Menopause is the time in a woman's life when her periods (menstruation) stop. Most often, it is a natural, normal body change that most often occurs between ages 45 to 55. After menopause, a woman can no longer become pregnant.
During menopause, a woman's ovaries stop releasing eggs. The body produces less of the female hormones estrogen and progesterone. Lower levels of these hormones cause menopause symptoms.
Periods occur less often and eventually stop. Sometimes this happens suddenly. But most of the time, periods slowly stop over time.
Menopause is complete when you have not had a period for 1 year. This is called postmenopause. Surgical menopause takes place when surgical treatments cause a drop in estrogen. This can happen if both of your ovaries are removed.
Menopause can also sometimes be caused by drugs used for chemotherapy or hormone therapy (HT) for breast cancer.
Symptoms vary from woman to woman. They may last 5 or more years. Symptoms may be worse for some women than others. Symptoms of surgical menopause can be more severe and start more suddenly.
The first thing you may notice is that periods start to change. They might occur more often or less often. Some women might get their period every 3 weeks before starting to skip periods You may have irregular periods for 1 to 3 years before they stop completely.
Common symptoms of menopause include:
Other symptoms of menopause may include:
Blood and urine tests can be used to look for changes in hormone levels. Test results can help your health care provider determine if you are close to menopause or if you have already gone through menopause. Your provider may need to repeat testing your hormone levels several times to confirm your menopausal status if you have not completely stopped menstruating.
Tests that may be done include:
Your provider will perform a pelvic exam. Decreased estrogen can cause changes in the lining of the vagina.
Bone loss increases during the first few years after your last period. Your provider may order a bone density test to look for bone loss related to osteoporosis. This bone density test is recommended for all women over age 65. This test may be recommended sooner if you are at higher risk for osteoporosis because of your family history or medicines that you take.
Treatment may include lifestyle changes or HT. Treatment depends on many factors such as:
HT may help if you have severe hot flashes, night sweats, mood issues, or vaginal dryness. HT is treatment with estrogen and, sometimes, progesterone.
Talk to your provider about the benefits and risks of HT. Your provider should be aware of your entire medical and family history before prescribing HT.
Several major studies have questioned the health benefits and risks of HT, including the risk of developing breast cancer, heart attacks, strokes, and blood clots.
Current guidelines support the use of HT for the treatment of hot flashes. Specific recommendations:
To reduce the risks of estrogen therapy, your provider may recommend:
Women who still have a uterus (that is, have not had surgery to remove it for any reason) should take estrogen combined with progesterone to prevent cancer of the lining of the uterus (endometrial cancer).
ALTERNATIVES TO HORMONE THERAPY
There are other medicines that can help with mood swings, hot flashes, and other symptoms. These include:
DIET AND LIFESTYLE CHANGES
Lifestyle steps you can take to reduce menopause symptoms include:
Exercise and relaxation techniques:
Some women have vaginal bleeding after menopause. This is often nothing to worry about. However, you should tell your provider if this occurs. It may be an early sign of other health problems, including cancer.
Decreased estrogen level has been linked to some long-term effects, including:
Call your provider if:
Menopause is a natural part of a woman's development. It does not need to be prevented. You can reduce your risk of long-term problems such as osteoporosis and heart disease by taking the following steps:
ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstet Gynecol. 2014;123(1):202-216. PMID: 24463691 www.ncbi.nlm.nih.gov/pubmed/24463691.
Brunner RL, Aragaki A, Barnabei V, et al. Menopausal symptom experience before and after stopping estrogen therapy in the Women's Health Initiative randomized, placebo-controlled trial. Menopause. 2010;17(5):946-954. PMID: 20505547 www.ncbi.nlm.nih.gov/pubmed/20505547.
Lobo R. Menopause and care of the mature woman. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 14.
Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888-902. PMID: 23985562 www.ncbi.nlm.nih.gov/pubmed/23985562.
Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA. 2013;310(13):1353-68. PMID: 24084921 www.ncbi.nlm.nih.gov/pubmed/24084921.
Moyer VA; US Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;158(9):691-696. PMID: 23440163 www.ncbi.nlm.nih.gov/pubmed/23440163.
North American Menopause Society. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017. [Epub ahead of print] PMID: 28650892 www.ncbi.nlm.nih.gov/pubmed/28650892.
Skaznik-Wikiel ME, Traub ML, Santoro N. Menopause. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 135.