-term health problems.
hot flashes, try keeping your environment cool, dressing in layers, and managing stress.
improve vaginal dryness and muscle tone, try using
a vaginal lubricant and doing
Kegel exercises regularly.
Medicines can help you cope with bothersome menopause symptoms. Some medicines contain hormones, and some don't.
Hormone therapy is sometimes used to treat menopause symptoms. But women who use it may have a higher risk of other health problems.
If your symptoms are the result of early menopause brought on by having your ovaries removed along with your uterus, you may consider estrogen therapy (ET). But ET may increase the risk of health problems in a small number of women.
Short-term, low-dose HT or ET can
be taken for up to 4 to 5 years, with regular checkups. This may work well for
many women, who will find that their menopause symptoms have subsided within
this period of time.
women have turned to alternative medicine for menopause symptom relief. Before you try prescription medicines or hormones, you can think about using one or more of the
following options for preventing or treating symptoms.
Remember that dietary supplements aren't regulated the way medicines are. It's important to be careful when taking supplements. Tell your doctor what you are taking.
Based on the
latest research, some treatments aren't recommended,
either because they don't work or because they can cause dangerous
effects.6 These include:
The Hormone Health Network is a nonprofit organization
started by the Endocrine Society. The organization promotes the prevention,
treatment, and cure of hormone-related conditions through public outreach and
The North American Menopause Society (NAMS) is a nonprofit
organization that promotes the understanding of menopause and thereby improves
the health of women as they approach menopause and beyond. NAMS members include
experts from medicine, nursing, sociology, psychology, nutrition, anthropology,
epidemiology, pharmacy, and education. The NAMS website has information on
perimenopause, early menopause, menopause symptoms and long-term health effects
of estrogen loss, and a variety of therapies.
Fritz MA, Speroff L (2011). Menopause and perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 673–748. Philadelphia: Lippincott Williams and Wilkins.
North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.
North American Menopause Society (2010). Estrogen and
progestogen use in postmenopausal women: 2010 position statement of the
North American Menopause Society. Menopause, 17(2):
242–255. Also available online: http://www.menopause.org/PSht10.pdf.
Cedars MI, Evans M (2008). Menopause. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 725–741. Philadelphia: Lippincott Williams and Wilkins.
Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749–857. Philadelphia: Lippincott Williams and Wilkins.
American College of Obstetricians and Gynecologists (2001, reaffirmed 2010). Use of botanicals for management of menopausal symptoms. ACOG Practice Bulletin No. 28. Obstetrics and Gynecology, 97(6, Suppl): 1–11.
Other Works Consulted
American Association of Clinical Endocrinologists
Menopause Guidelines Revision Task Force (2006). American Association of
Clinical Endocrinologists medical guidelines for clinical practice for the
diagnosis and treatment of menopause. Endocrine Practice, 12(3): 315–337.
Daley A, et al. (2011). Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews (9).
Grady D, Barrett-Connor E (2012). Menopause. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 1565–1571. Philadelphia: Saunders.
Levis S, et al. (2011). Soy isoflavones in the prevention of menopausal
bone loss and menopausal symptoms. Archives of Internal Medicine, 171(15): 1363–1369.
Manson JE, Bassuk SS (2012). The menopause transition and postmenopausal hormone therapy. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 3040–3046. New York: McGraw-Hill.
Shifren JL, Schiff I (2007). Menopause. In JS Berek,
ed., Berek and Novak's Gynecology, 14th ed., pp.
1323–1340. Philadelphia: Lippincott Williams and Wilkins.
U.S. Preventive Services Task Force 2012. Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf12/menohrt/menohrtfinalrs.pdf.
April 30, 2013
Anne C. Poinier, MD - Internal Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine
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