Menopause marks a significant milestone in a person’s life, denoting the culmination of 12 consecutive months without a menstrual period. It is a natural facet of the ageing process, signifying the conclusion of one’s reproductive years.
On average, menopause typically occurs around the age of 51. In the United States, more than a third of women, or approximately 36 million individuals, have experienced menopause. With a life expectancy of around 81 years, a woman reaching 50 can anticipate living more than one-third of her life beyond menopause. The scientific exploration of this phase and the intricacies of menopause’s biology is only just beginning, with many questions yet to be answered.
Menopause stands as the juncture in a woman’s life when menstruation permanently ceases, symbolizing the end of her fertility. Often referred to as the “change of life,” menopause constitutes the final phase of a gradual biological process in which the ovaries progressively reduce their production of female sex hormones.
This hormonal decline typically commences roughly 3–5 years before the occurrence of the last menstrual period. This transitional stage is known as the climacteric or perimenopause. Menopause is formally acknowledged once a woman has gone without menstruation for a full year, with an average onset at around age 50.
However, the timing of menopause, akin to the onset of menstruation in adolescence, varies from person to person. Notably, cigarette smokers tend to experience menopause at an earlier age than non-smokers.
Menopause: An Overview
Menopause is the definitive endpoint of menstrual cycles, officially confirmed after a continuous absence of menstruation for 12 months. Although menopause can manifest in one’s 40s or 50s, the typical age of onset in the United States is 51.
Menopause constitutes a natural biological progression, yet its physical symptoms, such as hot flashes, and emotional challenges may disrupt sleep, deplete energy levels, or impact emotional well-being. Fortunately, a range of effective treatments exists, ranging from lifestyle modifications to hormone therapy.
What is menopause?
Menopause crystallizes as a moment when an individual has traversed 12 uninterrupted months without experiencing a menstrual cycle. The period leading up to menopause is termed perimenopause, during which many women or individuals assigned female at birth (AFAB) begin transitioning into menopause. This phase may entail alterations in menstrual patterns and the emergence of symptoms like hot flashes.
Stages of menopause
Menopause, a natural biological process, marks the permanent cessation of menstruation and occurs without the influence of medical treatments. This transformative journey unfolds gradually, encompassing three distinct stages:
Perimenopause or “Menopause Transition”:
Perimenopause typically commences eight to ten years before menopause, when the ovaries gradually reduce their estrogen production. This phase commonly initiates in one’s 40s and persists until the onset of menopause, characterized by the cessation of egg release from the ovaries.
In the final one to two years of perimenopause, the decline in estrogen becomes more rapid, leading to the emergence of menopausal symptoms. Importantly, during this phase, menstrual cycles continue, and pregnancy remains a possibility.
Menopause:
Menopause signifies the moment when menstrual periods cease altogether. At this juncture, the ovaries cease both the release of eggs and the majority of estrogen production. Medical professionals typically diagnose menopause after an individual has gone without a menstrual period for 12 consecutive months.
postmenopause:
Post-menopause refers to the period following a full year without menstruation (or the entirety of one’s life after menopause). During this stage, menopausal symptoms like experiencing hot flashes may subside. However, some individuals may continue to experience these symptoms for a decade or more after the menopause transition. Due to lower estrogen and progestin levels, those in the postmenopausal phase face an increased risk of various health conditions, including osteoporosis and heart disease.
How does menopause occur?
The ovaries play a pivotal role in the process of menstruation. They house structures known as follicles that cradle the egg cells. At birth, an individual possesses approximately 2 million egg cells, but by the onset of puberty, only around 300,000 remain. Of these, only 400 to 500 will ever fully mature and be released during the menstrual cycle.
Over the years, the majority of these egg cells degenerate. Throughout the reproductive years, the pituitary gland in the brain produces hormones that prompt the release of a new egg from its follicle each month. Simultaneously, the follicle increases the production of sex hormones like estrogen and progesterone.
These hormones work together to thicken the lining of the uterus, preparing it to receive and nurture a fertilized egg in the event of conception. If fertilization does not occur, estrogen and progesterone levels drop, causing the uterine lining to break down, leading to menstruation.
Why does hormone production decline?
The reason behind the decline in hormone production by the ovaries starting in the mid-thirties remains unknown. However, this process accelerates in the late forties, resulting in hormone fluctuations that lead to irregular menstrual cycles and sporadic episodes of heavy bleeding.
By the early to mid-fifties, menstrual periods eventually cease. Nevertheless, estrogen production does not come to a complete halt. While the ovaries significantly reduce their output, they may still produce a small quantity.
Additionally, a different form of estrogen is generated in fat tissue with assistance from the adrenal glands, situated near the kidneys. Although this form of estrogen is weaker than that produced by the ovaries, its levels increase with age and the amount of fat tissue in the body.
Progesterone
Progesterone, the other crucial female hormone, plays a critical role in the latter half of the menstrual cycle. It creates a suitable uterine lining for a potential fertilized egg and triggers the shedding of this lining if fertilization does not occur.
If you skip a menstrual period, it could indicate that your body is not producing enough progesterone to initiate the breakdown of the uterine lining, even though your estrogen levels may remain elevated in the absence of menstruation.
During menopause, hormone levels do not consistently decline linearly; they fluctuate periodically. These shifting levels of ovarian hormones impact other glands in the body, collectively forming the endocrine system, which governs processes like growth, metabolism, and reproduction.
To function effectively, this system must continually adapt to changing hormone levels. Ovarian hormones also exert influence on various body tissues, including the breasts, vagina, bones, blood vessels, gastrointestinal tract, urinary tract, and skin.
Surgical Menopause
For premenopausal women who undergo surgical removal of both their ovaries, the onset of menopause is sudden and can be accompanied by more pronounced and enduring menopausal symptoms compared to those who experience natural menopause. They may endure more intense and frequent hot flashes, which persist for an extended duration.
Additionally, they face an elevated risk of developing heart disease and osteoporosis, and they may be more susceptible to experiencing depression. The precise reasons behind these heightened symptoms remain a mystery. In cases where only one ovary is surgically removed, menopause typically follows its natural course.
In situations involving a hysterectomy (removal of the uterus) while leaving the ovaries intact, menstrual periods cease, but any other menopausal symptoms that arise generally manifest at the same age they would during natural menopause. Nonetheless, some women who have undergone a hysterectomy may encounter menopausal symptoms at a younger age.
Symptoms of Menopause
The experience of menopause is highly individualized, with some women noticing minimal changes in their bodies or moods, while others find the transition to be considerably bothersome and disruptive. Estrogen and progesterone, two pivotal hormones, exert their effects on various tissues throughout the body, yet these effects can vary significantly from person to person.
Hot Flashes
Hot flashes, also known as flushes, rank as the most prevalent symptom of menopause, impacting over 60 per cent of menopausal women in the United States. A hot flash entails a sudden surge of intense heat in the upper body or across the entire body.
This sensation may cause the face and neck to flush, with red patches appearing on the chest, back, and arms. This is often followed by profuse sweating and subsequent cold shivering as the body regulates its temperature. Hot flashes can persist for a few moments or stretch on for 30 minutes or more.
These hot flashes occur sporadically and frequently, and begin several years before other signs of menopause become evident. Over time, they typically decrease in both frequency and intensity as a person ages.
How Hot Flashes Occur
Approximately 80 percent of women experiencing hot flashes do so for two years or less, while a smaller percentage may contend with them for over five years. Hot flashes can occur at any time and range from mild to severe, occasionally even disrupting sleep.
Some women find that certain triggers like caffeine, alcohol, hot beverages, spicy foods, and stressful or frightening events can provoke hot flashes. Nonetheless, avoiding these triggers may not guarantee the prevention of all episodes.
Hot flashes appear to result directly from declining estrogen levels. As estrogen levels drop, the body responds by releasing higher quantities of other hormones that impact the brain’s temperature regulation, leading to fluctuations in body temperature. Hormone therapy is a commonly employed approach to alleviate the discomfort associated with hot flashes.
Managing Hot Flashes
While some women report slight relief from hot flashes with vitamin E, it’s important to note that there hasn’t been a comprehensive study to substantiate this claim. Apart from hormone therapy, which may not be suitable for everyone, here are some suggestions to relieve hot flashes:
- Dress in layers to easily remove clothing at the onset of a hot flash.
- Consume a glass of cold water or juice as soon as a hot flash begins.
- Keep a thermos of iced water or an ice pack by your bedside at night.
- Opt for cotton sheets, lingerie, and clothing to promote better ventilation for your skin.
Vaginal and Urinary Tract Changes
As women age, the walls of the vagina tend to become thinner, drier, less elastic, and more susceptible to infections. These alterations can make sexual intercourse uncomfortable or even painful. Many women find it beneficial to use water-soluble lubricants, which help reduce the risk of infection.
It’s advisable to steer clear of petroleum jelly, as some women are allergic to it and it can damage condoms. If problems persist, consulting a gynaecologist is crucial.
Changes also occur in the tissues of the urinary tract with age, potentially rendering women more susceptible to involuntary urine leakage, known as incontinence. This risk increases, especially in the presence of certain chronic illnesses or urinary infections.
Activities such as exercise, coughing, laughing, lifting heavy objects, or other movements that exert pressure on the bladder may lead to minor urine leakage. It’s essential to recognize that incontinence is not a typical aspect of ageing to be masked by using adult diapers; instead, it is often a treatable condition warranting medical evaluation.
Bladder Training
Recent research highlights bladder training as a simple and effective treatment for most cases of incontinence, which is also more cost-effective and safer than medication or surgery.
Within four to five years after the final menstrual period, there is an elevated risk of vaginal and urinary tract infections. If you experience symptoms such as painful or frequent urination, it’s advisable to consult your doctor. Infections can be readily treated with antibiotics, although they may recur.
To help prevent these infections, consider urinating before and after intercourse, ensuring that your bladder is not full for extended periods, maintaining proper hydration, and maintaining cleanliness in your genital area. Douching is not considered an effective method for infection prevention.
Menopause and Mental Health
A common misconception depicts menopausal women as prone to unpredictable mood swings, depression, and unexplained stress. However, a study conducted by psychologists at the University of Pittsburgh suggests that menopause is not a primary cause of erratic mood swings, depression, or stress in most women.
In fact, for some, it may even lead to improved mental health, challenging the notion that menopause is inherently negative. The Pittsburgh study examined three groups of women: menstruating women, menopausal women not undergoing hormone therapy and menopausal women on hormone therapy.
The findings indicated that menopausal women did not experience more anxiety, depression, anger, nervousness, or stress than menstruating women within the same age range. Surprisingly, the group of menopausal women not taking hormones reported experiencing more hot flashes, yet they exhibited better overall mental health compared to the other two groups. Women on hormone therapy, however, reported greater concerns about their bodies and slightly higher levels of depression.
Nevertheless, it’s essential to consider that hormone therapy itself may contribute to these effects, or that women voluntarily opting for hormone therapy might have a heightened awareness of their bodies.
Research About Menopause and Mental Health
The researchers caution that their study focused solely on healthy women, so the results may not apply universally. Other research indicates that women who are already taking hormones and are experiencing mood or behavioural issues sometimes respond positively to adjustments in hormone dosage or type.
Studies have revealed that women in their childbearing years, particularly those with young children at home, are more likely to report emotional challenges compared to women in other age groups.
The findings from Pittsburgh align with those of a study conducted by the New England Research Institute, which found that menopausal women experienced depression at a rate similar to the general population.
Approximately 10 percent occasionally felt depressed, and 5 percent reported persistent depression. The exception was among women who underwent surgical menopause, who exhibited a depression rate reportedly twice as high as women experiencing natural menopause.
It’s also worth noting that many instances of depression appear to correlate more with life stressors or “mid-life crises” than solely with menopause. These stressors may involve shifts in family roles, such as children reaching adulthood and leaving home; altering social support networks, such as post-divorce changes in social circles; interpersonal losses like the death of a family member or spouse; and the onset of ageing and associated physical health concerns.
People respond differently to stress and crises, and an individual’s response can range from negative, leading to emotional distress and depression, to positive, resulting in the achievement of personal goals. For numerous women, this stage of life can represent a period of significant freedom.
Signs of Menopause
Menopause may be approaching if you begin encountering some or all of the following indications:
- Hot Flashes (Vasomotor Symptoms): Sudden sensations of warmth spreading across your body
- Night Sweats and/or Cold Flashes: Episodes of excessive perspiration at night or sudden bouts of coldness
- Vaginal Dryness: Uncomfortable dryness in the vaginal area, leading to discomfort during sexual intercourse.
- Urinary Urgency: A pressing need to urinate more frequently.
- Difficulty Sleeping (Insomnia): Challenges falling asleep or staying asleep.
- Emotional Changes: Mood swings, irritability, or mild depression.
- Dry skin, dry eyes, or dry mouth: Unusual dryness in these areas.
- Breast tenderness: Increased sensitivity or discomfort in the breasts.
- Worsening of Premenstrual Syndrome (PMS): Amplification of PMS symptoms.
- Irregular Periods: Periods that become irregular or vary in flow (heavier or lighter than usual).
Some individuals might also experience:
- Racing heart: Heart palpitations or increased heart rate.
- Headaches: Frequent or severe headaches.
- Joint and Muscle Aches and Pains: Discomfort or pain in joints and muscles.
- Changes in Libido (Sex Drive): Shifts in sexual desire.
- Difficulty Concentrating or Memory Lapses: Occasional struggles with focus or memory (often temporary).
- Weight gain: An increase in body weight.
- Hair Loss or Thinning: Diminished hair thickness or hair loss.
- Changes in Hormone Levels: These hormonal changes underlie these symptoms, with varying degrees of intensity from person to person. Not everyone will experience the same symptoms during their transition to menopause.
If you are uncertain whether your symptoms are related to menopause or another health condition, it is advisable to consult a healthcare provider.
Duration of Menopausal Symptoms
The symptoms of menopause can persist for up to a decade, although most individuals experience them for a shorter duration, typically less than five years.
What are hot flashes?
Hot flashes are among the most common menopausal symptoms, characterized by brief sensations of heat. They may also entail:
- A Red, Flushed Face: Facial redness.
- Sweating: Perspiration.
- A Chilled Feeling: A sensation of coldness following the heat.
The intensity, frequency, and duration of hot flashes vary from person to person. Generally, hot flashes tend to become less severe over time.
Signs and symptoms, including alterations in menstrual patterns, can differ among women. You’ll probably encounter irregularities in your menstrual cycles before they cease entirely.
The occurrence of skipped periods during perimenopause is both common and expected. Frequently, menstrual periods might skip a month and subsequently return, or they may be absent for several months before resuming every month for a brief period.
These periods might also occur on shorter cycles, bringing them closer together. Despite these irregularities, it’s important to note that pregnancy remains a possibility. If you’ve missed a period but are uncertain whether you’ve initiated the menopausal transition, it’s advisable to consider taking a pregnancy test for clarity.
What causes menopause?
Menopause, which occurs naturally (referred to as natural menopause), is an integral facet of the ageing process. It is characterized by a full year devoid of menstrual bleeding and typically excludes any surgery or medical conditions that could halt menstruation, such as hormonal birth control, radiation therapy, or surgical removal of the ovaries.
With the advancement of age, your reproductive cycle undergoes a gradual slowdown in preparation for eventual cessation. This cycle has been operational since puberty. As menopause approaches, your ovaries begin to produce diminished quantities of estrogen, a key hormone. This decline in estrogen marks the onset of changes in your menstrual cycle, leading to irregularities and ultimately its cessation.
Along with these hormonal fluctuations, you may also experience physical changes as your body adapts to varying hormone levels. The symptoms encountered during each stage of menopause (perimenopause, menopause, and postmenopause) are all part of your body’s adaptation to these transformations.
Hormonal Changes During Menopause
The hallmark changes often associated with “menopause” occur when the ovaries cease high-level hormone production. The ovaries, responsible for storing and releasing eggs, as well as producing the hormones estrogen and progesterone, play a vital role in regulating menstruation. Estrogen, in particular, influences calcium utilization in the body and maintains cholesterol levels in the bloodstream.
As menopause nears, the ovaries cease releasing eggs, culminating in your last menstrual cycle.
How to Determine Menopause
The definitive indication that you have entered menopause is the absence of menstruation for 12 consecutive months. If you experience any form of vaginal bleeding following menopause, it is crucial to contact your healthcare provider, as this could signify an underlying health concern.
Diagnosing Menopause
Healthcare providers employ several methods to diagnose menopause. Typically, your provider assesses your menstrual cycle history over the past year. Menopause is unique in that it is diagnosed after it occurs. If you have gone through a full year without a period (12 consecutive months), you have transitioned into menopause and may be considered postmenopausal.
Managing Menopause
While menopause is a natural process, some individuals may require treatment to alleviate disruptive menopausal symptoms. The primary aim of treatment during menopause is to address symptoms that significantly impact your quality of life. Various treatment options are available, including:
- Hormone Therapy: This therapy aims to supplement diminished hormone levels, particularly estrogen and progesterone, which can alleviate symptoms like hot flashes and vaginal dryness. It may also aid in preventing osteoporosis.
- Nonhormonal Treatments: Lifestyle and dietary adjustments, exercise, support groups, and prescription medications can help manage menopausal symptoms. These non-hormonal treatments are suitable for individuals with medical conditions or those who have recently undergone breast cancer treatment.
Hormone Therapy Details
Hormone therapy compensates for the loss of hormones that occurs during menopause. It elevates hormone levels, potentially alleviating symptoms like hot flashes and vaginal dryness. There are two main types of hormone therapy:
- Estrogen Therapy (ET): In this treatment, estrogen is administered alone, typically in a low dose, through various forms such as patches, pills, creams, vaginal rings, gels, or sprays. ET is not suitable for individuals who still have a uterus.
- Estrogen, Progesterone, and Progestin Hormone Therapy (EPT): Also known as combination therapy, EPT involves the use of estrogen and progesterone, which can be administered in their natural or synthetic forms (progestin). This therapy is suitable for individuals who retain their uterus.
It’s essential to weigh the benefits and risks of hormone therapy, as it may be associated with certain health risks, including endometrial cancer (in the case of estrogen therapy), gallstones, blood clots, deep vein thrombosis, pulmonary embolism, and stroke. The risks are generally lower when hormone therapy commences within ten years of menopause.
Severe hot flashes and night sweats have been linked to a higher risk of cardiovascular disease. In such cases, healthcare providers may recommend hormone therapy as an indicator of future cardiovascular risk.
Initiating hormone therapy is a personalized decision. It is crucial to discuss your medical history, family background, and specific needs with your healthcare provider to ascertain the suitability of hormone therapy.
Nonhormonal Therapies for Menopause
Nonhormonal treatments offer alternatives to hormone therapy for managing menopausal symptoms. These include dietary and lifestyle modifications, identification and avoidance of hot flashes triggers, regular exercise, participation in support groups, and prescription medications.
Dietary adjustments may include reducing caffeine and spicy food consumption, incorporating foods rich in plant estrogens, and maintaining hydration. Identifying and managing triggers for hot flashes, maintaining a cool sleeping environment, wearing layered clothing, quitting smoking, and achieving weight loss can help alleviate symptoms. Exercise, particularly activities like yoga, can enhance mood and reduce anxiety and stress.
Support groups provide an opportunity to connect with others experiencing menopause, facilitating emotional support and knowledge sharing. In some cases, healthcare providers may recommend nonhormonal medications, such as estrogen therapy (administered as a cream, gel, or pill), birth control pills, antidepressants (SSRIs and SNRIs), and prescription vaginal creams, to address specific symptoms.
Long-Term Health Risks Associated with Menopause
Several health conditions may carry a higher risk following menopause. The likelihood of these conditions varies depending on factors like family history, premenopausal health, and lifestyle choices. Two notable conditions are osteoporosis and coronary artery disease.
- Osteoporosis: This condition, characterized by decreased bone density, renders bones more fragile and susceptible to fractures. Estrogen plays a vital role in preserving bone mass, and its reduction during menopause contributes to bone loss.
On average, individuals lose 25% of their bone mass between menopause and age 60. Bone mineral density testing, or bone densitometry, can help assess bone health and detect osteoporosis or its precursor, osteopenia. Treatments, including estrogen therapy, may be prescribed for osteoporosis management.
- Coronary Artery Disease: This condition results from the narrowing or blockage of the arteries supplying the heart with blood. It is associated with the buildup of fatty plaque in artery walls (atherosclerosis), often linked to elevated cholesterol levels.
Following menopause, the risk of coronary artery disease increases due to factors like reduced estrogen levels, elevated blood pressure, decreased physical activity, and the cumulative effects of lifestyle habits (e.g., smoking and excessive alcohol consumption).
The benefits and risks of hormone therapy are influenced by age and medical history. Generally, individuals in their 50s tend to derive more benefits from hormone therapy than those in their 60s. Premature menopause cases, often treated with hormone therapy until age 50 to compensate for extended estrogen loss, are exceptions.
Living with Menopause
Menopause may affect various aspects of life, including sleep and sexual health. Some individuals may experience sleep disturbances and insomnia, often attributed to factors like hot flashes. Similarly, sexual health may be impacted due to reduced estrogen levels, leading to decreased arousal, sensitivity, and vaginal dryness. Additionally, other factors such as bladder control issues, sleep problems, stress, anxiety, depression, medical conditions, and medications can influence sexual desire during menopause.
Conversations with healthcare providers can help address these issues. Treatment options may include over-the-counter or prescribed lubricants for vaginal dryness or low-dose estrogen therapy in various forms. It’s important to note that not all individuals experience decreased sexual desire during menopause, and for some, it may even improve due to reduced pregnancy concerns.
Other Menopause-Related Questions
Can You Get Pregnant During Menopause? Once you have entered postmenopause, the possibility of pregnancy no longer exists. However, during the menopausal transition (perimenopause), pregnancy remains possible.
It is advisable to continue using contraception until you are certain that you have completed menopause, and consulting your healthcare provider is recommended before discontinuing contraception.
FAQs
Does menopause cause weight gain?
Menopause can influence weight because of hormonal changes and muscle loss associated with ageing. However, it is not a universal occurrence, and lifestyle factors play a significant role.
Does menopause affect dental and oral health?
Yes, hormonal changes during menopause can affect oral health, leading to symptoms like dry mouth, sensitive teeth, and gums. These changes may increase the risk of cavities and gingivitis.
Can menopause affect eye health?
Yes, dry eyes are one of the symptoms associated with the menopausal transition.
Can menopause lead to facial hair growth?
Facial hair growth can occur as a result of hormonal changes during menopause, with relatively higher testosterone levels. Various hair removal methods, including waxing, are available options.
Is difficulty concentrating and forgetfulness normal during menopause?
Concentration and memory problems can be normal during menopause for some individuals. Engaging in mentally stimulating activities, reducing passive behaviours like excessive television watching, regular exercise, and seeking medical advice can be beneficial.
Do men go through menopause?
While some refer to a gradual decline in testosterone levels in men as “andropause” or male menopause, it differs from the dramatic hormonal shifts seen in women during menopause. The intensity of symptoms is generally milder, and it occurs gradually over many years or decades.
Note:
Menopause is a highly individualized experience, and not all individuals will encounter the same symptoms or effects. Consultation with a healthcare provider is essential for personalized guidance and management.
Seeking Medical Guidance
Sustaining regular consultations with your healthcare professional for proactive health maintenance and addressing medical inquiries is essential. Maintain these appointments consistently throughout and following the onset of menopause.
As you age, proactive health management may encompass suggested health evaluation examinations, including colonoscopy, mammography, and triglyceride analysis. Your medical practitioner might also propose additional assessments and screenings, such as thyroid scrutiny if warranted by your medical history, as well as breast and pelvic inspections.
It is imperative to promptly consult with a healthcare specialist if you experience vaginal bleeding after the menopausal phase.
