Menopause

Menopause doesn’t have to sideline you. Learn more about managing menopause and staying active throughout your whole life.

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.

We call the years leading up to menopause perimenopause. Beginning in your 30s and 40s, the amount of estrogen produced by the ovaries begins to fluctuate. 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 normal during perimenopause, you still should report them to your health care provider. Abnormal bleeding may be a sign of a problem.

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. Dryness of vaginal tissues 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.

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, most often affecting the bones of the hip, wrist, and spine.

The estrogen produced by women’s ovaries before menopause protects against heart attack and stroke. Women lose much of this protection when the body makes less estrogen after menopause. 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.

Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and/or progestin therapy. If you have never had a hysterectomy and still have a uterus, you will need to take both hormones. Estrogen plus progestin sometimes is called combined hormone therapy or simply hormone therapy. Taking progestin helps reduce the risk of cancer of the uterus 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?

Your health care provider can prescribe estrogen in several forms. In addition to pills, estrogen can be applied to the skin. This treatment includes skin patches, gels and sprays. If your doctor provides progestin, you can take it separately or combined with estrogen in the same pill. It also comes in 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?

Studies show that systemic estrogen therapy (with or without progestin) treatment works best for the relief of hot flashes and night sweats. Both systemic and local types of estrogen therapy relieve vaginal dryness. Systemic estrogen protects against the bone loss that occurs 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 lining of the uterus to grow and can increase the risk of uterine cancer.
• Combined hormone therapy is associated with a small increased risk of heart attack. This risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy.
• Studies have showed a increased risk of stroke and eep vein thrombosis with combined hormone therapy and estrogen-only therapy . Forms of therapy not taken by mouth (patches, sprays, rings, and others) do not carry as great of a risk of developing a 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 greatest with oral forms of therapy.

Your doctor may prescribe an antidepressant to treat hot flashes. He or she may also recommend Gabapentin, an anti-seizure medication, and clonidine, a blood pressure medication. These drugs can help manage hot flashes and ease the sleep problems commonly associated with menopause.

Selective estrogen receptor modulators are drugs that act on tissues that respond to estrogen. Two drugs containing selective estrogen receptor modulators are available for the relief of hot flashes and pain during intercourse caused by vaginal dryness.

Plant and Herbal Supplements

Plants and herbs that have been used for relief of 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 U.S. Food and Drug Administration does not regulate the way that these products are made. There is no guarantee that the product contains safe ingredients or effective doses of the substance. If you do take one of these products, be sure to let your health care provider know.

Bioidentical Hormones

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 provider’s prescription. The U.S. Food and Drug Administration does not regulate compounded drugs. They have the same risks as hormone therapies approved by the U.S. Food and Drug Administration, but they also may have additional risks because of the way they are made. There is no scientific evidence that compounded hormones are safer or more effective than standard hormone therapy.

Vaginal Moisturizers and Lubricants

You can use these over-the-counter products  to help with vaginal dryness and painful sexual intercourse that may occur during menopause. They do not contain hormones, so they do not have an effect on the vagina’s thickness or elasticity. Vaginal moisturizers replace moisture and restore the natural acidity of the vagina. You can use them every 2–3 days as needed. You can safely use lubricants each time you have sexual intercourse.

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 your overall health. Weight-bearing exercise, such as walking, can help keep bones strong. Strength training strengthens your muscles and bones by resisting against 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, which could lead to broken bones.

Routine health care — Visit your health care provider once a year to have regular exams and tests. Dental checkups and eye exams are important, too. Routine health care visits, even if you are not sick, can help detect problems early.