Menopause: What You Should Know

Menopause affects roughly half the population worldwide. Despite this, many women are unaware of what to expect when this stage of life occurs. While there is emphasis placed on what to expect when you are getting your period for the first time, the latter—what happens when your periods come to end—is not often discussed. In this article we will discuss menopause symptoms and what you can do to alleviate them.

Perimenopause—the ‘Menopausal Transition’

Perimenopause also called the menopausal transition, refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. The beginning of perimenopause is different for every woman, most start to notice menstrual irregularities in their 40s but changes can occur as early as mid-30s. The level of estrogen in a women’s body rises and falls unevenly during perimenopause, your menstrual cycle may lengthen or shorten and you may have menstrual cycles where your ovaries do not release an egg at all. You may also start to experience menopause like symptoms such as hot flashes or sleep problems. When and how someone experiences menopause will vary from person to person but here are some things to take note of.

Menopause Symptoms

Some changes in your body will start to occur during this transitional period and every woman can experience these symptoms differently. You may experience:

• Irregular periods:
  As ovulation becomes irregular, so will your menstruation. The length of time between periods may be longer or shorter, your flow may be light or heavy and you may even skip some periods.
• Hot flashes and sleep problems:
  Hot flashes are a very well-known symptom of menopause and can vary in length, intensity and frequency. Sleep issues are often due to the hot flashes or night sweats.
• Mood changes:
  Mood swings, irritability or increased risk of depression may occur. These symptoms can be related to the sleep problems and the hormonal changes that occur during this time.
• Vaginal and bladder problems:
  As estrogen levels decrease, your vaginal tissues may lose lubrication and elasticity, causing intercourse to be painful. Low estrogen levels can also be associated with an increased risk of urinary and vaginal infections.
• Decreasing fertility:
  As ovulation becomes irregular, your ability to conceive decreases. However, as long as you are still having your period, you still have the ability to get pregnant.
• Loss of bone:
  When estrogen levels start to decline, you can start to lose bone faster than your body can replace it. This increases your risk of osteoporosis, a disease that causes fragile bones.
• Changing cholesterol levels:
  The decrease in estrogen levels may also lead to changes in your blood cholesterol levels. This includes increasing your “bad” cholesterol (LDL) and decreasing your “good” cholesterol (HDL), both of which contribute to an increased risk of heart disease.
• Weight gain:
  Many women gain weight because their metabolism slows. You may need to eat less and exercise more, just to maintain your current weight.

Menopause

Menopause is the time that marks the end of your menstrual cycles. It is diagnosed after you’ve gone 12 months without a menstrual period. Menopause can occur in your 40s or 50s, with the average age being 51 in the United States.

What causes menopause?

• Naturally declining reproductive hormones:
  Your ovaries will start producing less estrogen and progesterone as you approach your late 30s and your fertility will begin to decline. This will slowly lead to your ovaries no longer releasing eggs and then you will have no more periods.
• Surgery that removes the ovaries (oophorectomy):
  Since your ovaries are what produces the hormones needed for regular menstruation, surgical removal will cause immediate menopause. Your period will cease and you will likely start to experience menopause symptoms. These symptoms can be more severe than usual as the hormonal changes occur abruptly rather than a gradual decline over several years. A surgery that removes your uterus but not your ovaries (hysterectomy) usually does not cause immediate menopause. You will no longer be getting your periods but your ovaries can still release eggs and hormones.
• Chemotherapy and radiation therapy:
  Cancer therapies can induce menopause, causing various symptoms during or after treatment. The halt of menstruation is not always permanent following chemotherapy; therefore, birth control measures may still be required. Radiation therapy only affects ovarian function if the radiation is directed at the ovaries.
• Primary ovarian insufficiency:
  About 1% of women experience menopause before the age of 40 (premature menopause). This may result from the failure of your ovaries to produce normal levels of reproductive hormones, which can stem from genetic factors or autoimmune diseases. For these women, hormone therapy is recommended at least until the natural age of menopause in order to protect the brain, heart and bones.

Menopause treatment

Menopause requires no medical treatment. The following treatments are focused on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. Signs and symptoms can vary among women. Treatments may include:

• Hormone therapy:
  Estrogen therapy is the most effective treatment option for hot flashes and can also help prevent bone loss. Long-term use of the hormone therapy may have some cardiovascular and breast cancer risks, but many women have found benefit in starting hormone therapy around the time of menopause. Postmenopausal women taking estrogen hormone replacement therapy may also need to initiate progestin therapy to reduce the risk of endometrial cancer. Medroxyprogesterone (Provera®) tablets are used to treat abnormal menstrual bleeding, absent or irregular menstrual periods. They are also used to prevent the thickening of the uterine lining.
• Vaginal estrogen:
  To relieve vaginal dryness, estrogen can be administered directly to the vagina via a vaginal cream, tablet or ring. These treatments can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
• Low-dose antidepressant:
  These may be used for the management of hot flashes in women who can’t take estrogen or for women who need an antidepressant for a mood disorder.
• Medications for osteoporosis:
  Your healthcare provider may recommend medications to prevent or treat osteoporosis.

Everyone experiences menopause differently. It is important that you be your own advocate and speak with your healthcare provider about your options. An alternative option is to consult with a menopause specialist. The North American Menopause Society certifies menopause practitioners who have undergone advanced training on this topic (https://www.menopause.org/).