Menopause

What is menopause?

Menopause is the time in your life when you stop having your period and can no longer get pregnant. You have reached menopause when you have not had a period for 12 months.

The time leading up to menopause is called the menopausal transition, or perimenopause. This transition usually begins when you are in your 40s, but sometimes it can start earlier. It can last for several years. The most common age for reaching menopause is between 45 and 55 years old.

What is early and premature menopause?

Early and premature menopause happens when your ovaries stop making hormones and your periods stop at a younger age than usual. When menopause happens before age 40, it's called premature menopause. If menopause happens before age 45, it's called early menopause.

This can happen on its own (with no known cause). It can also happen because of surgery to remove the ovaries. Surgery to remove the uterus alone will cause your periods to stop, but it does not cause menopause unless the ovaries are also removed. Medical treatments such as chemotherapy or hormone therapy used to treat breast cancer may also cause menopause to start earlier than usual.

A condition called primary ovarian insufficiency (POI) happens when your ovaries stop working normally before you are age 40. But this condition is different from early menopause. If you have POI, you may still have periods, even though they might not come regularly. And you might still be able to get pregnant.

Other reasons for early or premature menopause can include:

• A family history of early or premature menopause
• Smoking
• Certain health conditions

What are the symptoms of menopause?

During the menopausal transition, your ovaries start to make less of the estrogen and progesterone hormones. The changes in these hormones cause the symptoms of menopause, which can include:

• A change in your periods; they may be:
  • Irregular, with more or less time in between periods.
  • Shorter or longer.
  • Lighter or heavier.
• Hot flashes, a sudden warm feeling in your face, neck, and chest. They may cause you to sweat. If they happen at night and cause sweating, they are called night sweats.
• Trouble sleeping, such as trouble falling asleep or getting back to sleep when you wake up. Over time, a lack of sleep can lead to fatigue and memory problems.
• Vaginal dryness, which may cause pain or discomfort during sexual intercourse.
• Mood changes, which can make you feel moody, anxious, or more irritable.
• Bladder issues, such as urinary incontinence (loss of bladder control) and urinary tract infections (UTIs).

You may also have other physical changes which could put you at risk for certain diseases. For example, the loss of estrogen can:

• Cause you to lose bone density. This can lead to osteoporosis, a condition that causes bones to become weak and break easily.
• Raise your cholesterol levels and increase your risk of heart disease and stroke.

What are the treatments for the symptoms of menopause?

You may not need treatment for the symptoms of menopause. But if you do, there are several different types of treatments:

Lifestyle changes

You may find that you can manage your symptoms with lifestyle changes. Here are some changes that might make you feel better:

• If you have hot flashes, dress in layers that can be removed at the start of a hot flash. You may want to carry a portable fan to use when you get a hot flash.
• Avoid alcohol, spicy foods, and caffeine. They can make your menopause symptoms worse.
• If you smoke, try to quit, not only for hot flashes, but for your overall health.
• Try to maintain a healthy weight. Being overweight or having obesity can make hot flashes worse.
• Have good sleep habits. Keep your bedroom dark, quiet, and cool.
• Get regular exercise. It can help you sleep better, improve your mood, and help lower your risk for many age-related diseases.
• Lower stress, for example by using relaxation techniques such as meditation, deep breathing, and muscle relaxation exercises.

If lifestyle changes are not enough to improve your symptoms, you may want to contact your health care provider. They will talk to you about your symptoms, family and medical history, and preferences. They also can explain the risks and benefits of the treatments.

Non-hormone treatments

There are various non-hormone treatments for menopause symptoms, such as:

• Medicines for hot flashes, including certain antidepressants, a medicine just for hot flashes, an antiseizure medicine, and a blood pressure medicine. Some of these medicines may also help with sleep problems.
• Medicines for urinary incontinence.
• Medicines to treat or help prevent osteoporosis.
• Low-dose birth control pills for very heavy bleeding or periods that are close together.
• Water-based lubricants to treat vaginal dryness.
• Medicines for painful intercourse that is caused by vaginal changes from menopause.
• Cognitive behavioral therapy (CBT), a type of talk therapy, for trouble sleeping.

Hormone treatments

Like all medicines, hormone therapy for menopause has benefits and risks. Talk with your provider about whether it is safe for you. If you decide to take it, your provider may recommend taking the lowest dose that works for the shortest time needed.

Supplements, herbs, and "natural" hormone creams

There are various products that are marketed for menopause symptoms. They include supplements, herbs, and over-the-counter "natural" hormone creams. There has been research on many of these products, but the results are mixed. Some studies suggest they may help, while others show little or no benefit. Also, there is little information on the long-term safety of these products. Some supplements can have harmful side effects or interact with medicines. Check with your provider before you take any of them.

Questions for your care team

General prompts to help prepare for your appointment.

• How does this information apply to my situation?
• Which symptoms or results need evaluation?
• Which tests are useful, and what can they tell us?
• What care options, benefits, and risks should we discuss?
• When should I seek urgent help, and whom should I call?
• When is follow-up, and how will we know whether the plan is working?