The Menopause Years

Menopause is the time in your life when you naturally stop having menstrual periods. Menopause happens when the ovaries stop making estrogen. Estrogen is a hormone that helps control the menstrual cycle. Menopause marks the end of the reproductive years. The average age that women go through menopause is 51 years.

Perimenopause

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What is Perimenopause?

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The years leading up to menopause are called perimenopause. Beginning in your 30s and 40s, the amount of estrogen produced by the ovaries fluctuates. A common sign of perimenopause is a change in your menstrual cycle. Cycles may become longer than usual for you or become shorter. You may begin to skip periods. The amount of flow may become lighter or heavier. Although changes in menstrual bleeding are regular during perimenopause, you still should report them to your health care professional. Abnormal bleeding may be a sign of a problem.

Symptoms

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Some women do not have any symptoms of perimenopause or have only a few mild symptoms. Others have many symptoms that can be severe. Common signs and symptoms include the following:

  • Hot flashes—A hot flash is a sudden feeling of heat that rushes to the upper body and face. A hot flash may last from a few seconds to several minutes or longer. Some women have hot flashes a few times a month. Others have them several times a day. Hot flashes that happen at night (night sweats) may wake you up and cause you to feel tired and sluggish during the day.
  • Sleep problems—You may have insomnia (trouble falling asleep) or wake up long before your usual time. Night sweats may disrupt your sleep.
  • Vaginal and urinary tract changes—As estrogen levels decrease, the lining of the vagina may become thinner, dryer, and less elastic. Vaginal dryness may cause pain during sex. Vaginal infections also may occur more often. The urethra can become dry, inflamed, or irritated. This can cause more frequent urination and increase the risk of urinary tract infections.

Health Risks

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The estrogen produced by women’s ovaries before menopause protects against heart attacks and stroke. Women lose much of this protection when less estrogen is made after menopause. Midlife is also when risk factors for heart disease, such as high cholesterol levels, high blood pressure, and being physically inactive, are more common. These combined factors increase the risk of heart attack and stroke in menopausal women.

Menopause

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What is Menopause?

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Menopause is the time in your life when you naturally stop having menstrual periods. Menopause happens when the ovaries stop making estrogen. Estrogen is a hormone that helps control the menstrual cycle. Menopause marks the end of the reproductive years. The average age that women go through menopause is 51 years.

Symptoms

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Some women do not have any symptoms of perimenopause or have only a few mild symptoms. Others have many symptoms that can be severe. Common signs and symptoms include the following:

  • Hot flashes—A hot flash is a sudden feeling of heat that rushes to the upper body and face. A hot flash may last from a few seconds to several minutes or longer. Some women have hot flashes a few times a month. Others have them several times a day. Hot flashes that happen at night (night sweats) may wake you up and cause you to feel tired and sluggish during the day.
  • Sleep problems—You may have insomnia (trouble falling asleep), or you may wake up long before your usual time. Night sweats may disrupt your sleep.
  • Vaginal and urinary tract changes—As estrogen levels decrease, the lining of the vagina may become thinner, dryer, and less elastic. Vaginal dryness may cause pain during sex. Vaginal infections also may occur more often. The urethra can become dry, inflamed, or irritated. This can cause more frequent urination and increase the risk of urinary tract infections.

Health Risks

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A small amount of bone loss after age 35 years is normal for both men and women. But during the first 4–8 years after menopause, women lose bone more rapidly. This rapid loss occurs because of the decreased levels of estrogen. If too much bone is lost, it can increase the risk of osteoporosis. Osteoporosis increases the risk of bone fracture. The bones of the hip, wrist, and spine are affected most often.

What other health risks increase during perimenopause and menopause?

The estrogen produced by women’s ovaries before menopause protects against heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. Midlife also is the time when risk factors for heart disease, such as high cholesterol levels, high blood pressure, and being physically inactive, are more common. All of these combined factors increase the risk of heart attack and stroke in menopausal women.

Treatment Options

Hormone Therapy

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Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus, a hormone called progestin. Estrogen plus progestin sometimes is called “combined hormone therapy” or simply “hormone therapy.” Taking progestin helps reduce the risk of uterus cancer that occurs when estrogen is used alone. If you do not have a uterus, estrogen is given without progestin. Estrogen-only therapy sometimes is called “estrogen therapy.”

How is hormone therapy given?

Estrogen can be given in several forms. Systemic forms include pills, skin patches, gels, and sprays applied to the skin. If progestin is prescribed, it can be given separately or combined with estrogen in the same pill or a patch. With systemic therapy, estrogen is released into the bloodstream and travels to the organs and tissues where it is needed. Women who only have vaginal dryness may be prescribed “local” estrogen therapy in the form of a vaginal ring, tablet, or cream. These forms release small doses of estrogen into the vaginal tissue.

What are the benefits of hormone therapy?

Systemic estrogen therapy (with or without progestin) is the best treatment for relieving hot flashes and night sweats. Both systemic and local types of estrogen therapy relieve vaginal dryness. Systemic estrogen protects against bone loss early in menopause and helps prevent hip and spine fractures. Combined estrogen and progestin therapy may reduce the risk of colon cancer.

What are the risks of hormone therapy?

Hormone therapy may increase the risk of certain types of cancer and other conditions:

  • Estrogen-only therapy causes the uterus lining to grow and can increase the risk of uterine cancer.
  • Combined hormone therapy is associated with a small increased risk of a heart attack. This risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy.
  • Combined hormone therapy and estrogen-only therapy are associated with a small increased risk of stroke and deep vein thrombosis (DVT). Forms of therapy not taken by mouth (patches, sprays, rings, and others) may have less risk of causing deep vein thrombosis than those taken by mouth. Combined hormone therapy is associated with a small increased risk of breast cancer.
  • There is a small increased risk of gallbladder disease associated with estrogen therapy with or without progestin. The risk is most significant with oral forms of therapy.

Bioidentical hormones

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Bioidentical hormones come from plant sources. They include commercially available products and compounded preparations. A compounding pharmacist makes compounded bioidentical hormones from a health care professional’s prescription. Compounded drugs are not regulated by the U.S. Food and Drug Administration (FDA). Compounding pharmacies must be licensed, but they do not have to show the safety, effectiveness, and quality control that the FDA requires of drug makers. The American College of Obstetricians and Gynecologists recommends FDA-approved hormone therapy over compounded hormone therapy.

Other Medicines

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Several antidepressants are available for the treatment of hot flashes. Gabapentin, an antiseizure medication, and clonidine, a blood pressure medication, are prescription drugs that can be prescribed to reduce hot flashes and ease sleep problems associated with menopause. Selective estrogen receptor modulators (SERMs) are drugs that act on tissues that respond to estrogen. SERMs are available to relieve hot flashes and pain during intercourse caused by vaginal dryness.

Vaginal ointments and lubricants

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These over-the-counter products can help with vaginal dryness and painful sexual intercourse during menopause. They do not contain hormones, so they do not affect the vagina’s thickness or elasticity. Vaginal moisturizers can be used every 2–3 days as needed. Lubricants can be used each time you have sexual intercourse.

Plant and Herbal Supplements

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Plants and herbs used to relieve menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness. Also, the way that these products are made is not regulated. There is no guarantee that the product contains safe ingredients or effective doses of the substance. If you take one of these products, be sure to let your health care professional know.

How to stay healthy

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A healthy lifestyle can help you make the best of the years after menopause. The following are some ways to stay healthy during midlife:

  • Nutrition—Eating a balanced diet will help you stay healthy before, during, and after menopause. Be sure to include enough calcium and vitamin D in your diet to help maintain strong bones.
  • Exercise—Regular exercise slows down bone loss and improves overall health. Weight-bearing exercise, such as walking, can help keep bones strong. Strength training strengthens your muscles and bones by resisting weight, such as your own body, an exercise band, or handheld weights. Balance training, such as yoga and tai chi, may help you avoid falls, leading to broken bones.
  • Routine health care—Visit your health care professional once a year to have regular exams and tests. Dental checkups and eye exams are essential, too. Even if you are not sick, routine health care visits can help detect problems early.

Frequently Asked Questions

What is the link between osteoporosis and menopause?

Estrogen, a female hormone, protects against bone loss. After menopause, the ovaries produce very little estrogen. This decrease in estrogen triggers a period of rapid bone loss in women that starts one year before the final menstrual period and lasts for about three years. The natural effects of aging on bones may also contribute to this bone loss.

How can osteoporosis be prevented?

Lifestyle plays a crucial role in preventing osteoporosis. Exercise, a healthy diet, and not smoking can help keep your bones strong and healthy.

How will menopause affect my sex drive?

My patients are usually hesitant to bring up this topic – understandably, it’s very personal.

The fluctuation of hormones during menopause can lead to vaginal dryness, which in turn causes pain during sex. Then women may find they don’t initiate sex anymore for fear of this pain.

Vaginal moisturizers and lubricants can provide relief. Talk with your ob-gyn about topical or oral medications if those don’t work. (See Experiencing Vaginal Dryness? Here’s what you need to know.)

Don’t be resigned to abstinence after middle age. With some help, everything can work as you want it to.

Will menopause increase your chances of getting a UTI?

The answer is yes; women going through menopause have a greater risk of getting a UTI. Women, in general, are more likely than men to get UTIs. This is because the urethra is shorter and closer to the anus in a woman than a man. This means bacteria can reach the bladder more easily.

Symptoms of UTIs can come on quickly. One sign is a strong urge to urinate that cannot be delayed (urgency). Sharp pain or burning may be felt in the urethra as urine flows. The desire to urinate then returns minutes later (frequency). There may be soreness in the lower abdomen, in the back, or on the sides.

How can perimenopause and menopause affect sleep quality?

Many women have hot flashes during perimenopause and menopause. Hot flashes can make it hard to sleep. Sleep problems reported by women during menopause include:

  • trouble falling asleep
  • trouble staying asleep
  • waking up often during the night
  • getting up too early

Women also may be more likely to experience mood disorders, sleep apnea, and chronic medical conditions as they age, affecting sleep quality.

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