Patient education: Menopause (The Basics)

What is menopause? — Menopause is the time in a woman's life when she stops having monthly periods. At this time, her ovaries stop releasing eggs and stop making the hormones estrogen and progesterone. Menopause usually occurs between the ages of 45 and 55. The average age is 51.

How do I know if I am going through menopause? — Most women start to wonder about menopause when their periods start to change. If you are going through menopause, you might:

●Have periods more or less often than usual (for example, every 5 to 6 weeks instead of every 4)

●Have bleeding that lasts for fewer days than before

●Skip 1 or more periods

●Have symptoms of menopause, such as hot flashes or depression (described below)

If your uterus has been removed, but you still have your ovaries, it might be tough to tell when you are going through menopause. Still, women who do not have a uterus can have menopause symptoms. If your ovaries were removed before the usual age of menopause, you had what doctors call "surgical menopause." That just means that you went through it early, because your ovaries were removed.

What are the symptoms of menopause? — Some women go through menopause without symptoms. But most have 1 or more of these symptoms:

●Hot flashes – Hot flashes feel like a wave of heat that starts in your chest and face and then moves through your body. Hot flashes usually start happening before you stop having periods.

●Night sweats – When hot flashes happen during sleep, they are called "night sweats." They can make it hard to get a good night's sleep.

●Sleep problems – During the transition to menopause, some women have trouble falling or staying asleep. This can happen even if night sweats are not a problem.

●Vaginal dryness – Menopause can cause the vagina and tissues near the vagina to become dry and thin. This usually starts a few years after menopause. It can be uncomfortable or make sex painful.

●Depression – During the transition to menopause, many women start having symptoms of depression or anxiety. That's especially true for women who have been depressed before. Depression symptoms include:

•Sadness

•Losing interest in doing things

•Sleeping too much or too little

●Trouble concentrating or remembering things – This might be caused by lack of sleep that often happens at menopause, or by the lack of estrogen. Some experts suspect that estrogen is important for good brain function.

Should I see a doctor or nurse? — If your periods start changing and you are 45 or older, you do not need to see your doctor or nurse. But you should see your doctor or nurse if you have symptoms that really bother you. For instance, you should see your doctor if you cannot sleep because of night sweats, if it is hard to work because of your hot flashes, or if you feel sad or blue and don't seem to enjoy things anymore.

You should also see your doctor or nurse if you:

●Have your period more often than every 3 weeks

●Have very heavy bleeding during your period

●Have spotting between your periods

●Have been through menopause (have gone 12 months without a period) and start bleeding again, even if it's just a spot of blood

Is there a test for menopause? — There is a test that can point to menopause. But doctors usually use that test only in women who are too young to be in menopause or who have special circumstances.

Can I still get pregnant? — As long as you are still having periods, even if they do not happen often, you could get pregnant. If you have sex and do not want to get pregnant, use some form of birth control. If you have not had a period for a full year, it is probably safe to say you have been through menopause and can no longer get pregnant.

How are the symptoms of menopause treated? — There are treatments that can help relieve symptoms.

Treatments for hot flashes include:

●Hormones (estrogen) – The hormone estrogen is the most effective treatment for menopause symptoms. Most women need to take estrogen with another hormone, called progesterone. Women who have had a hysterectomy (surgery to remove the uterus) can take estrogen by itself. Experts think these hormones are effective and safe for many women in their 40s and 50s with symptoms of menopause. If you want to take hormones, ask your doctor or nurse if it is an option for you. You should not take hormones if you have had breast cancer, a heart attack, a stroke, or a blood clot.

●Antidepressants – Some types of antidepressants can ease hot flashes and depression. Even women who are not depressed can take them to help with hot flashes.

●Anti-seizure medicine – One of the medicines used to prevent seizures seems to help some women with hot flashes, even if they do not have seizures.

Treatments for vaginal dryness include:

●Vaginal estrogen – This is an option for women who have vaginal dryness without other symptoms of menopause. Vaginal estrogen is any form of estrogen that goes directly into the vagina. It comes in creams, tablets, or a flexible ring. Vaginal estrogen comes in small doses that don't increase the levels of estrogen in other parts of the body very much.

●Other medicines – In most cases, doctors recommend vaginal estrogen. That's because there is more evidence that it helps with vaginal dryness compared with other medicines. But for women who do not want to use vaginal estrogen, doctors might suggest 1 of these medicines:

•Ospemifene (brand name: Osphena) is similar to estrogen, but is not estrogen. It comes as a pill you take once a day. It helps relieve vaginal dryness caused by menopause, but it can also cause hot flashes. It is an option for women who have trouble using a vaginal medicine or prefer a pill. You should not take it if you have a high risk of blood clots.

•Prasterone (brand name: Intrarosa) is also known as DHEA. It comes in tablets you insert into your vagina once a day.

Some doctors are not used to prescribing hormone treatment for women who are going through menopause. If you feel that you are not getting the help you need, you might choose to talk to a different doctor who is an expert in menopause treatment. You can ask your doctor or nurse to refer you to someone.

Can I do anything on my own to reduce the symptoms of menopause? — Yes. There are some steps you can try (table 1). But ask your doctor before you take any "natural remedies" like black cohosh, especially if you have a history of breast cancer.

What can I do to protect my bones? — You can:

●Take calcium and vitamin D supplements

●Be active (exercise helps keep bones strong)

●Ask your doctor when you should start having bone density tests

If needed, your doctor can prescribe medicines to help keep your bones strong.

More on this topic

Patient education: Menopause (Beyond the Basics)
Patient education: Menopausal hormone therapy (Beyond the Basics)
Patient education: Osteoporosis prevention and treatment (Beyond the Basics)
Patient education: Sexual problems in females (Beyond the Basics)
Patient education: Non-estrogen treatments for menopausal symptoms (Beyond the Basics)