Menopause

Menopause marks the end of a woman's menstrual periods. A woman has officially gone through menopause when it has been one year since her last period.

In the months to years before menopause—a time called perimenopause—the production of hormones that regulate the menstrual cycle changes.

In the United States, the average age of menopause is 51. But there is a wide range: some women have their last period in their 40s, others in their late 50s.

Anything that damages the ovaries or stops estrogen production can cause menopause to occur earlier. These include:

  • smoking
  • chemotherapy or radiation therapy
  • surgery to remove the ovaries

Symptoms of menopause

Each woman’s experience of perimenopause and menopause is unique. Common symptoms of perimenopause and menopause include:

  • irregular periods
  • hot flashes and night sweats
  • vaginal dryness
  • disturbed sleep
  • urinary incontinence

Women are also more likely to develop depression for the first time or have it recur. Some women report trouble with memory and the ability to concentrate.

Easing menopause symptoms

There are effective ways to deal with some of the symptoms of menopause.

Irregular periods. Low-dose birth control pills are an option for nonsmokers. Use of progesterone-like hormones also can help control heavy, irregular bleeding.

Vaginal dryness. Over-the-counter vaginal moisturizers can relieve dryness.

Hot flashes. Many women can manage hot flashes with self-help approaches like beginning deep-breathing exercises at the beginning of a hot flash, wearing loose, comfortable clothing and dressing in layers, keeping the work place and home —especially the bedroom — cool.

Taking estrogen or other hormones can be safe and effective for short-term relief of symptoms like hot flashes and night sweats—provided it’s prescribed with a woman’s individual health in mind. Hormone therapy is also effective for preventing osteoporosis in women at high risk for breaking bones.

Menopause Articles

When sex gives more pain than pleasure

Millions of women experience pain before, during, or after sexual intercourse—a condition called dyspareunia. Many suffer in silence and don't seek the help they need, or they have trouble finding a clinician who can diagnose and treat the causes of their pain. That is unfortunate, because treatments are available for many of the problems that underlie this vexing condition. More »

Bioidentical hormones: Help or hype?

Bioidentical hormones are promoted as being safer than FDA-approved postmenopausal hormones, but their production is not regulated and their claims of effectiveness have not yet been substantiated by long-term clinical trials. there’s been growing interest in “bioidentical” hormones, which are promoted as safer and more effective than FDA-approved hormones. The interest is driven in no small part by claims made in entertainer Suzanne Somers’  book, Ageless: The Naked Truth About Bioidentical Hormones (and her appearance on the Oprah Winfrey Show). More »

FDA-approved bioidentical hormones for menopausal symptoms

FDA-approved bioidentical hormones for menopausal symptoms Type/source Brand name(s) Preparations Bioidentical? Estrogens Estradiol Estrace, Gynodiol, Innofem Pill Yes*   Estrace Vaginal cream+ Yes   Alora, Climara, Esclim, Estraderm, FemPatch, Menostar, Vivelle, generic Transdermal patch Yes   Estrogel, Elestrin, Divigel Topical gel Yes   Evamist Topical spray Yes   Estring Vaginal ring+ Yes Estradiol acetate Femring Vaginal ring Yes++ Estradiol hemihydrate Vagifem Vaginal tablet+ Yes   Estrasorb Topical lotion Yes Progesterone Progesterone Prometrium Pill Yes Crinone 4% Vaginal gel Yes Combined hormones Estradiol and norethindrone acetate Combipatch Patch The estradiol is bioidentical but not the progestin. Estradiol and norgestimate Prefest Pill The estradiol is bioidentical but not the progestin. Estradiol and levonorgestrel Climara Pro Patch The estradiol is bioidentical but not the progestin. * Bioidentical estradiol until ingested and converted in the liver to estrone.+ For vaginal symptoms only.++ Converts to bioidentical estradiol in the bloodstream. (Locked) More »

Another drug prevents breast cancer in postmenopausal women

Exemestane (Aromasin), tamoxifen (Nolvadex, generic) and raloxifene (Evista) are three drugs used to prevent breast cancer in postmenopausal women who are at elevated risk for the disease. Exemestane appears to have less frightening side effects — hot flashes, joint pain, and loss of bone density. All three of these drugs target estrogen, which fuels the growth of most breast cancers, but exemestane belongs to a different class of drugs, called aromatase inhibitors, which work by blocking the body's production of estrogen. Previous studies have shown that aromatase inhibitors are more effective than tamoxifen in preventing breast cancer from recurring. This study, funded Pfizer, and conducted under the auspices of the National Cancer Institute's clinical trials unit, looked at whether exemestane could reduce the likelihood of a first occurrence of breast cancer. (Locked) More »

Major depression more likely during perimenopause than during premenopause

Perimenopause begins several years before menopause (the end of menstruation) and ends a year after the last menstrual period. During this transition, ovarian hormones are in flux, resulting in irregular periods and sometimes vasomotor symptoms (hot flashes and night sweats). In a study, approximately one-third of women in perimenopause had at least one episode of major depression. (Locked) More »

Hormone therapy: The next chapter

Hormone therapy (HT) was a mainstay of postmenopausal health care. Besides relieving hot flashes and other troublesome symptoms, it was thought to offer protection against a host of degenerative disorders. Perimenopausal women were commonly urged to consider HT, not just for symptom relief but also for benefits that included protection against osteoporosis and possibly heart disease, colon cancer, and Alzheimer's disease. Its risks were thought to be limited — mainly increased susceptibility to breast cancer and gallbladder disease. Today HT is linked not only to these conditions but also to an increased risk for stroke, blood clots, and Alzheimer's disease. Amid the growing evidence of harmful effects it's still too early to close the book on HT. More »

Perimenopause: Rocky road to menopause

(This article was first printed in a previous issue of the Harvard Women's Health Watch. For more information or to order, please go to www.health.harvard.edu/womens.) You're in your 40s, you wake up in a sweat at night, and your periods are erratic and often accompanied by heavy bleeding: Chances are, you're going through perimenopause. Many women experience an array of symptoms as their hormones shift during the months or years leading up to menopause — that is, the natural end of menstruation. Menopause is a point in time, but perimenopause (peri, Greek for "around" or "near" + menopause) is an extended transitional state. It's also sometimes referred to as the menopausal transition, although technically, the transition ends 12 months earlier than perimenopause (see "Stages of reproductive aging" below). Perimenopause has been variously defined, but experts generally agree that it begins with irregular menstrual cycles — courtesy of declining ovarian function — and ends a year after the last menstrual period. More »