Menopause: All That You Need to Know

Introduction

A woman who has not had menstrual periods for 12 consecutive months and cannot become pregnant naturally may have entered menopause. Usually, menopause age spans between the ages of 45 and 55. However, it can occur before or after the age range, 45 – 55 years. Menopause symptoms vary.

For example, hot flashes and weight gain are very common and uncomfortable symptoms. However, most women do not need medical treatment for menopause.

When does menopause start?

Menopause symptoms occur in most women about four years before their last period. These symptoms continue until about four years after their last period.

Actually, a few women may experience symptoms for 10 years before menopause begins. Also, 1 in 10 women have symptoms for 12 years after their last period.

The median age for menopause is 51 years. However, in African-American and Latina women, menopause may begin up to 2 years earlier.

For non-Caucasian women, more studies need to be done to better understand menopause onset.

What are the factors determining onset of menopause?

Many factors such as genetics and ovary health determine a woman’s menopause age. Perimenopause precedes menopause.

Perimenopause occurs when your hormones begin to change in preparation for menopause. It may last a few months or several years. Perimenopause occurs in many women in their mid-40s.

However, some women do not experience perimenopause before entering menopause. About 1%  of women enter menopause age before they clock 40 years of age. This is called primary ovarian insufficiency or premature menopause.

Also, about 5% of women may reach menopause age early between the ages of 40 and 45 years.

How to distinguish between perimenopause, menopause, and postmenopause

Menstrual periods become irregular during perimenopause. You may miss one or more periods or your periods may come late. During perimenopause, your menstrual flow may also become lighter or heavier.

Menstruation occurs when a woman has not experienced menstrual periods for one full year.

On the other hand, postmenopause refers to the period or years following menopause.

What are the menopause symptoms?

It is important to note that every woman’s experience of menopause is unique. Symptoms usually become more severe when menopause begins suddenly, or occurs over a shorter period of time.

Certain lifestyle choices such as smoking may increase the duration and severity of menopause symptoms. Also, conditions impacting ovary health such as cancer, or hysterectomy may worsen the symptoms.

Apart from menstruation changes, the perimenopause, menopause and postmenopause symptoms are typically the same.

Here are the most common early signs of perimenopause:

• Vasomotor symptoms including night sweats, flushing and hot flashes
• Lighter or heavier periods than normally experienced
• Less frequent menstruation

Common menopause symptoms include:

• Hot flashes (75% of women experience hot flashes)
• Vaginal dryness
• Anxiety
• Insomnia
• Weight gain
• Depression
• Reduced libido
• Memory problems
• Sore or tender breasts
• Increased urination
• Dry skin
• Increased hair growth on the face, neck, chest and upper back
• Dry eyes and mouth
• Urinary tract infections
• Headaches
• Difficulty concentrating
• Painful joints
• Stiff joints
• Reduced muscle mass
• Reduced bone mass
• Hair thinning or loss
• Less full breasts
• Racing heart

What are the common complications of menopause?

The complications of menopause include:

• Cataracts
• Vulvovaginal atrophy
• Periodontal disease
• Heart disease
• Blood vessel disease
• Urinary incontinence
• Mood or sudden emotional changes
• Slower metabolic function
• Dyspareunia (painful intercourse)
• Osteoporosis (weaker bones with reduced mass and strength)

Why is menopause inevitable?

Menopause occurs naturally as the ovaries age, producing less reproductive hormones.

The body undergoes changes as it responds to lower levels of estrogen, testosterone, progesterone, follicle stimulating hormone and luteinizing hormone.

A major change that occurs is the loss of active ovarian follicles. Ovarian follicles produce and release eggs from the ovary, allowing menstruation and fertility.

Most women first observe reduced frequency of their periods which come with heavier and longer flow. They experience this change in their mid- to late 40s. Most U.S. women, for example, have undergone menopause by the age of 52 years.

In some cases, menopause may be induced. It may also be caused by injury or surgical removal of the ovaries and the surrounding structures.

Common induced menopause causes include:

• Ovarian ablation (shutdown of ovary function) may be done by hormone therapy, radiotherapy or surgery in women with estrogen receptor-positive tumors
• Bilateral oophorectomy (surgical removal of the ovaries)
• Pelvic injuries that destroy or damage the ovaries
• Pelvic radiation

How is menopause diagnosed?

Speak with your doctor if you experience disabling or troublesome menopause symptoms. Similarly, talk to your doctor if you are 45 years of age or younger and experience menopause symptoms.

Your doctor may ask for PicoAMH Elisa diagnostic test to determine whether you have entered or about to enter menopause. This test was approved by the Food and Drug Administration.

The PicoAMH Elisa test may help women with premenopause symptoms which can be associated with adverse health impact. For example, early menopause is associated with a high risk of heart disease, vaginal changes, osteoporosis and fracture, mood changes, cognitive changes and loss of libido.

Also, your doctor may order a blood test for hormones like follicle stimulating hormone (FSH) and estradiol.

Consistent blood FSH levels of 30mIU/mL or higher alongside absent menstruation for 12 consecutive months usually confirm menopause. Though expensive and unreliable, saliva tests and over-the-counter urine tests are also available.

FSH and estrogen levels fluctuate daily during perimenopause. So most healthcare professionals usually diagnose menopause based on symptoms, menstrual information and medical history.

Your healthcare provider may also order additional blood tests depending on your symptoms and health history. These tests will help rule out other underlying conditions that may cause your symptoms.

Additional blood tests that help confirm menopause include:

• Blood lipid profile
• Thyroid function tests
• Kidney function tests
• Testosterone, prolactin, chorionic gonadotropin (hCG), progesterone and estradiol tests
• Liver function tests

How is menopause treated?

You may need to talk to your doctor if your symptoms affect your quality of life. Also, visit your doctor if your symptoms are severe. Your doctor may recommend hormone therapy if you are under the age of 60.

Hormone therapy is effective in ameliorating symptoms such as night sweats, vaginal atrophy, hot flashes, flushing and osteoporosis in women under the age of 60 years.

Similarly, hormone therapy may be effective in women within 10 years of the onset of menopause.

For vaginal dryness and hair loss, the following medications may be used:

• Eflornithine hydrochloride topical cream for hair growth
• Nonhormonal vaginal moisturizers
• Topical minoxidil 5%, for hair thinning and loss
• Selective serotonin reuptake inhibitors like paroxetine for depression, hot flashes and anxiety
• Sleep medications for insomnia
• Prophylactic antibiotics for urinary tract infections
• Raloxifene, teriparatide, calcitonin or denosumab for postmenstrual osteoporosis
• Low-dose estrogen-based vaginal lubricants, used as a tablet, ring or cream
• Ospemifene for painful intercourse and vaginal dryness
• Antidandruff shampoos like 2% ketoconazole and 1% pyrithione for hair loss

Home remedies for menopause

You can reduce some symptoms naturally. Lifestyle changes, home remedies and in fact some other natural treatments may be effective.

Here are important tips for managing menopause symptoms at home:

Exercise and control your weight

Try to exercise for at least 20 to 30 minutes a day. Also, try to reduce daily intake of calories by 400 to 600 calories. This will help you manage your weight.

Exercising can help improve your mood, promote your health and wellbeing, increase your energy and promote a good night sleep.

Communicate your needs

If you feel anxious, isolated, unable to sleep well, sad or depressed, talk to a psychologist or a therapist about it.

Also, try to talk to your loved ones, family members or friends about feelings of mood changes, depression, anxiety or identity changes. Communicating your needs will attract appropriate support.

Stay comfortable and keep cool

Dress in loose clothing especially at night and during an unpredictable or warm weather. Wearing loose clothing will help you manage hot flashes.

Try and keep your bedroom cool. Avoid heavy blankets at night to reduce your chances of night sweats.

If you sweat regularly at night, you can place a waterproof sheet under your bedding to protect your mattress.

Also, try to use fan to cool you down if you experience flushing.

Take care of your skin

Try to reduce skin dryness by applying moisturizers daily. Also, try to avoid excessive swimming or bathing to prevent skin irritation or getting your skin dried out.

Quit smoking and limit alcohol use

Quit smoking. Also, avoid exposure to second hand smoke. Your menopause symptoms may get worse if you smoke.

Try and limit your intake of alcohol to prevent your symptoms from getting worse. Further drinking heavily during menopause may increase your health risks.

Manage your sleep problems

You can use over-the-counter drugs to manage your sleep problems temporarily. Talk to your doctor for possible use of natural sleep aids.

Also, let your doctor know if you have trouble sleeping. They can help you manage it so you will get a good night of sleep.

Herbal remedies

Limited studies support the use of herbal remedies for menopause symptoms due to estrogen deficiency.

Natural supplements

Some natural supplements and nutrients may help improve menopause symptoms. They include vitamin E, isoflavone, melatonin, soy and flaxseed.

Some people claim that black cohosh may limit symptoms like night sweats and hot flashes. However, recent research provides little evidence to corroborate these claims.

Also, another research in 2015 provides no evidence supporting the claim that omega-3 fatty acids improve vasomotor symptoms of menopause.

Conclusion

Menopause heralds the end of fertility as it is the natural end of a woman’s menstrual cycle. As noted above, most women enter menopause at the age 52. However, menopause may begin suddenly earlier in life due to ovarian or pelvic damage.

You may experience menopause symptoms such as night sweats, flushing and hot flashes few years before menopause onset. You may continue to experience these symptoms for four or more years after menopause has occurred.

Hormone therapy may help to improve severe symptoms. Finally, symptoms may be managed with lifestyle changes and natural remedies.

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