What is Menopause

Menopause is the normal time of life when menstrual periods stop completely. It is usually confirmed by 12 months without a menstrual period. The transition to menopause (perimenopause) most often happens between the ages of 45 and 55.

During perimenopause, hormone levels change in your body, which can cause symptoms and affect your health. Menopause may increase your risk for:

• Loss of bone (osteoporosis), which causes bone breaks (fractures).
• Depression.
• Hardening and narrowing of the arteries (atherosclerosis), which can cause heart attacks and strokes.

What are the causes?

This condition is usually caused by a natural change in hormone levels that happens as you get older. The condition may also be caused by surgery to remove both ovaries (bilateral oophorectomy).

What increases the risk?

This condition is more likely to start at an earlier age if you have certain medical conditions or treatments, including:

• A tumor of the pituitary gland in the brain.
• A disease that affects the ovaries and hormone production.
• Radiation treatment for cancer.
• Certain cancer treatments, such as chemotherapy or hormone (anti-estrogen) therapy.
• Heavy smoking and excessive alcohol use.
• Family history of early menopause.

This condition is also more likely to develop earlier in women who are very thin.

What are the signs or symptoms?

Symptoms of this condition include:

• Hot flashes.
• Irregular menstrual periods.
• Night sweats.
• Changes in feelings about sex. This could be a decrease in sex drive or an increased comfort around your sexuality.
• Vaginal dryness and thinning of the vaginal walls. This may cause painful intercourse.
• Dryness of the skin and development of wrinkles.
• Headaches.
• Problems sleeping (insomnia).
• Mood swings or irritability.
• Memory problems.
• Weight gain.
• Hair growth on the face and chest.
• Bladder infections or problems with urinating.

How is this diagnosed?

This condition is diagnosed based on your medical history, a physical exam, your age, your menstrual history, and your symptoms. Hormone tests may also be done.

How is this treated?

In some cases, no treatment is needed. You and your health care provider should make a decision together about whether treatment is necessary. Treatment will be based on your individual condition and preferences. Treatment for this condition focuses on managing symptoms. Treatment may include:

• Menopausal hormone therapy (MHT).
• Medicines to treat specific symptoms or complications.
• Acupuncture.
• Vitamin or herbal supplements.

Before starting treatment, make sure to let your health care provider know if you have a personal or family history of:

• Heart disease.
• Breast cancer.
• Blood clots.
• Diabetes.
• Osteoporosis.

Follow these instructions at home:

Lifestyle

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Get at least 30 minutes of physical activity on 5 or more days each week.
• Avoid alcoholic and caffeinated beverages, as well as spicy foods. This may help prevent hot flashes.
• Get 7–8 hours of sleep each night.
• If you have hot flashes, try:
  • Dressing in layers.
  • Avoiding things that may trigger hot flashes, such as spicy food, warm places, or stress.
  • Taking slow, deep breaths when a hot flash starts.
  • Keeping a fan in your home and office.
• Find ways to manage stress, such as deep breathing, meditation, or journaling.
• Consider going to group therapy with other women who are having menopause symptoms. Ask your health care provider about recommended group therapy meetings.

Eating and drinking

• Eat a healthy, balanced diet that contains whole grains, lean protein, low-fat dairy, and plenty of fruits and vegetables.
• Your health care provider may recommend adding more soy to your diet. Foods that contain soy include tofu, tempeh, and soy milk.
• Eat plenty of foods that contain calcium and vitamin D for bone health. Items that are rich in calcium include low-fat milk, yogurt, beans, almonds, sardines, broccoli, and kale.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Talk with your health care provider before starting any herbal supplements. If prescribed, take vitamins and supplements as told by your health care provider. These may include:
  • Calcium. Women age 51 and older should get 1,200 mg (milligrams) of calcium every day.
  • Vitamin D. Women need 600–800 International Units of vitamin D each day.
  • Vitamins B12 and B6. Aim for 50 micrograms of B12 and 1.5 mg of B6 each day.

General instructions

• Keep track of your menstrual periods, including:
  • When they occur.
  • How heavy they are and how long they last.
  • How much time passes between periods.
• Keep track of your symptoms, noting when they start, how often you have them, and how long they last.
• Use vaginal lubricants or moisturizers to help with vaginal dryness and improve comfort during sex.
• Keep all follow-up visits as told by your health care provider. This is important. This includes any group therapy or counseling.

Contact a health care provider if:

• You are still having menstrual periods after age 55.
• You have pain during sex.
• You have not had a period for 12 months and you develop vaginal bleeding.

Get help right away if:

• You have:
  • Severe depression.
  • Excessive vaginal bleeding.
  • Pain when you urinate.
  • A fast or irregular heart beat (palpitations).
  • Severe headaches.
  • Abdomen (abdominal) pain or severe indigestion.
• You fell and you think you have a broken bone.
• You develop leg or chest pain.
• You develop vision problems.
• You feel a lump in your breast.

Summary

• Menopause is the normal time of life when menstrual periods stop completely. It is usually confirmed by 12 months without a menstrual period.
• The transition to menopause (perimenopause) most often happens between the ages of 45 and 55.
• Symptoms can be managed through medicines, lifestyle changes, and complementary therapies such as acupuncture.
• Eat a balanced diet that is rich in nutrients to promote bone health and heart health and to manage symptoms during menopause.