Menopause and Perimenopause

Menopause: What Is It?

Menopause is the permanent end of menstruation. It's a turning point, not a disease, but it can have a big impact on a woman's wellbeing. Although menopause can bring physical upheaval from hot flashes, night sweats, and other symptoms, it can also be the start of a new and rewarding phase of a woman's life -- and a golden opportunity to guard against major health risks like heart disease and osteoporosis.

What Causes Menopause?

Age is the leading cause of menopause. It's the end of a woman's potential childbearing years, brought on by the ovaries gradually slowing down their function. Certain surgeries and medical treatment can induce menopause. Those include surgical removal of the ovaries (bilateral oopharectomy), chemotherapy, and pelvic radiation therapy. Having a hysterectomy (surgical removal of the uterus) without removing the ovaries does not lead to menopause, although you will not have periods anymore.

When Does Menopause Start?

On average, women are 51 at natural menopause, notes the National Institute on Aging. But menopause can start earlier or later. A few women start menopause as young as 40, and a very small percentage as late as 60. Women who smoke tend to go through menopause a few years earlier than nonsmokers. There is no proven way to predict menopause age. It's only after a woman has missed her periods for 12 straight months, without other obvious causes, that menopause can be confirmed.

Before Menopause, Perimenopause

Natural menopause happens gradually. The ovaries don't abruptly stop; they slow down. The transition to menopause is called perimenopause. Menopause is a milestone -- it's the day that marks 12 months in a row since a woman's last period. During perimenopause, it's still possible to get pregnant -- a woman's childbearing years are winding down, and although her periods may become more unpredictable, her ovaries are still functioning and she still may ovulate, though not necessarily on a monthly basis.

Menopause: What to Expect

Menopause isn't a one-size-fits-all event. It affects each woman differently. Some women reach natural menopause with little to no trouble; others experience severe symptoms that drastically hamper their lives. And when menopause starts suddenly as a result of surgery, chemotherapy, or radiation, the adjustment can be tough. Here is a look at menopausal symptoms that many women experience, though the intensity can vary.

Menopause Sign: Period Changes

As menopause approaches, a woman's menstrual periods will likely change. But those changes can vary from woman to woman -- periods may get shorter or longer, heavier or lighter, with more or less time between periods. Such changes are normal, but the National Institute on Aging recommends seeing a doctor if your periods come very close together, if you have heavy bleeding or spotting, and if your periods last more than a week.

Menopause Symptom: Hot Flashes

Hot flashes (or hot flushes) are common around menopause. A hot flash is a brief feeling of heat that may make the face and neck flushed, cause temporary red blotches to appear on the chest, back, and arms. Sweating and chills may follow. Hot flashes vary in intensity and typically last between 30 seconds and 10 minutes. Dressing in light layers, using a fan, getting regular exercise, avoiding spicy foods and heat, and managing stress may help you deal with hot flashes.

Menopause Symptom: Sleep Issues

Nighttime hot flashes can hamper sleep and cause night sweats. Try these sleep tips:

• Use a fan in your bedroom.
• Avoid heavy bedding.
• Choose light cottons or sheer materials for your nightclothes.
• Keep a damp cloth nearby to cool yourself quickly if you wake up feeling hot and sweaty.
• Keep pets out of your bedroom; they can give off heat.
• Consult your doctor if menopause sleep problems persist.

Menopause Symptom: Sex Problems

Less estrogen can lead to vaginal dryness, which may make intercourse uncomfortable or painful. Try using a water-soluble lubricant. Libido may also change, for better or worse, but many factors besides menopause -- including stress, medications, depression, poor sleep, and relationship problems -- affect sex drive. Talk to your doctor if sex problems occur -- don't settle for a so-so sex life. And remember, sexually transmitted diseases (STDs) don't end with menopause; "safer" sex still counts.

Managing Severe Symptoms

If menopause symptoms are a problem, talk with your doctor. He or she can help you weigh the risks and benefits of menopausal hormone therapy, also known as hormone replacement therapy. Other treatments include low-dose birth control pills if you're perimenopausal; antidepressants, blood pressure drugs, or other medications to help with hot flashes; and vaginal estrogen cream. Your doctor may also have lifestyle tips about adjusting your diet, exercise, sleep, and stress management.

Hormone Replacement Therapy

Hormone replacement therapy can ease menopausal symptoms. Various prescription products are available to treat hot flashes and vaginal symptoms. Some are also recommended to prevent osteoporosis. The FDA recommends taking the lowest dose that helps, and only for the shortest time because studies have linked long-term use of hormone replacement therapy to a greater risk of heart attacks, strokes, blood clots, and breast cancer.

Bioidentical Hormone Therapy

"Bioidentical hormone therapy" for menopausal symptoms can refer to certain FDA-approved prescription drugs. Or it can refer to custom-compounded hormones derived from plants prepared at compounding pharmacies to match each unique patient. Some doctors claim that compounded bioidentical hormones are safer, but the FDA isn't convinced. The FDA's advice -- take the lowest dose for the shortest time -- applies to bioidentical hormone therapy. Custom-compounded bioidentical hormones aren't FDA approved.

Alternative Menopause Treatments

Interested in trying alternative or complementary treatments for menopause symptoms? According to the National Institutes of Health, there hasn't been a lot of well-designed research on this topic, so the research isn't firm enough to draw conclusions about treatments such as black cohosh, dong quai, red clover (shown here), and soy. Talk it over with your doctor, and tell him about any supplements you take, so he can check on drug interactions.

Menopause Health Risks

With menopause comes a greater chance of heart disease (which is the No. 1 cause of death for U.S. women) and osteoporosis (thinning bones, seen here). Loss of estrogen may play a role for heart disease after menopause, but hormone replacement therapy is not recommended to reduce the risk of heart disease or stroke. Of course, heart and bone health is important throughout a woman's life, but menopause means it's really time to step up and get serious about it, if you haven't already.

Menopause: Staying Healthy

Living a healthy lifestyle is important throughout a woman’s life. And, it’s not too late to start at menopause. Get a checkup that includes measuring your blood pressure, cholesterol, and blood sugar and make appointments for routine screenings such as mammograms. Menopause is also a great time to upgrade your diet, physical activity, and stress management skills -- your doctor can give you pointers as you work together to plan for a healthy menopause.

Active Menopause a Must

One of the smartest things a woman can do as she transitions to menopause and afterward is to get regular physical activity. That includes aerobic exercise for her heart and weight-bearing exercise for her bones -- both of which may help ward off weight gain and provide a mood boost. Even if a woman hasn't been very active in her younger years, it's never too late to start. Menopause is a new beginning, and the perfect time to weave more activity into your life.

Menopause: A New Era Starts

Western culture has long been obsessed with youth. But today's menopausal women are making the most of -- and even celebrating -- their new phase of life. Instead of looking back mournfully, physician-author Christiane Northrup recommends using menopause as a time to redefine yourself with positive thoughts, love yourself, explore what brings you pleasure, and revive (not retire) your sex life.