Menopause is a huge mental, emotional and physical change. Here's what you need to know about this stage of life, including what menopause is, its symptoms and current menopause treatments that may help you with any unpleasant side effects.
What is menopause?
Sometimes referred to as “the change,” menopause is the time when your period (menstruation) stops for good. It is marked by physical and often emotional changes that are driven largely by the drop in the female sex hormone estrogen. Menopause is officially diagnosed once you have missed 12 straight menstrual cycles without any other obvious causes for the cessation. Menopause also signifies the end of fertility, which is why it can bring up mixed emotions for many women. In the United States, menopause occurs at age 51 on average, according to information from the Mayo Clinic.
Some women experience menopause much earlier than age 51. This is known as early and premature menopause. Early menopause occurs between the ages of 40 and 45, and premature menopause occurs when a woman is 40 or younger, according to the Office on Women's Health.
Early or premature menopause may be caused by anything that damages your ovaries or stops your body from producing estrogen, including certain cancer treatments or surgery to remove your ovaries or your uterus.
Menopause doesn’t come on suddenly. Perimenopause means "around menopause” and marks the menopause transition, or the time around menopause when your ovaries gradually stop working and release eggs less frequently. You also produce less estrogen and other hormones, which results in irregular menstrual cycles. All of these factors lead to declining fertility, according to Johns Hopkins Medicine.
How long does menopause last?
Perimenopause can span 7 to 14 years, depending on such lifestyle factors as smoking, the age it begins, and your race and ethnicity. After you have not had your period for a full year, you are officially postmenopausal.
What causes menopause?
Menopause isn’t a disease. It is a natural part of the aging process. Estrogen levels decline dramatically during menopause after years of your body relying on it to support many organ systems in the body. The decrease in this hormone may lead to a variety of symptoms, which may be different for everyone.
According to the North American Menopause Society (NAMS), some examples of menopause symptoms may include:
Vaginal dryness
Mood changes
Night sweats
Hot flashes
Moodiness
Skin changes
Every woman experiences and copes with menopause and its symptoms differently.
Signs of menopause caused by a drop in estrogen levels include the following.
Hot flashes: This is the most common menopause symptom, and the intense warm feeling can come on fast and furiously. Hot flashes usually last one to five minutes, NAMS says.
Night sweats: These drenching sweats may rob you of sleep and force you to change pajamas in the middle of the night.
Thinning of vaginal tissue: This may make sex painful and increase your risk for vaginal infections.
Mood issues, such as anxiety and depression: This is due to hormonal fluctuations, sleep interrupted by night sweats and sometimes concerns about body image and growing older.
Thinning skin: Collagen and elastin are the main structural proteins that give the skin its youthful elastic properties, but our natural supply dwindles with advancing age and diminished levels of estrogen. The result? Fine lines and wrinkles, dryness, and uneven tone.
Weight gain: Your weight may start creeping up during perimenopause. The Mayo Clinic reports that women may gain about 1.5 pounds a year in their 50s, and this weight tends to gather around the abdomen.
Brittle bones: Brittle bones may increase your chances of developing osteoporosis and fractures.
Menopause medications and treatments
In the past, long-term use of hormone replacement therapy (HRT) was widely recommended to relieve the symptoms of menopause. This practice fell from grace in 2002 when the Women's Health Initiative study found hormones increased the risk of strokes as well as breast and ovarian cancer.
These days, short-term use of hormone therapy is considered safe for some women with severe menopausal symptoms. The goal is to use the lowest dose of hormone possible for the shortest amount of time. Estrogen-only therapy is reserved for women who have had a hysterectomy; women with an intact uterus who use HRT must take the hormone progestin with estrogen to prevent uterine cancer.
So far, two medications (described below) are Food and Drug Administration (FDA)-approved to treat bothersome hot flashes. Other symptoms may be managed with self-care and lifestyle changes.
Many of today’s menopause treatments are geared toward specific symptoms. The good news is that there is a lot you can do to relieve the symptoms of menopause, from lifestyle changes to the use of medication.
Night sweats and hot flashes
The National Institute on Aging suggests lifestyle changes to help you cool down from the outside in and inside out, including:
Dressing in layers that can be easily removed when you have a hot flash
Carrying a portable fan
Layering your bedding so you can cool down easily at night
Considering cooling sheets and pillowcases
Maintaining a normal, healthy weight. Women who are overweight or obese may experience more frequent and severe hot flashes.
Saying ohm. Mind-body practices such as yoga, tai chi and mindfulness meditation may help with hot flashes.
If your hot flashes are affecting your quality of life and you can’t or don’t want to take hormones, you have other options. The FDA approved the use of the antidepressant paroxetine for hot flashes under the brand name Brisdelle in 2013. In addition, the FDA recently gave its nod to fezolinetant (brand name Veozah) for moderate to severe hot flashes caused by menopause. Veozah is not a hormone. Instead, it targets the neural activity that causes hot flashes.
Vaginal atrophy
Treatments for thinning vaginal tissue may include:
Sleep loss and poor-quality sleep
Most adults need between 7 and 8 hours of sleep each night. The National Institute on Aging points out that good sleep hygiene may go a long way to improving your sleep. Some sleep hygiene tips include:
Sticking to a regular wake and sleep schedule, even on weekends
Developing a relaxing pre-bedtime ritual that does not include looking at your phone or computer, as the blue light from these devices may make it harder to fall asleep
Keeping your bedroom cool and dark
Other tips for better sleep include:
Exercising daily (just not right before bed)
Avoiding large meals before bedtime
Limiting any caffeine later in the day
If following this advice doesn’t improve your sleep, talk to your healthcare provider about over-the-counter or prescription sleep medications.
Memory problems
Staying socially active may help you remain sharp as you move through menopause. In addition, try doing crossword puzzles, sudoku, taking a class or learning a new language to stay engaged, suggests the Office on Women’s Health.
Mood changes
If you’re feeling depressed or anxious, talk to your healthcare provider about depression medications or anxiety medications that may help. Your provider may recommend therapy, medication or both to treat depression or anxiety that may travel with the hormonal fluctuations and life changes of menopause.
The Office on Women’s Health also points out that self-care such as getting regular exercise, good sleep and eating a healthy diet may all go a long way toward improving mood.
Other nontraditional menopause treatments
Buyer beware. The American College of Obstetricians and Gynecologists (ACOG) does not recommend the use of certain alternative menopause treatments.
Bioidentical hormones get their share of buzz on social media and by some celebrities. These come from plant sources, and they behave like hormones made in your body. They are often made by compounding pharmacies and are not regulated by the FDA. Other alternative menopause treatments include black cohosh, DHEA or soy isoflavones, but there’s no proof that they are effective, and they may pose significant risks. Always tell your healthcare provider about anything you’re taking to treat your symptoms.
There’s no one menopause diet, but there are foods that may help boost your health and reduce certain symptoms.
For example, including calcium-rich foods in your diet, such as milk, yogurt and low-fat cheese, may help keep your bones strong. The Cleveland Clinic suggests aiming for about 1,200 to 1,500 milligrams of calcium a day.
Soy foods such as edamame, soy milk and tofu contain phytoestrogens, which are plant-based estrogens. These may also help with hot flashes, according to information from the Cleveland Clinic.
In addition to eating a healthy diet rich in colorful fruits and vegetables, low-fat sources of protein, fiber and healthy fats, and getting regular exercise may also help with weight gain.
Living with menopause
Leading a healthy lifestyle and taking care of yourself is the best way to thrive during and after menopause. Regular exercise, not smoking, drinking alcohol in moderation (if at all) and maintaining a normal weight may help reduce your risk for diseases associated with advancing age, including heart disease, cancer and osteoporosis.
Make sure to check in with your healthcare provider to make sure you’re doing all that you can to protect your health during and after menopause.
References
Mayo Clinic: Menopause.
U.S. Office on Women's Health: Early or premature menopause.
Cleveland Clinic: Premature and Early Menopause.
Johns Hopkins University: Perimenopause.
North American Menopause Society (NAMS): Menopause FAQs: Understanding the Symptoms.
NAMS: Menopause 101: A primer for the perimenopausal.
NAMS:. Depression, Mood Swings, Anxiety.
Mayo Clinic: The reality of menopause weight gain.
Women's Health Initiative: Largest women's health prevention study ever – Women's Health Initiative.
National Institute on Aging: Hot Flashes: What Can I Do?
U.S. Food and Drug Administration (FDA): Brisdelle.
FDA: FDA Approves Novel Drug to Treat Moderate to Severe Hot Flashes Caused by Menopause.
National Institute on Aging: Sleep Problems and Menopause: What Can I Do?
Office on Women’s Health: Menopause symptoms and relief.
American College of Obstetricians and Gynecologists: The Menopause Years.
Cleveland Clinic: Menopause Diet: What To Eat To Help Manage Symptoms.
