What is menopause?

Most women think of menopause as the time of life when their menstrual periods end. This usually occurs during middle age, when women are also experiencing other hormonal and physical changes. For this reason, menopause is sometimes called the "change of life".

A woman is said to be in menopause after she has gone for one full year without periods. While most women in the United States go through menopause around the age of 51, a small number will experience menopause as early as age 40 or as late as their late 50s. Rarely, menopause occurs after age 60. When menopause is diagnosed before age 40, it is considered to be abnormal or premature menopause.

For most women, menopause is a normal process of aging. If a woman has had her ovaries removed by surgery or has had damage to her ovaries for other reasons, such as radiation therapy, she may become menopausal from that process.

A hot flash is a feeling described as suddenly being hot, flushed and uncomfortable, especially in the face and neck. Hot flashes come in bursts or flushes that usually last a few seconds to a few minutes. They are caused by changes in the way blood vessels relax and contract and are thought to be related to the changes in a woman's estrogen levels.

A woman can have irregular periods for several months to years before her periods finally stop. Any vaginal bleeding that develops after a year of no periods is abnormal and should be evaluated by a doctor.

As estrogen levels fall, the vagina's natural lubricants decrease. The lining of the vagina gradually becomes thinner and less elastic (less able to stretch). These changes can cause sex to be uncomfortable or painful. They can also lead to inflammation in the vagina known as atrophic vaginitis. These changes can make a woman more likely to develop vaginal infections from yeast or bacterial overgrowth and urinary tract infections.

Before menopause, women have lower rates of heart attack and stroke than men. After menopause, however, the rate of heart disease in women continues to rise and equals that of men after age 65.

For most women, the diagnosis of menopause is made based on a woman's description of her symptoms and the ending of her menstrual periods. Laboratory testing is not usually needed.

Because women can still become pregnant while they are perimenopausal, doctors may do a pregnancy test when a woman's periods become irregular, infrequent or light. In some cases, a blood test for levels of follicle-stimulating hormone (FSH) may be recommended. FSH levels are normally high in menopause, so high FSH levels can help to confirm that a woman is in menopause.

Perimenopause usually lasts three to five years but it can take as few as two years or as many as eight years for some women. The changes in the body that occur during menopause last for the rest of a woman's life. However hot flashes usually improve over time, becoming less frequent and less severe

A number of medications are used to treat the symptoms of menopause. The type of medication needed is a complicated decision and each woman should discuss the issue with her doctor. The treatment will depend on what symptoms are most bothersome and how bothersome they are.

Estrogen taken as a pill or applied to the skin as a patch can reduce hot flashes, sleep disturbances, mood changes and vaginal dryness. Estrogen can be prescribed alone when a woman no longer has her uterus. A combination of estrogen and progesterone is used when a woman still has her uterus. Progesterone is necessary to balance estrogen's effect on the uterus and prevent changes that can lead to uterine cancer.

However, recent evidence has shown that there are some risks associated with the use of these medicines. Estrogen therapy can increase the risk of heart disease, stroke, breast cancer and blood clots in a small number of women. On the other hand, it prevents fractures and can decrease the risk of colon cancer. Therefore, the decision to use hormone replacement therapy to treat symptoms of menopause is an individual decision. A woman should talk to her doctor about the risks and benefits of hormone replacement therapy for her.

The Gabapentin (Neurontin) moderately effective in treating hot flashes. Gabapentin's main side effect is drowsiness. Taking it at bedtime may help improve sleep while decreasing hot flashes.

Etidronate (Didronel), alendronate (Fosamax) and other similar drugs are the most effective medicines that can be used to both prevent and treat osteoporosis. They increase bone density and decrease the risk of fractures.

Raloxifene (Evista) drug has some of the beneficial effects of estrogen without the increased risk of breast cancer. It is effective in building bone strength and preventing fractures.

There is no relation between the time of a woman's first period and her age at menopause. The age at menopause is not influenced by a woman's race, height, number of children or use of oral contraceptives.

Terms on this page

Anxiety

• A state of uneasiness and apprehension, as about future uncertainties.


• Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.

Chlorella

• Chlorella is a genus of single-celled green algae, belonging to the phylum Chlorophyta. It is spherical in shape, about 2 to 10 nm in diameter, and is without flagella. Chlorella contains the green photosynthetic pigments chlorophyll-a and -b in its chloroplast. It depends on photosynthesis for growth and multiplies rapidly, requiring only carbon dioxide, water, sunlight, and a small amount of minerals..

Estrogen

• Any one of a group of hormones synthesized by the reproductive organs and adrenal glands in females and, in lesser quantities, in males. The estrogens cause the thickening of the lining of the uterus and vagina in the early phase of the ovulatory, or menstrual, cycle; in lower animals cyclical estrogen secretion also induces estrus, or "heat". The estrogens are also responsible for female secondary sex characteristics such as, in humans, pubic hair and breasts, and they affect other tissues including the genital organs, skin, hair, blood vessels, bone, and pelvic muscles..

Menopause

• The period marked by the natural and permanent cessation of menstruation, occurring usually between the ages of 45 and 55.

PMS

• Premenstrual syndrome.

Perimenopause

• The time period prior to menopause that may last 10 to 15 years, even beginning in one's 30s. It is associated with decreased ovarian function and decreasing estrogen levels.

Progesterone

• Steroid hormone secreted by the female reproductive system that functions mainly to regulate the condition of the endometrium (see uterus), preparing it to accept a fertilized egg. If the egg is not fertilized, the level of progesterone drops, the uterine lining breaks down, and menstruation ensues. If the egg is fertilized, the placenta produces progesterone, whose effects include preparing the mammary glands for lactation..

Biopsy

• Bone marrow aspiration, also called bone marrow sampling, is the removal by suction of fluid from the soft, spongy material that lines the inside of most bones. Bone marrow biopsy, or needle biopsy, is the removal of a small piece of bone marrow.

Climacteric

• A period of life characterized by physiological and psychic change that marks the end of the reproductive capacity of women and terminates with the completion of menopause.


• A corresponding period sometimes occurring in men that may be marked by a reduction in sexual activity, although fertility is retained.

Depression

• In psychiatry, a symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection.

Estrogen

• Any one of a group of hormones synthesized by the reproductive organs and adrenal glands in females and, in lesser quantities, in males.

Hormone

• A substance, usually a peptide or steroid, produced by one tissue and conveyed by the bloodstream to another to effect physiological activity, such as growth or metabolism.

Osteoporosis

• A disease in which the bones become extremely porous, are subject to fracture, and heal slowly, occurring especially in women following menopause and often leading to curvature of the spine from vertebral collapse.

Premenstrual syndrome

• The syndrome occurs in several distinct forms: emotional upheaval, including anxiety, irritability, insomnia, depression, forgetfulness, confusion, and lethargy; cravings for sweets, increased appetite, and intolerance to sugar (headache, heart palpitations, fatigue, and fainting); and fluid retention symptoms with weight gain, puffiness of hands and feet, breast swelling and tenderness, and abdominal bloating and tenderness. Some women suffer with symptoms of all these forms, others only a few..

Progesterone

• A drug prepared from natural or synthetic progesterone, used in the prevention of miscarriage, in the treatment of menstrual disorders, and as a constituent of some oral contraceptives.


• A female hormone that acts on the inner lining of the uterus and prepares it for implantation of the fertilized egg.

Stress

• A state of extreme difficulty, pressure, or strain.


• A physical and psychological response that results from being exposed to a demand or pressure.

Testosterone

• A white crystalline steroid hormone, C19H28O2, produced primarily in the testes and responsible for the development and maintenance of male secondary sex characteristics. It is also produced synthetically for use in medical treatment.

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