As a woman ages, her concerns about menopause may increase. We hear about it from family and friends, on TV and from healthcare providers. A lot of what we hear has us dreading going through menopause. And maybe that’s because we don’t have all the right information on what we can actually expect and what our options are when it comes to treating it.
What is Menopause?
The American College of Obstetrics and Gynecology (ACOG) explains that menopause is the time in a woman’s life when she naturally stops having menstrual periods. Menopause is generally confirmed when 12 consecutive periods have been missed. However, other symptoms may be used to determine the onset of menopause.
This marks the end of the reproductive years. This is the basic definition, and as we will explore later, menopause involves more than the cessation of menstruation.
It is important to remember that menopause is not a disease. It is not something that is wrong with you. It is a normal and natural process.
In the years before menopause, women experience what is called perimenopause when periods can become irregular and flow changes. Perimenopause is triggered by the fluctuation of estrogen levels.
What Causes Menopause?
Basically, menopause occurs because the ovaries stop making estrogen and progesterone. Estrogen is a reproductive hormone that causes growth of the lining of the uterus. Progesterone is another reproductive hormone that is produced after ovulation. As you age, levels of both estrogen and progesterone, which also affects fertility, decline. While this is usually a naturally occurring process that happens with age there are a number of reasons this can happen:
- Natural decline, as stated above
- Hysterectomy that includes removal of the ovaries (known as total hysterectomy and bilateral oophorectomy) can cause immediate menopause
- Chemotherapy and radiation therapy can induce menopause during or after treatment. The effect is not always permanent
- Primary ovarian insufficiency; This is when your ovaries do not produce normal levels of reproductive hormones unrelated to age. This can be caused by genetic factors or autoimmune disease but sometimes the cause is unknown. In these cases, hormone therapy is often recommended until the age when menopause typically naturally occurs to protect against menopause-related risks.
When Does Menopause Occur?
The age women go through menopause obviously varies based on the individual but the average woman goes through menopause at 51 years old. With the most common range being between 45 and 55.
Perimenopause can start as early as your 30s, and more commonly in your 40s.
What are the Signs and Symptoms of Menopause?
There is a list of typical signs and symptoms of menopause that many women experience, but they vary from woman to woman. So, do not be worried or confused if you do not tick off every symptom on the list or if you experience other symptoms. Common symptoms include:
- Irregular periods or loss of menstrual period
- Most women will experience irregularity before their period stops completely.
- In perimenopause skipping periods is also common. Or skipping some and them having them regularly for several months can also be expected. Cycle length can also change. Pregnancy in perimenopause is still possible.
- Hot flashes
- Sleep problems
- Night sweats
- Mood changes
- Vaginal dryness
- Thinning and dry skin
- Weight gain and slowing metabolism
- Loss of breast tissue/fullness
- Foggy thinking/inability to focus
What Other Health Risks Come with Menopause?
Menopause is related to a decline in reproductive hormone levels, and this can have an effect on other medical conditions. During menopause risks and complications for the following conditions can increase:
- Heart and cardiovascular disease. This includes high cholesterol and high blood pressure. Also, inactivity leads to an increase in the risk of stroke and heart attack in menopausal women.
- Weight gain due to change in metabolism. As mentioned previously, during and after menopause, a woman’s metabolism may slow down so she may gain weight. Exercise regimens and diets may need to be adjusted to maintain a healthy weight.
- Osteoporosis, when bones become brittle and more prone to fracturing. After menopause, bone density may decrease quickly in the first few years.
- Sexual dysfunction, which is often linked to the vaginal dryness listed above. Loss of vaginal elasticity and decrease in libido might also occur.
- Urinary incontinence due to loss of vaginal and urethral elasticity. This can be combatted with pelvic floor exercises.
Are there Treatment Options for Menopause?
Now that you know the basics about menopause, you might be wondering if there is anything you can do once you inevitably go through it. The answer is definitely yes, there are treatment options for menopause. Speak to your doctor about which treatment is right for you. You may discuss the following options:
- Hormone therapy is the most effective treatment for menopausal symptoms. Estrogen therapy is extremely effective for hot flash relief and bone loss prevention. If you still have your uterus, progestin should also be given. Hormone therapy has been shown to be very beneficial, with the benefits significantly outweighing the risks. Using hormone therapy after menopause decreases the risk of osteoporosis, colon cancer, heart attack and stroke, and possibly even Alzheimer’s disease.
- Probably the most common form of hormone therapy is with the use of an estradiol (bioidentical estrogen) patch, but estrogen can also be given as a tablet, cream or gel. Progesterone is also necessary in many cases and is given in the form of a capsule.
- Hormone pellet therapy is a more convenient option to explore. Using bioidentical hormones, this type of therapy is long-lasting and customizable. Treatment is required every 3-4 months. Pellets are very popular outside the United States.
- Vaginal estrogen in the form of a ring, tablet or cream can help with dryness and relieve sexual discomfort and some urinary symptoms. This treatment is preferred by some women because it releases only very small amounts of estrogen locally to the vagina.
- Antidepressants administered in low doses can decrease hot flashes and are also useful for women who are unable to take estrogen. Obviously, this is also a good option for women with depression or other mood disorders.
- Osteoporosis medications can be used either to treat or prevent the disease.
- Traditional Chinese medicine using herbs and acupuncture also can provide relief for menopausal symptoms.
If you have concerns about menopause, whether you’re approaching it or currently experiencing it, call Dr. Clark at Chapel Hill Gynecology. She has extensive experience helping women through this phase and can guide you through choosing the right hormone therapy for you. Call (919) 960-2720 to schedule an appointment.