What is menopause and how to manage it?

What is menopause?

Menopause is a natural biological process that marks the end of a woman's reproductive years. It is caused by a decrease in the production of estrogen and progesterone.

Once you've gone 12 months without having a period, you're then diagnosed with menopause.

Most frequently, menopausal starts between the ages of 45 through 55. It typically lasts about 7 years, although it can last up to 14 years. The length of time might vary depending on your lifestyle variables including tobacco use, the age at which menopause starts, as well as race and ethnicity.

Menopause can occur in your 40s or 50s, but the average age is 51, although women of color, including Black and Latina women, may experience it on average up to 2 years sooner.

3 stages of menopause

Perimenopause or “menopause transition”

Perimenopause referred to the period between pre-menopaus and menopaus.

During this time your ovaries gradually produce less estrogen and your menstrual cycles become more irregular. You can miss one or more periods entirely or have late periods.

Perimenopause can start about 8 to 10 years prior to menopause, and it often begins when you are in your 40s, but can happen in women between the ages of 30s to 60s.

Estrogen levels decline more quickly in the latter 1–2 years of this period. Symptoms of menopause are common among women during this time.

Menopause

If your last menstruation (period) was a year ago (you have not had a period of 12 consecutive months), you are in the menopause stage. If you want to avoid becoming pregnant, you should continue using birth control for at least a full year following her last menstruation.

Signs and symptoms of menopause

Keep in mind you may encounter the following symptoms and indicators in the months or years (perimenopause) before officially going into menopause:

• Vasomotor symptoms (VMS): hot flashes, nocturnal sweats, flushing

  Hot flashes: Among the most prevalent signs of menopause involves hot flashes, which includes a short hot feeling, and is generally experienced by nearly 75% of women.

  However, every woman experiences hot flashes differently in terms of severity, frequency, and length. Fortunately, the severity of hot flashes often decreases with time.

  Hot flashes can cause: sweating, a chilling sensation following the heat, having a flushed or red face

• Unusual menstrual cycles, also referred to as irregular periods
• Vaginal dryness and/or burning
• Painful intercourse
• Shivers or chills
• Issues with sleep, including insomnia
• Mood swings
• Depression
• Increased weight and decreased metabolism
• Hair loss and/or thinning
• Greater body hair production, especially on your face, neck, chest, and/or upper back
• Dry skin, as well as dry mouth and/or eyes
• Frequent headaches
• Decline in breast volume, or experiencing sore or tender breasts
• Increased urination
• Urinary tract infections (UTIs)
• Racing heart
• Decrease in muscle mass

During this time, your ovaries no longer produce the majority of their estrogen and cease the production of eggs.

Keep in mind that the severity and length of symptoms frequently worsen under circumstances that affect the health of your ovary, including cancer, or specific lifestyle conditions, such as smoking.

While menopause symptoms might last up to 10 years, many women go through them for 5 years.

After you have gone 12 months without a menstrual cycle, your doctor may diagnose you with menopause.

It’s important to know that an increased risk of osteoporosis, heart disease, cognitive decline, vaginal changes, libido loss, and mood swings are linked to early menopause.

Postmenopause

Postmenopause is the years following menopause.

Hot flashes and nocturnal sweats associated with menopause often subside. However, as you age, the health concerns associated with the decrease of estrogen rise, including osteoporosis, or bone loss, and heart disease.

How is menopause diagnosed?

Diagnostics are often not required to identify menopause. In some cases, your specialist could recommend completed particular blood tests to measure your levels of the following:

• Follicle-stimulating hormone (FSH) and estrogen: when menopause begins, your estrogen levels drop and your FSH levels rise.
• Thyroid-stimulating hormone (TSH): In some cases hypothyroidism, or under-active thyroid, can result in symptoms that generally resemble menopausal symptoms.

Although they are both costly and inaccurate, saliva and over-the-counter (OTC) urine tests are also available

Additionally, the Food and Drug Administration (FDA) has recently authorized a new blood test called the PicoAMH Elisa diagnostic test. This test is performed to evaluate if a woman has reached menopause or is on the verge of doing so.

What are complications that could arise from menopause?

As you get older, the following health issues become more prevalent because of the lack of estrogen associated with menopause.

After menopause, women are more likely to experience some of the following:

• Osteoporosis, or bone loss
• Heart disease
• Increased likelihood of developing Alzheimer’s disease
• Vision problems
• Bladder issues
• Decreased sex drive

Medication options

If your symptoms are severe or are impairing your quality of life, you might need therapy.

Women who are under the age of 60, or within the first 10 years of menopause, may benefit from hormone therapy for the management of menopausal symptoms.

Oral hormonal medications

Estradiol (brand: Estrace, Vivelle)

Estradiol is a form of estrogen to treat the menopause symptoms, including hot flashes, vaginal pain, burning, itching, or dryness. Additionally, Estradiol is often used to prevent of bone fractures, also known as osteoporosis.

Common side effects:

• Nausea
• Vomiting
• Diarrhea or upset stomach or stomach cramps
• Headache
• Changes in your mood
• Weight gain
• Trouble sleeping, including insomnia
• Cold-like symptoms, including stuffy nose, sinus pain, or sore throat

Conjugated Equine Estrogens (Premarin tablets)

Premarin is used to prevent bone loss, or osteoporosis, in menopausal women as well as treat menopause symptoms including hot flashes and vaginal changes.

Common side effects:

• Hair loss
• Swelling
• Back pain
• Breast pain
• Abdominal issues, including bloating, gas, ingestion, nausea and/ vomiting
• Vaginal itching or discharge
• Dizziness
• Headache

Medroxyprogesterone (Provera)

This medication is a contraceptive that can be used endometrial hyperplasia, an overgrowth of the uterine lining that occurs after menopause and could raise your risk of uterine cancer.

Common side effects:

• Vaginal itching or discharge
• Breast tenderness or discharge
• Hair loss
• Weight gain
• Extreme fatigue and tiredness
• Vision changes

Topical hormone therapy

17-Beta-Estradiol

Brand: Vagifem (vaginal tablet), Estring (vaginal ring), Estrace (vaginal cream)

This medication is often used to treat menopause symptoms, including dryness, burning, and irritation in and around the vagina.

Common side effects:

• Swelling that may occur in your hands and/or feet
• Weight gain
• Breast pain
• Vaginal itching and discharge
• Abdominal issues, including stomach cramps, nausea, vomiting, and/ or bloating
• Headache

Conjugated Equine Estrogens (Premarin)

Vaginal cream: 0.625 mg/gram. This vaginal cream is used in the vagina to treat the vaginal symptoms, including dryness, burning, irritation, and/or painful sexual intercourse.

Common side effects:

• Pelvic pain or breast pain
• Flushing, which could include redness, warmth, and/or a tingling sensation
• Vaginal itching or discharge
• Headache

Non-hormone medications

Gabapentin (brand: Neurontin)

This medication belongs to a drug class knowns gamma-aminobutyric acid analogs, commonly abbreviated as “GABA.”

Although Gabapentin is Food and Drug Administration (FDA) approved to treat seizures, it has also been shown to be effective in decreases hot flashes.

Women who cannot utilize estrogen treatment or who frequently have nocturnal hot flashes might also benefit from this medication.

Common side effects:

• Swelling that may occur in your legs or feet
• Fever, chills, sore throat, and/or body aches
• Vision problems
• Extreme fatigue or tiredness
• Nausea and/or vomiting

Ospemifene (brand: Osphena): 60 mg tablet

This medication is a selective estrogen receptor modulator that’s commonly used to relieve vaginal dryness and painful sexual intercourse, also called dyspareunia, caused by menopause in women

Keep in mind that this medication has risks associated with its use and is not indicated for mild symptoms, but topical vaginal products are safer for this purpose.

Common side effects:

• Hot flashes
• Vaginal discharge
• Increased sweating
• Headaches
• Night sweats

Paroxetine (brand: Brisdelle)

7.5 mg taken by mouth every night. This medication is a selective serotonin reuptake inhibitor, commonly abbreviated as “SSRI,” often used to treat hot flashes caused by menopause in women.

Common side effects:

• Increased sweating
• Extreme fatigue, tiredness, and/or dizziness
• Sleep problems, including insomnia
• Decreased appetite
• Vision changes
• Nausea, vomiting, diarrhea, or constipation
• Reduced sex drive

Topical Minoxidil (brand: Rogaine)

Can be used once a day to regrow your hair or for thinning hair

Common side effects: changes in the color or texture of your hair

Natural treatment options

Black Cohosh

Used for hot flashes as well as night sweats

It's important to know that whether black cohosh is effective at reducing hot flashes has been the subject of conflicting research. According to some research, it could be helpful for short-term therapy of mild hot flashes and nocturnal sweats, and could even reduce blood pressure, as well.

Soy

Could possibly decrease your hot flashes as well as night sweats

Several studies have discovered that soy could be useful in lowering menopausal symptoms. Even so, some studies have also found no benefit.

It’s important to know that certain edible forms of soy, including tofu and soy milk, are preferred. Soy that's in tablet or powder form is not recommended.

Flaxseed

Often used for hot flashes during menopause

Despite conflicting findings from research, certain women may find relief from their symptoms. It is also thought to assist in lowering cholesterol.

Vitamin D supplements

Used to prevent bone loss caused by osteoporosis, and helps strengthen your bones

Vitamin E

Used for vaginal dryness as well as hot flashes

Lifestyle changes

Little to moderate menopausal symptoms can be potentially reduced naturally in a number of ways, including through lifestyle adjustments, home remedies, and alternative therapy, including the following:

• Continuously exercising for about 20 to 30 minutes daily, and maintaining a healthy weight
• Getting enough sleep
• Decrease alcohol consumption
• Supplements, including taking vitamin D, calcium, and magnesium
• Consuming a balanced diet, including fruits, vegetables, and whole grains
• Quitting smoking and tobacco cessation

When to see a doctor

Menopause affects women in various ways. Although menopausal symptoms are relatively common, you should still see a doctor to help manage them, find out which therapies might lessen discomfort, and discuss any concerns you may have.

Is it still possible to get pregnant during menopause?

Postmenopausal women are no longer able to become pregnant. Yet, being pregnant during the menopausal transition, or perimenopause is possible.

You should continue using birth control until you are certain that you have reached menopause if you don't want to get pregnant. It's important to note that before stopping the use of your birth control, it's recommended to first consult your doctor.