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

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

  What are the signs of perimenopause? 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). More »

Depression at perimenopause

New research has confirmed a link between depression and the menopausal transition, or perimenopause — that time of erratic periods, chaotic hormone fluctuations, disturbed sleep, and, for some, uncomfortable hot flashes. Among the findings: little or no correlation between hormone levels and depression during perimenopause. However, a host of other factors have been implicated. In 2006, the Harvard Study of Moods and Cycles reported that one in six participants with no history of depression developed depressive symptoms during perimenopause. In addition to hormone fluctuations, researchers have explored the possible influence of psychosocial factors, hot flashes and their impact on sleep, and genetic vulnerabilities. In 2006, the Study of Women's Health Across the Nation identified several genetic mutations that increase the likelihood of perimenopausal depressive symptoms. In the March/April 2008 issue of the journal Menopause, scientists published data from the Seattle Midlife Women's Health Study. Most of the 302 participating women were in their late 30s or early 40s in the early 1990s, when the 15-year study began. More »

Nighttime awakenings in menopause may be caused by sleep disorders, not hot flashes

Hot flashes aren't anybody's friend, but they may be getting an unfair rap for disrupting women's sleep at midlife. Studies have often reported that sleep problems increase during the menopausal transition, reinforcing the idea that hot flashes (also called vasomotor symptoms) are to blame. But even under controlled conditions in sleep laboratories, the connection between hot flashes and sleep disruption remains unclear. Moreover, in certain circumstances, vasomotor symptoms may be the result — not the cause — of nighttime awakenings. Now, a study concludes that some of the sleep problems that women typically attribute to hot flashes may instead be caused by primary sleep disorders such as apnea. The findings suggest that women may not be receiving appropriate treatment for their sleep difficulties. To determine the cause of poor sleep in peri- and postmenopausal women, researchers at Wayne State University School of Medicine in Detroit assessed the sleep of 102 women, ages 44 to 56, who reported having trouble sleeping. The researchers found that 31 women had periodic limb movements (PLM), 23 had sleep apnea, and six had both. In other words, 53% had a primary sleep disorder. Among the entire group, 56% had measurable hot flashes. A separate analysis of the data showed that while apnea, PLM, and brief awakenings were the best predictors of poor sleep in the laboratory, on the questionnaires completed beforehand, poor sleep was more likely to be associated with anxiety and hot flashes during the first half of the night. The Wayne State investigation is the first to examine menopausal sleep complaints using both objective and subjective measures. The study was small and may not be representative of all menopausal women with sleep complaints. But the finding that half the women in this sample had primary sleep disorders, not just hot flashes, bears further investigation. Sleep problems are often assumed to result from hot flashes, but treating hot flashes isn't likely to resolve a serious underlying sleep disorder. More »