Overview
Menopause occurs when for 12 consecutive months a woman has not had her period and can no longer get pregnant naturally. It usually starts between 45 and 55 years old, but can develop before or after this age group.
Uncomfortable symptoms, such as hot flashes and weight gain can be caused by menopause. For most women, no medical treatment is needed for menopause.
When does menopause start and how long it last?
Symptoms of menopause are developed in most women about four years before their last period. Symptoms often persist for up to about four years after a woman’s last period.
A small number of women experience symptoms of menopause for up to a decade before menopause actually occurs, and 1 in 10 women experience symptoms of menopause for 12 years after their last period.
The median age of menopause is 51, although it can occur on average up to two years earlier for black and Latin women. More studies are needed to understand the onset of menopause in women of color.
There are many factors that help determine when you will begin menopause, including genetics and ovarian health. Perimenopause occurs before menopause. A time when your hormones start to change in preparation for menopause is perimenopause.
It can last from months to several years. Many women begin perimenopause after their mid-forties. Other women skip perimenopause and suddenly enter menopause.
Before the age of 40, about 1 percent of women start menopause which is called premature menopause or primary ovarian failure. About 5 percent of women experience menopause between the ages of 40 and 45. This is called early menopause.
Perimenopause vs menopause vs postmenopause
During perimenopause, periods become irregular. Your period may be late, or entirely, you may skip one or more periods. The menstrual flow may be heavier or lighter.
A lack of menstruation for a full year is known as menopause.
Postmenopause refers to the years after menopause.
What are the symptoms of menopause?
Every woman’s experience of menopause is unique. When menopause comes on suddenly or over a shorter period of time, its symptoms are more severe.
Conditions that impact the health of the ovary, such as cancer or hysterectomy, or certain lifestyle choices, such as smoking, tend to increase the severity and duration of symptoms.
Menstrual changes aside, the symptoms of perimenopause, menopause, and postmenopause are generally the same. The most common early signs of perimenopause are:
- less frequent periods
- heavier or lighter periods than you normally experience
- vasomotor symptoms, including hot flashes, night sweats, and redness
It is estimated that 75% of women experience hot flashes with menopause.
Other common symptoms of menopause include:
- insomnia
- vaginal dryness
- weight gain
- depression
- anxiety
- difficulty concentrating
- memory problems
- decreased libido or sex drive
- dry skin, mouth and eyes
- increased urination
- sore or tender breasts
- headache
- Beating heart
- urinary tract infections (UTIs)
- reduced muscle mass
- painful or stiff joints
- reduced bone mass
- less full breasts
- thinning or falling hair
- increased hair growth in other areas of the body, such as the chest, face, neck, and upper back
Complications
Common complications of menopause include:
- vulvovaginal atrophy
- dyspareunia or painful intercourse
- slower metabolic function
- osteoporosis or weaker bones with less mass and strength
- sudden mood or emotional changes
- cataracts
- periodontal disease
- urinary incontinence
- heart or vascular disease
Why does menopause occur?
Menopause is a natural process that occurs as the age of ovaries grow and produce less reproductive hormones.
The body undergoes many changes in response to lower levels of:
- estrogen
- progesterone
- testosterone
- follicle stimulating hormone (FSH)
- luteinizing hormone (LH)
One of the most seen changes is the loss of active ovarian follicles. Ovarian follicles are the structures that produce and release eggs from the ovarian wall, enabling fertility and menstruation.
Most women first notice that the frequency of their periods becomes less constant, as the flow becomes heavier and longer. This usually happens at some point in the mid to late 1940s. By the age of 52, most American women have gone through menopause.
In some cases, menopause is induced or caused by injury or surgical removal of the ovaries and associated pelvic structures.
Common causes of induced menopause include:
- bilateral oophorectomy or surgical removal of the ovaries
- ovarian removal or failure of ovarian function, which may be done with hormone therapy, surgery, or radiation therapy in women with estrogen receptor positive tumors
- pelvic radiation
- pelvic injuries that destroy the ovaries or severely damage them
How is menopause diagnosed?
It is worth talking to your health care provider if you are experiencing debilitating menopause symptoms, or at 45 years of age or under, if you have menopause symptoms.
Recently, the Food and Drug Administration approved a new blood test known as the PicoAMH Elisa diagnostic test. This test is used to help determine if a woman has entered menopause or is about to enter menopause.
This new test may be useful for women with symptoms of perimenopause, which can also have adverse health effects. Early menopause is associated with a higher risk of cognitive changes, heart disease, osteoporosis and fracture, vaginal changes and loss of libido and mood changes.
Your doctor may also order a blood test that will measure the level of certain hormones in the blood, usually FSH and a form of estrogen called estradiol.
Consistently elevated FSH blood levels of 30 mIU / mL or more, combined with a consecutive year lack of menstruation, is usually a confirmation of menopause. Over-the-counter (OTC) saliva and urine tests are also available, but they are unreliable and expensive.
During perimenopause, FSH and estrogen levels fluctuate daily, so most healthcare providers will diagnose this condition based on medical history, menstrual information, and symptoms.
Depending on your symptoms and medical history, your healthcare professional may also order additional blood tests to help rule out other underlying conditions that could be responsible for your symptoms.
Additional commonly used blood tests to help confirm menopause include:
- thyroid function tests
- blood lipid profile
- Liver function tests
- kidney function tests
- tests for testosterone, progesterone, prolactin, estradiol and chorionic gonadotropin (hCG)
Treatments
You may need treatment if your symptoms are severe or affect your quality of life. Hormonal therapy can be effective treatment in women under the age of 60, or within 10 years of the onset of menopause, for the reduction or management of:
- hot flashes
- night sweats
- rinsing
- vaginal atrophy
- osteoporosis
Other medicines can be used to treat more specific symptoms of menopause, such as hair loss and vaginal dryness.
Additional medications sometimes used for symptoms of menopause include:
- 5 percent topical minoxidil, used once a day for thinning and hair loss
- dandruff shampoos, typically 2 percent ketoconazole and 1 percent zinc pyrithione, used for hair loss
- topical eflornithine hydrochloride cream for unwanted hair growth
- selective serotonin reuptake inhibitors (SSRIs), usually paroxetine 7.5 milligrams for anxiety, depression, and hot flashes
- non-hormonal vaginal moisturizers and lubricants
- low-dose estrogen-based vaginal lubricants in cream, ring or tablet form
- ospemifene for vaginal dryness and painful intercourse
- prophylactic antibiotics for recurrent urinary tract infections
- sleeping pills for insomnia
- denosumab, teriparatide, raloxifene or calcitonin for postmenstrual osteoporosis
