Menopause (MEN-o-pawz) is the time in a woman's life when menstruation (men-stroo-AY-shun) has permanently stopped and the woman is no longer fertile. Although it is a natural occurrence and is not an illness, menopause and the time surrounding it can cause a number of symptoms, which vary from one woman to the next.
Women go through a number of natural stages in their lives, and menopause is one of them. A woman typically begins her menstrual cycle * by her early teens and continues to have periods for many years afterward. Eventually, when she gets older, her periods become less frequent, and she may begin to skip a month or several months at a time even though she is not pregnant. This time of irregular periods is called perimenopause (PARE-e-men-o-pawz). When a woman has not had a period for an entire year, she has reached menopause. Menopause, therefore, is the permanent end to a woman's menstruation. Once her periods have stopped, she can no longer become pregnant. Sometimes, perimenopause and menopause are together known as “the change of life” or “the change.” After the onset of menopause, the next stage of a woman's life is called postmenopause, which simply means “after menopause.”
Women go through perimenopause and reach menopause at different ages, and they also have different symptoms. Some women have very few symptoms, whereas others may struggle with a number of both physical and emotional issues that can be quite difficult. Treatments exist for many of these symptoms.
Perimenopause and menopause are caused by changes in the levels of certain hormones * , known as progesterone (pro-JES-teh-ron) and estrogen (ES-tro-jen), or collectively as female sex hormones.
Estrogen is important in helping a girl to begin developing into a woman. As a girl approaches puberty * , her ovaries (O-vuh-reez), which are small, oval-shaped organs in the reproductive system, begin secreting estrogen. The estrogen causes a number of changes in the girl's body, including the growth of hair in her armpits and in her pubic area and also the gradual development of breasts. Estrogen's role continues once a girl begins menstruating, and its level increases and decreases during each menstrual cycle. In addition, estrogen prepares the woman's body for the fertilization of an egg, which is also produced by the ovaries.
The ovaries also make progesterone, which is important during a woman's child-bearing years. It helps prepare the uterus * so that it is a good environment in which a fertilized egg can develop into a fetus and eventually into a baby.
The ovaries continue to make estrogen and progesterone for many years after a girl first starts to menstruate. During this time, a woman begins to use up her supply of eggs. Once a woman reaches a certain age, and this age can vary from woman to woman, her egg supply becomes low, the ovaries start to shrink, the levels of hormones begin to fluctuate, and she enters perimenopause. The ups and downs of the hormone levels cause menstrual periods to become irregular. In some women, periods can become more frequent or even heavier, but in others, periods can come less often and may be lighter. Eventually, the ovaries start making less and less estrogen, until they make so little that a woman no longer has periods at all and cannot become pregnant anymore. Once a year has passed without a period, a woman has reached menopause and begins postmenopause. Within about a year, estrogen levels reach a certain low point and remain there, and progesterone levels drop to nearly zero.
Besides this natural progression during a woman's life, a female who has her ovaries surgically removed starts menopause immediately, even if she is very young.
The symptoms of perimenopause and menopause vary among women. Some women may have almost no symptoms, whereas others may have severe symptoms. Symptoms may include none, one, or a combination of the following:
Some women stop having most symptoms about a year after menopause. In many women, however, symptoms may continue. Medical professionals believe this may result from a woman having especially low estrogen levels.
All women should be alert to several health concerns that are associated with postmenopause and related to a lower estrogen level. These may include increased bone loss, which can lead to osteoporosis * , a serious health condition that can result in broken bones; osteopenia, low bone mineral density that is often considered a precursor to osteoporosis; heightened risk of tooth loss and gum disease * ; and an increased risk for heart disease * . In addition, postmenopausal women may notice that they have more wrinkles, thinner and drier skin, and increased infections of the urinary tract and the vagina.
For most women, many of the perimenopausal or menopausal symptoms eventually disappear on their own. Medical professionals encourage women to eat a healthy diet and exercise regularly to help them through their “change of life.” Women who want assistance in coping with their symptoms should see their physicians to select treatments that are right for them.
In addition, a study of women who took estrogen-progestin hormone therapy or took estrogen alone found that they had a higher incidence of abnormal mammograms (MAM-o-gramz), which are special types of x-rays used to look for possible evidence of breast cancer. The abnormal mammograms reported “false positives,” which means that they found signs of cancer although the women did not have the disease. The false positives may have resulted from estrogen in hormone therapy making the breast tissue more dense, which made it look like cancer even though none was present.
Hormone therapy may also cause a number of side effects, such as nausea, headaches, breast tenderness, and vaginal bleeding. A woman's doctor will typically prescribe the lowest possible dose of hormone therapy to get the desired results and prescribe it only for a short time. The doctor will typically also schedule a follow-up appointment when that period of time is almost over to determine whether to continue hormone therapy. Hormone therapy comes in a number of different forms, including pills, skin patches, vaginal creams, and others.
For women who have reached menopause because they have had their ovaries removed in surgery, doctors sometimes prescribe hormone therapy with just estrogen. For other women, however, doctors typically recommend estrogen combined with progestin because estrogen alone can increase the risk of uterine cancer.
Many women try to treat their symptoms on their own. The following are home treatments for some menopausal symptoms:
Natural, or “alternative,” treatments for the symptoms of perimenopause and menopause are increasingly common. One of the most popular is soy, a plant that contains phytoestrogen, which is a plant chemical similar to estrogen. Soy comes in many forms, including soy beans (also called edamame), tofu, and soy milk (which is soy flour mixed with water). Soy is also available as a supplement in pill and powder form. Other commonly used alternative therapies for perimenopausal and menopausal symptoms are:
Medical professionals highly recommend that women who are considering alternative therapy consult with their doctors before trying them. Doctors can tell their patients whether the therapy will have any interaction with any other drugs they are taking and can also discuss possible safety issues.
See also Aging • Breast Cancer • Colorectal Cancer • Depressive Disorders: Overview • Heart Disease: Overview • Menstruation and Menstrual Disorders • Osteoporosis • Uterine Cancer
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Northrup, Christiane. The Wisdom of Menopause: Creating Physical and Emotional Health During the Change. New York: Bantam, 2012.
Shaffer, Leah. “No One Really Understands How to Treat Menopause.” The Atlantic. September 15, 2015. http://www.theatlantic.com/health/archive/2015/09/menopause-hormones-estrogen-treatment/405448/ (accessed November 18, 2015).
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National Institute on Aging. PO Box 8057, Gaithersburg, MD 20898-8057. Toll-free: 800-222-2225. Website: https://www.nia.nih.gov (accessed October 26, 2015).
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* menstrual cycle (MEN-stroo-al SY-kul) culminates in menstruation (men-stroo-AY-shun), the discharging through the vagina of blood, secretions, and tissue debris from the uterus that recurs at approximately monthly intervals in females of reproductive age.
* hormones are chemical substances that are produced by various glands and sent into the bloodstream carrying messages that have certain effects on other parts of the body.
* puberty (PU-ber-tee) is the period during which sexual maturity is attained.
* uterus (YOO-teh-rus) is the muscular, pear-shaped internal organ in a woman where a baby develops until birth.
* autoimmune disease (awtoh-ih-MYOON) is a disease in which the body's immune system attacks some of the body's own normal tissues and cells.
* diabetes (dye-uh-BEE-teez) is a condition in which the body's pancreas does not produce enough insulin or the body cannot use the insulin it makes effectively, resulting in increased levels of sugar in the blood. This can lead to increased urination, dehydration, weight loss, weakness, and a number of other symptoms and complications related to chemical imbalances within the body.
* chemotherapy (KEE-mo-THER-apee) is the treatment of cancer with powerful drugs that kill cancer cells.
* radiation therapy is a treatment that uses high-energy radiation from x-rays and other sources to kill cancer cells and shrink cancerous growths.
* incontinence (in-KON-ti-nens) is loss of control of urination or bowel movement.
* insomnia is an abnormal inability to get adequate sleep.
* osteoporosis (ah-stee-o-por-Osis) is the loss of material from the bone. This makes the bones weak and brittle.
* gum disease is an infection caused by bacteria that affect the tissues surrounding and supporting the teeth.
* heart disease is a broad term that covers many conditions that prevent the heart from working properly to pump blood throughout the body.