Menopause: The Transition, Its Symptoms, and the Treatments That Help

Menopause is the time of life when your periods stop and you can no longer get pregnant. You've reached it when you've gone 12 months without a period.

The years leading up to it are the menopausal transition, or perimenopause. It usually starts in your 40s — sometimes earlier — and can last several years. Menopause most often arrives between 45 and 55.

Early and premature menopause

When the ovaries stop making hormones and periods stop younger than usual:

It can happen on its own, or because of:

• surgery to remove the ovaries (removing only the uterus stops periods but doesn't cause menopause unless the ovaries go too);
• chemotherapy or the hormone therapy used for breast cancer;
• a family history of early or premature menopause;
• smoking;
• certain health conditions.

Primary ovarian insufficiency (POI) — the ovaries stop working normally before 40 — is different: with POI you may still have periods, though irregular, and may still be able to get pregnant.

Symptoms

During the transition, the ovaries make less estrogen and progesterone, causing:

• changes in periods — irregular, shorter or longer, lighter or heavier;
• hot flashes — a sudden warmth in the face, neck and chest, sometimes with sweating (night sweats when they come at night);
• trouble sleeping — which over time can bring fatigue and memory problems;
• vaginal dryness, which can make sex painful;
• mood changes — moodiness, anxiety, irritability;
• bladder problems — incontinence and urinary tract infections.

Losing estrogen also affects long-term health: it can cause bone loss, leading to osteoporosis (weak bones that break easily), and raise cholesterol, increasing the risk of heart disease and stroke.

Treatment

You may not need any. If you do:

Lifestyle changes

• For hot flashes: dress in layers, carry a portable fan, and avoid alcohol, spicy food and caffeine.
• Quit smoking.
• Keep a healthy weight — overweight and obesity can make hot flashes worse.
• Sleep in a dark, quiet, cool room.
• Exercise regularly, for sleep, mood and lower risk of many age-related diseases.
• Lower stress with meditation, deep breathing or muscle relaxation.

If that isn't enough, see your health care provider, who will consider your symptoms, history and preferences and explain the risks and benefits of each option.

Non-hormone treatments

• medicines for hot flashes — certain antidepressants, a medicine made just for hot flashes, an antiseizure medicine and a blood pressure medicine (some help sleep too);
• medicines for incontinence, and to treat or prevent osteoporosis;
• low-dose birth control pills for very heavy or very frequent periods;
• water-based lubricants for dryness, and medicines for painful sex caused by vaginal changes;
• cognitive behavioral therapy (CBT), a talk therapy, for sleep problems.

Hormone therapy

Like any medicine, hormone therapy for menopause has benefits and risks; ask your provider whether it's safe for you. If you take it, the usual advice is the lowest dose that works for the shortest time needed.

Supplements, herbs and "natural" creams

Many products are marketed for menopause. Research on them is mixed — some studies suggest benefit, others show little or none — and there's little long-term safety information. Some supplements have harmful side effects or interact with medicines, so check with your provider first.

Sources

Based on the MedlinePlus health topic "Menopause," National Library of Medicine; a work of the United States government in the public domain.