Menopause is a phase in a woman’s life when she stops having her period. Menopause means the end of menstruation. As a woman ages, there is a decline in the production of the hormone estrogen, and the ovaries experience a functional decline. 

At the age of 40, the process of menopause speeds up and is known as perimenopause. Usually, a woman will menstruate for the very last time when she is around 51 years of age. Some women stop menstruating at the age of 40 and a few menstruate till the age of 60.

Women who are in the habit of smoking can go through menopause earlier than non-smokers. Women can experience certain changes such as skipping of periods, heavy periods, and periods occurring closer together, a few years before menopause.

Different women can experience menopause differently. They may experience, hot flashes, night sweats, and mood changes. In addition to this, they can experience, urinary symptoms, vaginal dryness, and painful intercourse. These symptoms occur as the body is adjusting to the new phase and are temporary. 

Start of Menopause and How Long Does it Last?

The average age for the onset of menopause in women is around 51 years. Women begin developing symptoms around four years before the last period, and they may continue up to 4 years after the last period. 

A small population can also experience the symptoms almost a decade before menopause. Around 1 in 10 women can experience symptoms of menopause for 10-12 years after menopause as well. Multiple factors affect the age when a woman can experience menopause, like ovary health and genetics. Menopause takes place in 3 stages – perimenopause, menopause, and postmenopause. 

Perimenopause usually begins 10 years before menopause. In this stage, the ovaries gradually produce less estrogen. This stage lasts until menopause sets in when the ovaries stop producing eggs. The last two years of perimenopause have estrogen levels dropping drastically in the ovary. Women still continue to have periods in this phase and can get pregnant. 

Menopause, the next stage is when the periods stop. The ovaries have stopped producing most of the estrogen and also stopped releasing eggs. Women cannot get pregnant at this stage. The stage after menopause is post-menopause when even the symptoms of menopause begin to reduce. Estrogen levels are low in this phase, and many are vulnerable to the risk of heart disease and osteoporosis. Lifestyle changes and hormone therapy can reduce the risks of unfavorable health conditions in this phase.

Basic Stages of Menopause

Menopause is the normal transition for women’s bodies between the ages of 33 to 55. Ovaries become smaller, eggs stop getting released, estrogen levels fall and fertility in affected. Eventually, a woman can no longer get pregnant. The different stages of menopause are described as follows:

  • Perimenopause – The period before menopause that usually lasts for 3 to 5 years is perimenopause when estrogen levels fall. Estrogen is an essential hormone for women that affects the ovaries, breasts, vagina, and bones, to name a few. Typically, perimenopause occurs in the late 40s. Women can experience irregular periods or other symptoms such as insomnia, hot flashes elevated heartbeat rate, urinary issues, or mood changes. In this stage, a woman does have a chance of getting pregnant, so birth control is advised.
  • Early Menopause – Menopause can set in a woman’s body earlier than what is determined naturally due to various factors. The removal of the uterus or hysterectomy, removal of ovaries or ovarian failure can all lead to early onset of menopause. Premature ovarian failure can result from cancer treatments, ovarian surgery dysfunction, insufficient follicles, or genetics.
  • Menopause – Women enter menopause when they are 51 or 52. Technically it involves the absence of periods for 12 months without other causes like breastfeeding, medication, pregnancy, or illness. Perimenopause, menopause, and post-menopause can take around 1 to 3 years as a complete transition.
  • Post Menopause – This stage occurs after one has crossed the menopause stage. The levels of estrogen in this stage are very low, creating health risks for women.

Signs & Symptoms of Menopause

Most women experience symptoms of menopause in the perimenopause stage. While for some, it is a smooth experience without any unpleasant symptoms, there are many who face debilitating symptoms throughout different stages of menopause. The symptoms may vary widely due to different hormonal effects on the body. Some of the common signs and symptoms of menopause are explained below:

  • Hot flashes

A hot flash is a sudden feeling of warmth or heat in the upper part or all over the body. A woman may feel flushed or sweaty, and the neck and face may turn red. A hot flash can be high or low in intensity and sometimes can even wake one from sleep. It usually lasts for a time period ranging from 30 seconds to 10 minutes. Hot flashes may occur after menopause as well, but they reduce in intensity.

  • Change in the menstrual cycle 

Women may face irregular periods, and it may be longer or shorter in duration. There may be spotting, or bleeding may be heavier or lighter than normal. A change in the cycle could also mean pregnancy, so take a test to rule that out. A missed period could be an indicator of menopause if the woman is not pregnant.

  • Pain during intercourse and vaginal dryness

 The reduction in the release and production of beneficial hormones like progesterone and estrogen affect the layer of moisture coating the vaginal walls. Vaginal dryness can happen at any age, but it is a particular symptom for women going through menopause. Stinging or burning and itching along the vulva are common indicators of dryness. Women may feel the need to relieve themselves frequently, and dryness can make intercourse painful.

  • Insomnia 

During menopause, women may find it difficult to stay asleep or fall asleep. One may wake up earlier than usual and may have trouble going back to sleep. Lifestyle changes and relaxation can help one combat this.

  • Urinary incontinence 

 Women may lose control over their bladder during menopause. One may feel pain during urination or may feel a constant need to urinate even when the bladder is not full. During menopause, the tissues in the urethra and the vagina lose elasticity, and the lining becomes thin. Pelvic muscles may also weaken, causing this symptom.

  • Decreased libido 

 Less interest in sex is very common during menopause. This can be caused by changes brought on by a reduction in estrogen. The physical changes include slow orgasmic response or delayed clitoral reaction.

  • Urinary tract infection 

 Changes in the urinary tract and lower estrogen levels make a woman susceptible to infection.

  • Vaginal atrophy 

 The condition caused by inflammation and thinning of vaginal walls is known as vaginal atrophy. This may make intercourse painful and is caused due to changes in hormone levels during menopause.

  • Mood swings 

 Depression and changes in mood are quite common during menopause. Hormonal changes are occurring in the body, which might make a woman irritable or just unhappy. There might be experiences of extreme highs and lows in short time periods.

  • Other changes 

 The body experiences other changes like dry and thinning skin because of the loss of collagen and fatty tissues. There might be hair loss as well, due to hormonal changes.

How is Menopause Diagnosed?

The best way is to talk to the health care provider if a woman is experiencing menopausal symptoms, and she is 45 or younger. The blood test – PicoAMH Elisa can help determine if a woman has entered menopause or is close to entering menopause. 

This FDA approved diagnostic test is beneficial for women showing symptoms of perimenopause which can have adverse health effects. Menopause is associated with the risk of osteoporosis, heart disease, fractures, cognitive changes, loss of libido, and mood changes. Additionally, there is another test that measures the level of hormones in the blood. Usually, FSH is measured along with estradiol (a form of estrogen). 

Elevation in FSH blood levels at 30 mIU/mL or higher and lack of menstruation for one year or 12 consecutive months confirms menopause. OTC urine tests and saliva tests are also available, but they are not fully accurate. Estrogen and FSH levels frequently fluctuate during perimenopause and healthcare providers will diagnose menopause based on multiple factors such as medical history, symptoms, and menstrual data.

Complications During Menopause

Menopause causes changes in the female body, and often, these changes affect health drastically. There is always a risk of the following medical conditions:

  • Urinary incontinence 

 Menopause affects the elasticity of the urethra and vaginal tissues. This can lead to strong, sudden, and frequent urges to urinate, which is followed by loss of urine or urge incontinence, or loss of urine while coughing, lifting or laughing. There is a higher chance of Urinary Tract Infections

  • Osteoporosis 

Estrogen is good for bones, but during menopause this hormone level reduces. Osteoporosis leads to brittle and weak bones which increases the risk of fractures. In the first few years of menopause, there is a rapid loss in bone density. Women in postmenopause who have osteoporosis are highly susceptible to fractures in the hip, spine, or wrists. 

  • Cardiovascular diseases 

 The decline in estrogen levels increases the risk of heart diseases. Heart disease is a common cause of death in women and men. Talking to a medical practitioner and a healthy lifestyle can help with this risk.

  • Weight gain 

After menopause, the body’s metabolism rate slows down. Because of this, a woman may gain weight quickly. However, it again depends on various factors such as genetics, lifestyle changes, etc.

  • Sexual functions

Vaginal dryness, a side effect of menopause can make intercourse uncomfortable. There may be bleeding and decreased sensation during sexual activity. This may make sex less desirable for women.

Treatment of Menopause Complications

 Menopause is an uncomfortable phase for women, but it can be managed in many ways. The discomfort arising during menopause can be treated to make life easier. Some of the treatments offered during the menopause complications are as follows:

  • Hormone replacement therapy (HRT)

During menopause, there is a drop-in hormone level because of which a woman might endure discomfort and is at the risk of certain diseases. However, to manage menopause symptoms, she can take supplements for progestin and estrogen. A simple skin patch can deliver these hormones into the body. 

Hormone replacement therapy has its own benefits and risks, so both need to be considered. Some benefits include – effective treatment of menopausal symptoms, prevents osteoporosis and can reduce the chances of colorectal cancer.

HRT can increase the risk of ovarian cancer, uterine cancer, and breast cancer. There is a higher risk of strokes and coronary heart diseases. Hormone therapy can also accelerate the loss of tissue in certain areas of the brain that is crucial for memory and thinking in women who are 65 or above.

  • Medicines 

Doctors prescribe medicines to curb symptoms related to Menopause. The prescriptions help women lower down and offer relief from different medical conditions such as hot flashes, bone-related issues, and vaginal concerns. 

  • Antidepressants

Low-dose antidepressants can help with menopause. SSRIs or Selective serotonin reuptake inhibitors are known to decrease hot flashes during menopause. Drugs having SSRIs include citalopram, paroxetine, fluoxetine, and venlafaxine.

  • Osteoporosis treatments

Drug therapy and dietary supplements that are used in osteoporosis treatments are also good for managing menopause.

  • Drugs for hot flashes

Hot flashes are treated with gabapentin which is available under the brand Neurontin and clonidine or Catapres. 

  • Medications for vaginal symptoms

Vaginal estrogen can be used for the vagina as a ring, tablet, or cream. This treats dyspareunia, urinary problems, and vaginal dryness. There are over the counter moisturizers that can help with vaginal discomfort. In addition to the above-mentioned treatments, here’s how you can treat menopause through natural remedies and changes in lifestyle.

Managing the Symptoms of Menopause

Throughout the different phases of menopause, the estrogen and progesterone level in women’s body keeps on fluctuating. The fluctuation of these hormones in the female body is the reason behind the different menopausal symptoms. Find out how you can manage common symptoms and improve your overall lifestyle after reaching menopause.

  • Nutrition 

Women must try to maintain a varied and healthy diet while managing the physical effects of menopause. Research suggests that Omega-3, available in certain foods like oily fish, can ease depressive symptoms and psychological distress. 

Women experiencing menopause must eat a diet that includes fruits, vegetables, whole grains, fiber, unsaturated fats, and unrefined carbohydrates, along with 1200-1500 mg of calcium and Vitamin D.

  • Exercises 

Generally, exercise has beneficial effects on the human body. During menopause, it can help with managing weight gain, protecting bones, boosting mood, and reducing the risk of cancer. For example, Pilates can help in reducing menopausal symptoms that are unrelated to the genitals and urinary tract system. Exercising early in the day is good and avoids interrupting the sleep cycle. Kegel exercises are good for managing urinary incontinence as it strengthens the pelvic floor.

  • Psychological assistance 

 Research proves that hypnosis can reduce hot flashes during menopause by 74%. Guided meditation, deep breathing techniques, and relaxation can limit sleep disturbance. Stress is known to aggravate night sweats, and hot flashes and relaxation is a good way to be comfortable.

  • Managing sleeping issues 

 Lifestyle changes and OTC medicines can temporarily manage insomnia. Talking to a medical practitioner is the best way to decide the course of action to manage sleep issues.

Final Thoughts

Menopause is a natural stage in a woman’s life, and it cannot be avoided. The natural cessation of the menstrual cycle marks the end of the fertility period. Most women go through menopause in their 50s, or more like around 52. But ovarian or pelvic damage can cause the onset of menopause earlier. Genetics can also trigger early menopause. Find out Menopause related FAQs or contact your obstetrician-gynecologist for more clarity on specific issues related to the condition.

Women may experience menopausal symptoms like hot flashes and night sweats, which might continue even after the onset of menopause. Women can manage menopausal symptoms through medication, lifestyle changes, and medication. This natural stage may be inconvenient, but with the right information can be managed effectively.

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