Causes

Menopause is now recognized as a normal part of aging that affects every woman in an individual way. Some women notice little difference in their bodies or moods; others find menopause very uncomfortable and disruptive. Each woman experiences the years leading up to menopause, called perimenopause, differently.

Beginning in your mid-30s, your ovaries start to change how much estrogen they produce. Estrogen is a hormone that is necessary for menstruation and pregnancy. As you get older, you produce less estrogen until menstruation stops and pregnancy can no longer occur. Changes in estrogen levels can affect many parts of the body, including your heart, bones, urinary tract, skin, and hair.

Symptoms

The hormonal changes that occur before and after menopause can cause various symptoms. Although not all women experience them, some of the symptoms of menopause are irregular periods, hot flashes, vaginal dryness, urinary problems, mood changes, and sleep disturbances.

• Irregular periods are often common during the years leading up to menopause. The time between periods may become shorter or longer. The flow may be lighter or heavier than you have experienced. Bleeding between periods or missed periods may also occur.
• Hot flashes describe a flushed feeling that usually begins around the chest and spreads to the neck, face, and arms. This sensation usually lasts 3 to 4 minutes and can occur as often as once an hour. Hot flashes are often followed by sweating and then chills. Hot flashes can occur at anytime and may wake you up at night. These are called night sweats. Three out of four women experience hot flashes. Only one out of three women have symptoms for 5 or more years.
• Vaginal dryness can be the result of reduced estrogen levels in the body. With much less estrogen in the body, the vaginal walls lose elasticity, become thin, and secrete less fluid. A drier, less elastic vagina can mean discomfort or pain during intercourse.
• Loss of bladder control can occur when reduced estrogen levels cause the muscle tone in your urinary tract to decrease. The tube that carries urine from the bladder does not have the necessary pressure and strength to prevent urine from leaking out of the body. This is called incontinence.
• Mood changes and sleep disturbances may occur during perimenopause and after menopause. Scientific studies suggest a relationship between lower hormone levels and depression, moodiness, irritability, fatigue, sleep problems, and psychological symptoms commonly felt during menopause. Researchers have come to believe that lack of adequate sleep as a result of nighttime hot flashes aggravates the moodiness and other psychological symptoms linked with menopause.

Health Problems That Occur at Menopause

When you reach menopause, your risk for heart disease and osteoporosis increases.

Heart disease is the number one cause of death in women. Women are protected against heart disease up until menopause because of the positive effects of estrogen, which controls the cholesterol in your blood and keeps your arteries healthy. The risk of heart disease increases dramatically after menopause, when estrogen production slows down.

Osteoporosis risk increases at menopause, as does the risk of broken bones, because bone mass diminishes with the decrease in estrogen.

Treatment

Hormone replacement therapy (HRT) can be used to help manage many of the symptoms of menopause. It can relieve hot flashes, vaginal dryness, and urinary tract symptoms that occur as a result of estrogen deficiency. It can also improve symptoms of irritability and anxiety in many women and may relieve mild depressive symptoms. It is unclear whether HRT has a direct effect on mood or whether these effects are due solely to the alleviation of physical symptoms, especially hot flashes and sleep disturbances. HRT decreases skin wrinkles in some women. One of the most beneficial effects of HRT is in bone density. HRT helps decrease bone loss and prevents osteoporosis. HRT may not protect against coronary artery disease as once thought.

There are many different estrogen and progesterone preparations used for HRT. Hormone replacement therapy comes in the form of pills, patches, and creams. Your doctor will work with you to decide what type of preparation is best for you considering your current symptoms and medical history.

Risks of HRT

• Endometrial cancer. In the 1960s estrogen was often given alone, and some women later developed low-grade endometrial (uterine) cancer. When both estrogen and progesterone are given for hormone replacement therapy, the risk of endometrial cancer is actually less than if the woman was not taking estrogen at all. For this reason, both estrogen and progesterone are recommended for women who have a uterus. Estrogen alone is recommended as a replacement therapy for women who have had a hysterectomy.
• Breast cancer. There seems to be a small increase in breast cancer risk with HRT. The possibility of developing breast cancer is one of the reasons women decide not to take hormone replacement therapy. There may be a small increase in the risk of breast cancer after taking HRT for 5 to 10 years. There does not seem to be an increased risk of breast cancer in women who take HRT for less than 5 years. It’s important to discuss concerns about breast cancer risk with your doctor when considering HRT.
• Gallbladder disease. Women taking HRT have an increased chance of developing gallbladder disease.
• Venous thromboembolism (VTE). The risk for developing VTE (blood clots) is increased in women who are taking HRT.

Side Effects of HRT

About 10 percent of women receiving HRT have minor side effects such as breast tenderness, nausea, headaches, fluid retention, or irregular vaginal bleeding. For most women, these side effects disappear quickly and do not interfere with continuing the hormone therapy.

Self-Care

• Eat a healthy diet. Eating well contributes to overall good health. During menopause, when your body is changing, a diet that includes a variety of fruits, vegetables, and whole grains is especially important. Select foods that are lower in fat and aim for at least three servings of dairy products a day. If you do not drink milk, take a calcium supplement (1000 milligrams) with vitamin D (400 International Units) each day. Use alcohol and caffeine in moderation.
• Exercise regularly. Try to be active at least 30 minutes of every day to help reduce hot flashes and guard against osteoporosis. Walk whenever you can, make extra trips around your yard or house, take the stairs instead of the elevator. Dress in layers so that you can remove them if you experience a hot flash.
• Use a water-soluble lubricant. Try a product such as K-Y Jelly, Astroglide, Replens, or Surgilube to relieve vaginal dryness. Don’t use petroleum jelly products, such as Vaseline.
• Many women have reportedly found relief for their menopausal symptoms by using over-the-counter products that promote a holistic or natural effect. Because these “natural” hormone replacement compounds are not regulated by the Food and Drug Administration, their potency and dosage may differ among different brands of the same product. Some of the more common products claiming to help with menopause are yam extract, black cohosh, sarsaparilla, kava, licorice, dong quai root, gingko biloba, Vitex, flaxseed, DHEA, soy, red clover, and St. John’s wort. There have been few, if any, clinical trials to show that these products are useful or even safe. Talk to your doctor if you have questions about any of the over-the-counter preparations that claim to help with menopausal symptoms.