Menopause is a gradual biological process that eventually leads to the cessation of menstrual periods. Once a woman becomes menopausal, ovarian functions cease, and she will no longer be able to have children. Signs of menopause may vary among different women, especially regarding menstruation changes; a doctor will diagnose a woman with menopause after she has gone a full 12 months without experiencing a menstrual period. Going through menopause can be an incredibly emotional experience, and the loss of the ability to have children can be devastating, especially for a woman who has never had children and who experienced menopause earlier than usual. However, several effective treatments are available to help manage menopause symptoms, from simple adjustments to lifestyle changes to hormone therapy.
Excluding external causes, menopause typically results from the natural decline of a woman’s reproductive hormones as she ages. Menopause generally occurs in the early 50s, but some women can experience it as young as the 30s or as old as the 60s. In most cases, as a female nears her late 30s, her ovaries will make lower amounts of the hormones progesterone and estrogen, the two primary hormones responsible for regulating menstruation and for releasing eggs during ovulation, and fertility declines. After reaching her 40s, she will experience irregular periods that become shorter or longer, lighter or heavier, and occur more or less frequently. Then, usually around the age of 51, her ovaries will stop releasing eggs, and she will no longer experience periods.
Signs of Menopause
Menopause generally includes three stages, perimenopause, menopause, and post-menopause.
First Stage: Perimenopause
Perimenopause can last for quite a long time and generally entails symptoms that prepare the woman’s body for menopause. Perimenopause lasts for about four to five years or until menopause occurs, which is when the ovaries stop releasing eggs altogether.
During the years between the onset of perimenopause and menopause itself, women generally experience:
- Low estrogen levels
- Irregular periods
- Worsened premenstrual symptoms
- Mood changes
- Slowed metabolism and weight gain
- Vaginal dryness
- Breast tenderness
- Loss of fullness in breasts
- Dry skin and hair loss
- Hot flashes, accompanied by sweating or a flushed face
- Decreased sexual interest
- Fatigue, sleep problems, and night sweats
- Aches and pains in joints and muscles
- Urinary incontinence
Second Stage: Menopause
The full onset of menopause refers to the cessation of menstrual cycles for one full year. During this time, women may experience a wide range of possible effects, and may develop other medical conditions as a result. For example, some women develop osteoporosis or heart disease during menopause. Doctors can provide customized treatment to individual patients to address their unique symptoms.
A frequently asked question by women close to menopause age is: Can you get pregnant during menopause? The answer is yes; even though periods are irregular, it is still possible to become pregnant. If you have experienced a skipped period but are unsure if you have entered menopause, you should take a pregnancy test.
Final Stage: Post-Menopause
The term “postmenopausal” simply refers to women who have already reached menopause. Every woman will experience menopause and the postmenopausal stage differently.
Hormonal imbalances can lead to the appearance of more body hair in some women, as testosterone production continues while estrogen production diminishes. Some women experience weight fluctuations and changes in skin texture.
External Causes of Menopause
Although every woman will inevitably experience menopause due to declining hormones, some women experience it at earlier ages due to external influences. Some medical conditions and diseases may require surgeries that cause menopause to begin very soon thereafter. Women who experience menopause in this manner often report more significant symptoms than women who experience menopause naturally.
Some women will experience menopause early due to problems with the ovaries. If a woman develops ovarian cysts or ovarian cancer, her doctor may recommend surgical removal of the ovaries, which will then spur the onset of menopausal symptoms. Typical menopause entails a full year of cessation of ovarian function, so surgical removal of the ovaries will lead to menopause. Symptoms may be severe because these hormonal changes occur abruptly instead of increasing gradually over several years as they would under normal circumstances.
A hysterectomy is a surgical procedure that removes a woman’s uterus; it may be performed due to fibroids, cancer, endometriosis, pelvic inflammatory disease, or uterine prolapse. A hysterectomy can involve the removal of the ovaries and can include the removal of the cervix, uterus, fallopian tubes, and the top portion of the vagina. Only removing the ovaries will induce immediate menopause, but a hysterectomy without removal of the ovaries can still cause women to experience menopausal symptoms such as hot flashes after surgery. These symptoms are typically only temporary and become less severe as the patient recovers.
Chemotherapy and Radiation Therapy
Women who develop some forms of cancer and undergo radiation treatment and chemotherapy may also experience menopause sooner than expected. Cancer therapies can induce menopause symptoms during or shortly after receiving treatment, but some women do not report experiencing such symptoms for quite a long time after completing cancer treatment. The impact on menstruation and fertility may not be permanent, so it is recommended to continue using birth control methods. Depending on the cancer and the treatments’ location, an ovulating woman can experience menopause due to interference from these treatments. Radiation therapy should only affect ovarian function if the radiation is directly targeted to the ovaries, while radiation targeted to the other parts of the body does not affect menopause.
Primary Ovarian Insufficiency
About 1 percent of all women experience premature ovarian failure—or ovarian failure before 40. This occurs when the ovaries fail to produce normal amounts of reproductive hormones, referred to as primary ovarian insufficiency. Doctors cannot predict when this will occur and do not know for certain why it happens; many researchers suspect genetic links and autoimmune diseases as contributing factors. In these cases, hormone therapy is recommended to protect the brain, heart, and skeletal system, at least until the woman reaches the natural menopause age.
The loss of estrogen that results during menopause is associated with various health problems that increase in prevalence as women age, including decreased skin elasticity, reduced muscle strength and tone, a higher risk of developing Alzheimer’s disease, and vision problems such as cataracts and macular degeneration. The following medical complications are most common in postmenopausal women: cardiovascular disease, osteoporosis, urinary issues, sexual dysfunction, and weight gain.
Cardiovascular disease is the number one leading cause of death among women, and the decline in estrogen women experience during menopause directly correlates with an increased risk of cardiovascular disease. Estrogen has a protective influence on the artery wall’s inner layer by helping the blood vessels stay flexible, so they can relax and expand when necessary to accommodate blood flow. Along with the reduced estrogen, other changes occur later in life that can affect postmenopausal women’s heart health, including increases in blood pressure, bad cholesterol, and triglycerides, a certain form of fat in the blood. Eating a healthy diet full of nutritious foods, keeping a regular exercise routine, and maintaining a normal weight is essential for reducing cardiovascular disease risk during menopause.
Osteoporosis is a progressive medical condition that causes bones to weaken and become brittle, increasing their vulnerability to fractures. Women comprise 80% of osteoporosis patients and are four times as likely to develop this disease as men due to thinner, lighter bones and longer life expectancy. Along with its function in the reproductive system, estrogen supports the strength and density of bone mass by inhibiting the process of bone resorption. Throughout the first few years of menopause, decreased estrogen levels cause women to rapidly lose bone density, heightening the risk of developing this condition. Postmenopausal women suffering from osteoporosis are particularly susceptible to fractures in the wrists, hips, and spine.
The loss of elasticity in the vagina tissues and urethra may lead to several urinary system issues. Typically, this includes the sudden, frequent, strong need to urinate, followed by incontinence. Incontinence occurs in two types, urge incontinence and stress incontinence. Urge incontinence is losing urine after experiencing this sudden need to urinate. In contrast, stress incontinence involves losing urine due to laughing, coughing, sneezing, lifting, or other motions that place stress on the bladder. Additionally, urinary tract infections may occur more frequently. Treatment of incontinence includes Kegel exercises that strengthen the pelvic floor, topical estrogen applied to the vagina, and hormone therapy.
A combination of vaginal dryness due to reduced moisture production and loss of elasticity in vaginal tissue may result in discomfort, pain, and slight bleeding during intercourse. These adverse side effects make it difficult for many postmenopausal women to become aroused as easily as they did in the past, causing a significant loss in libido or even a total lack of sex drive. Lower estrogen also causes less blood to flow to the vulva, clitoris, and vagina, and these decreased sensations may also reduce the libido. Water-based lubricants and moisturizers can alleviate vaginal dryness in many cases, but when this isn’t enough, local vaginal estrogen treatment can be recommended in the form of a vaginal tablet, cream, or ring.
Due to the hormonal changes that occur, many women gain weight quickly during menopause, especially in the abdomen. Simultaneously, as a woman ages, she loses muscle mass while gaining fat, slowing down her metabolism. This makes it more challenging to maintain a healthy weight, even with the same eating and exercise habits maintained before the onset of menopause. Genetic factors can also increase vulnerability to postmenopausal weight gain. Excess weight, particularly in the abdomen, heightens the risk of developing cardiovascular disease, breathing problems, Type 2 diabetes, and several forms of cancer, such as colon, breast, and endometrial cancers. Combating this weight gain requires exercise, healthy eating habits, limiting sugary foods, and avoiding alcohol.
What Is Menopause: Diagnosis
Menopause symptoms are typically sufficient to alert most women that they have begun the menopausal transition. However, if you are experiencing irregular periods, hot flashes, or other signs of low estrogen, it is always a good idea to contact your primary care physician to discuss your situation. In some circumstances, your doctor may recommend blood screenings to measure your levels of follicle-stimulating hormone (FSH) and estrogen (estradiol). As menopause occurs, FSH levels increase, and estrogen levels decrease. Because hypothyroidism can produce symptoms similar to those experienced during menopause, you may also undergo a thyroid-stimulating hormone (TSH) screening to rule this out as the cause of your symptoms.
Menopause Treatment Options
Although some external factors can cause menopause early, naturally occurring menopause is a fact for every woman. While menopause is not a medical condition and does not require treatment, it can still produce negative symptoms for some women. In fact, numerous studies of postmenopausal women conducted around the world found that hot flashes after menopause continue to occur for years, sometimes affecting women even 20 years after the initial onset of menopause. With these symptoms occurring so frequently and potentially lasting for decades, many women seek treatment options to manage their symptoms.
Based on your medical history and menopause symptoms, your doctor may suggest estrogen therapy to make up for lost natural estrogen production and relieve hot flashes. Typically, estrogen is provided at the lowest dose and within the shortest time frame that will provide effective symptom relief. Women who experience vaginal dryness, unwanted hair growth, and hot flashes can find relief with hormone therapy. However, doctors are often hesitant to prescribe these options unless necessary, due to their links to increased risk of stroke, heart disease and breast cancer. Estrogen and progestin can increase these risks, and estrogen-based hormone therapy can lead to the development of endometrial cancer.
To provide relief of menopause symptoms without the risks of hormone therapy, doctors can prescribe different medications to handle hot flashes, mood swings, cramps and other issues. When taken in low doses, antidepressants called selective serotonin reuptake inhibitors (SSRIs) may help women who cannot take estrogen for health reasons or women who are experiencing a mood disorder while undergoing menopause. Seizure medication Gabapentin and high blood pressure medication Clonidine can alleviate hot flashes. Doctors may also recommend medications that help prevent or treat osteoporosis and Vitamin D supplements to strengthen the bones.
Finding the Right Solution for You
Every woman experiences menopause differently, and it’s vital for every woman to know the best options for handling the potentially unpleasant side effects of the different stages of menopause. At Arizona Gynecology Consultants, our expert team of health care professionals has comprehensive knowledge in all aspects of women’s health care and can guide you through this challenging time with dedication and compassion. We provide the highest quality of health care services at several locations in the Phoenix metropolitan area, each with experienced menopause specialists who help patients manage their symptoms during every stage of menopause.
If you have questions about menopause, contact us for more information about resources in your area.
Related Reading: How Long Does Menopause Last on Average?
*Editor’s Note: This article was originally published August 9, 2017 and has been updated April 4, 2021.
Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS
Dr. Kelly Roy is a specialist in surgical gynecology and advanced laparoscopy (and hysteroscopy). She is a long-time resident of Arizona and obtained her Bachelor of Science degree in Biomedical Engineering at Arizona State University before finishing her Doctorate of Medicine at the University of Arizona in 1997.
Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.
Well known for her teaching and surgical ability, she is on the faculty at the residency program at both Banner University Medical Center and Saint Joseph’s Hospital in central Phoenix and is a Clinical Assistant Professor of Medicine at the University of Arizona College of Medicine, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years.
Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.