What is menopause?

Menopause is the time in a woman's life when menstruation stops.

Menopause is usually a gradual process. The ovaries begin to produce lower amounts of hormones. The reduced amounts of hormones cause menstrual periods to become irregular and eventually to stop completely. The hormonal changes often cause other symptoms.

Menopause can also occur when the ovaries are surgically removed.

Most women go through menopause between ages 45 and 60. In the U.S. the average age for menstrual periods to stop completely is 51.

What are the symptoms?

You may have both physical and psychological symptoms during menopause. Symptoms may occur for a few weeks, a few months, or sometimes over several years. Your symptoms may come and go, or they may occur regularly.

These physical symptoms are common during menopause:

• irregular menstrual periods

• hot flashes

• night sweats

• disturbed sleep patterns

• vaginal dryness and shrinkage of genital tissues, sometimes resulting in discomfort or pain during sexual intercourse

• dry skin

• more frequent urination or leakage of urine (urinary incontinence)

• more frequent minor vaginal and urinary infections.

Menopause usually occurs at a time in life when other dramatic changes take place. Some of these changes may include loss of parents, adjustment to children growing up and leaving home, becoming a grandparent, retirement, or career changes. These changes, in addition to the changes in your body, may result in psychological or emotional stress. Psychological symptoms of menopause may include:

• anxiety

• depression

• tearfulness, irritability

• sleeplessness

• less desire for sex

• lack of concentration

• more trouble remembering things.

How is it diagnosed?

Menopause can often be diagnosed through your medical history. Your health care provider will then examine you. He or she may order blood tests. A pelvic exam and Pap smear may show effects of decreased estrogen.

How is it treated?

Menopause is a natural part of a woman's life cycle. It is not a disease and does not necessarily require any treatment. However, certain health problems, such as osteoporosis and increased heart disease, are associated with low estrogen. To help prevent such problems, many women choose to take estrogen to replace what their body is no longer producing. This treatment is called estrogen replacement therapy (ERT), or hormone replacement therapy (HRT).

You and your health care provider should discuss the pros and cons of hormone replacement therapy for you. Factors such as your age, race, family history, and health history will be considered in the discussion. Hormone replacement therapy is the most effective treatment for preventing osteoporosis (loss of bone density). However, it is not the right treatment for every woman. Women who have had some types of breast cancer or other cancer, blood clots, or certain liver disease should not take estrogen. There are other ways to help prevent osteoporosis. For example, you can take calcium supplements and exercise regularly.

Hormone replacement therapy may also benefit your heart and blood vessels. Discuss these potential benefits with your health care provider, especially if you have a family history of heart disease.

If you and your health care provider decide you will start taking estrogen, it may be prescribed in the form of tablets to be swallowed, patches to be applied to the skin, or a cream to be inserted into the vagina. You will probably continue the treatment for at least several months and possibly many years.

If your uterus has been removed, you may take only estrogen. Otherwise you will need to take both estrogen and progesterone. Taking estrogen alone may increase your risk of cancer of the uterus.

Ask your health care provider about any side effects or special precautions you should know about while you are taking hormones. Make sure that your provider knows about any other medications you are taking.

How long will the effects last?

Symptoms of menopause may last only a month or may continue for several years.

If you have had no menstrual periods for several months and then have bleeding from the vagina, check with your health care provider promptly. Vaginal bleeding in a woman who has not had periods for months, or especially years, can be a symptom of cancer.

How can I take care of myself?

To help your general mental and physical well-being, you should:

• Have a mammogram every 2 years between the ages of 40 and 50, and every year after age 50.

• Eat more foods that are high in calcium, such as dark green vegetables and nonfat (skim) milk and dairy products.

• Reduce saturated fats in your diet. Check labels for product contents before you buy them.

• Get regular physical exercise. Exercise will help you fight depression and maintain good circulation, mobility, bone density, and a sense of well-being.

• Use birth control during sexual intercourse until your health care provider says that you may stop. It is not possible to know exactly when you will stop being able to get pregnant and it is important to avoid high-risk pregnancies.

You may also choose to:

• Wear cotton sleepwear to reduce discomfort from night sweats.

• Use a vaginal lubricating cream or jelly if intercourse is painful. This problem is usually caused by a lack of estrogen and should be discussed with your health care provider.

• Talk and share feelings with a friend or family member who understands what you are experiencing.

• Join a support group for women who have been or are going through menopause.