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Menopause is the point in a woman's life when she has not had her period for 1 year. It marks the end of the childbearing years. It's sometimes called "the change of life."
For most women, menopause happens around age 50. But every woman's body has its own time line. Some women stop having periods in their mid-40s. Others continue well into their 50s.
Perimenopause is the process of change that leads up to menopause. It can start as early as your late 30s or as late as your early 50s. How long perimenopause lasts varies, but it usually lasts from 2 to 8 years. You may have irregular periods or other symptoms during this time.
Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you. But it's a good idea to learn all you can about menopause. Knowing what to expect can help you stay as healthy as possible during this new phase of your life.
Normal changes in your reproductive and hormone systems cause menopause. As your egg supply ages, your body begins to ovulate less often. During this time, your hormone levels go up and down unevenly (fluctuate), causing changes in your periods and other symptoms. In time, estrogen and progesterone levels drop enough that the menstrual cycle stops.
Common symptoms include:
Some women have only a few mild symptoms. Others have severe symptoms that disrupt their sleep and daily lives.
Symptoms tend to last or get worse the first year or more after menopause. Over time, hormones even out at low levels, and many symptoms improve or go away.
You don't need to be tested to see if you have started perimenopause or reached menopause. You and your doctor will most likely be able to tell based on irregular periods and other symptoms.
If you have heavy, irregular periods, your doctor may want to do tests to rule out a serious cause of the bleeding. Heavy bleeding may be a normal sign of perimenopause. But it can also be caused by infection, disease, or a pregnancy problem.
You may not need to see your doctor about menopause symptoms. But it is important to keep up your annual physical exams. Your risks for heart disease, cancer, and bone thinning (osteoporosis) increase after menopause. At your yearly visits, your doctor can check your overall health and recommend testing as needed.
Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you. But if your symptoms are upsetting or uncomfortable, you don't have to suffer through them. There are treatments that can help.
The first step is to have a healthy lifestyle. This can help reduce symptoms and also lower your risk of heart disease and other long-term problems related to aging.
If lifestyle changes aren't enough to relieve your symptoms, you can try other measures, such as breathing exercises and yoga.
If you have severe symptoms, you may want to ask your doctor about prescription medicines. Choices include:
All medicines for menopause symptoms have possible risks or side effects. A very small number of women develop serious health problems when taking hormone therapy. Be sure to talk to your doctor about your possible health risks before you start a treatment for menopause symptoms.
Remember, it is still possible to become pregnant until you reach menopause. To prevent an unwanted pregnancy, keep using birth control until you have not had a period for 1 full year.
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Learning about menopause:
Living with symptoms of perimenopause and menopause:
Menopause is a natural part of aging. As you age, the number and quality of your eggs decline, hormone levels fluctuate, and your menstrual cycle becomes less predictable until it finally stops completely.
Certain lifestyle choices and medical treatments can cause or are linked to an earlier menopause, including:
The first sign that you are nearing menopause is a change in your menstrual periods. They may become less frequent. And they may be lighter or heavier than you're used to.
Menopause symptoms range from mild (or none) to severe. They include:
These symptoms usually go away after 1 or 2 years. But some women have them for several years longer.
Other conditions can cause similar symptoms. Examples include pregnancy; a significant change in weight; depression; anxiety; or uterine, thyroid, or pituitary problems.
Menopause caused by surgery, chemotherapy, or radiation therapy can cause more severe symptoms than usual. Preexisting conditions such as depression, anxiety, sleep problems, or irritability can also make symptoms worse.
After you stop having menstrual periods, you may get other symptoms, including:
In your late 30s, your egg supply begins to decline in number and quality. As a result, your hormone production changes. You may notice a shortened menstrual cycle and some premenstrual syndrome (PMS) symptoms that you didn't have before.
Gradually, your periods become irregular. This can start as early as your late 30s or as late as your early 50s. It continues for 2 to 8 years before menstrual cycles end.
During this time, your ovaries are sometimes producing too much estrogen and/or progesterone and at other times too little. Your progesterone is likely to fluctuate more than before. This can lead to heavy menstrual bleeding. (If you have heavy or unexpected vaginal bleeding, see your doctor to be sure it isn't caused by a more serious condition.)
About 6 months to a year before your periods stop, your estrogen starts to drop. When it drops past a certain point, your menstrual cycles stop. After a year of no menstrual periods, you are said to have "reached menopause."
During the next year or so, estrogen levels keep going down. This lowers your risk for certain types of cancers (estrogen is linked to some types of cancerous cell growth). But low estrogen also creates some health concerns, such as:
Although the reasons aren't well understood, a woman's risk of heart disease increases after menopause. Because heart disease is the number one killer of women, consider your heart risk factors when making lifestyle and treatment decisions.
Call your doctor if you have:
The following health professionals can help you manage menopause symptoms and evaluate menstrual period changes:
Your age, your history of menstrual periods, your symptoms, and the results of your pelvic exam will tell your doctor whether you are near or at menopause. If possible, bring a calendar or journal of your periods and symptoms.
If you have severe symptoms, if your doctor suspects another medical condition, or if you have a medical condition that makes a diagnosis difficult, your doctor may do one or more of the following blood tests:
If you have had no menstrual periods for 1 year, this is a good time to have a full physical exam, with particular focus on your heart health and risk factors for osteoporosis.
Menopause is a natural part of aging. But symptoms can be difficult for some women.
If you have trouble sleeping, mood swings, hot flashes, cloudy thinking, heavy menstrual periods, or other symptoms, treatment can help you get through this time more comfortably.
Treatment for menopause symptoms may include:
A healthy lifestyle can help you manage menopause symptoms. It can also help lower your risk for heart disease, osteoporosis, and other long-term health problems.
To manage hot flashes, try keeping your environment cool, dressing in layers, and managing stress.
To improve vaginal dryness and muscle tone, try using a vaginal lubricant and doing Kegel exercises regularly.
Medicines can help you cope with bothersome menopause symptoms. Some medicines contain hormones, and some don't.
Hormone therapy is sometimes used to treat menopause symptoms. But women who use it may have a higher risk of other health problems.
If your symptoms are the result of early menopause brought on by having your ovaries removed along with your uterus, you may consider estrogen therapy (ET). But ET may increase the risk of health problems in a small number of women.
Short-term, low-dose HT or ET can be taken for up to 4 to 5 years, with regular checkups. This may work well for many women, who will find that their menopause symptoms have subsided within this period of time.
Many women have turned to alternative medicine for menopause symptom relief. Before you try prescription medicines or hormones, you can think about using one or more of the following options for preventing or treating symptoms.
Remember that dietary supplements aren't regulated the way medicines are. It's important to be careful when taking supplements. Tell your doctor what you are taking.
Based on the latest research, some treatments aren't recommended, either because they don't work or because they can cause dangerous effects.6 These include:
|American Congress of Obstetricians and Gynecologists (ACOG)|
|409 12th Street SW|
|P.O. Box 70620|
|Washington, DC 20024-9998|
American Congress of Obstetricians and Gynecologists (ACOG) is a nonprofit organization of professionals who provide health care for women, including teens. The ACOG Resource Center publishes manuals and patient education materials. The Web publications section of the site has patient education pamphlets on many women's health topics, including reproductive health, breast-feeding, violence, and quitting smoking.
|American Heart Association (AHA)|
|7272 Greenville Avenue|
|Dallas, TX 75231|
Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.
|Hormone Health Network|
|8401 Connecticut Avenue|
|Chevy Chase, MD 20815-5817|
The Hormone Health Network is a nonprofit organization started by the Endocrine Society. The organization promotes the prevention, treatment, and cure of hormone-related conditions through public outreach and education.
|National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health|
|9000 Rockville Pike|
|Bethesda, MD 20892|
The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) explores complementary and alternative healing practices in the context of rigorous science, trains complementary and alternative medicine researchers, and gives out authoritative information.
|National Osteoporosis Foundation (NOF)|
|1150 17nd Street NW, Suite 854|
|Washington, DC 20036|
The National Osteoporosis Foundation (NOF) funds research and publishes educational material about osteoporosis for consumers and health professionals. The NOF also provides information about bone density testing sites, new treatment, and local groups interested in osteoporosis. The foundation's mission is to prevent osteoporosis, promote lifelong bone health, help improve the lives of those affected by osteoporosis and related fractures, and find a cure.
|North American Menopause Society (NAMS)|
|5900 Landerbrook Drive|
|Mayfield Heights, OH 44124|
The North American Menopause Society (NAMS) is a nonprofit organization that promotes the understanding of menopause and thereby improves the health of women as they approach menopause and beyond. NAMS members include experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education. The NAMS website has information on perimenopause, early menopause, menopause symptoms and long-term health effects of estrogen loss, and a variety of therapies.
|Office on Women's Health|
|Department of Health and Human Services|
|200 Independence Avenue, SW Room 712E|
|Washington, DC 20201|
The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of audiences, including consumers, health professionals, and researchers.
- Fritz MA, Speroff L (2011). Menopause and perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 673–748. Philadelphia: Lippincott Williams and Wilkins.
- North American Menopause Society (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause, 19(3): 257–271. Also available online: http://www.menopause.org/PSht12.pdf.
- North American Menopause Society (2010). Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause, 17(2): 242–255. Also available online: http://www.menopause.org/PSht10.pdf.
- Cedars MI, Evans M (2008). Menopause. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 725–741. Philadelphia: Lippincott Williams and Wilkins.
- Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749–857. Philadelphia: Lippincott Williams and Wilkins.
- American College of Obstetricians and Gynecologists (2001, reaffirmed 2010). Use of botanicals for management of menopausal symptoms. ACOG Practice Bulletin No. 28. Obstetrics and Gynecology, 97(6, Suppl): 1–11.
Other Works Consulted
- American Association of Clinical Endocrinologists Menopause Guidelines Revision Task Force (2006). American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice, 12(3): 315–337.
- Daley A, et al. (2011). Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews (9).
- Grady D, Barrett-Connor E (2012). Menopause. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 1565–1571. Philadelphia: Saunders.
- Levis S, et al. (2011). Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms. Archives of Internal Medicine, 171(15): 1363–1369.
- Manson JE, Bassuk SS (2012). The menopause transition and postmenopausal hormone therapy. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 3040–3046. New York: McGraw-Hill.
- Shifren JL, Schiff I (2007). Menopause. In JS Berek, ed., Berek and Novak's Gynecology, 14th ed., pp. 1323–1340. Philadelphia: Lippincott Williams and Wilkins.
- U.S. Preventive Services Task Force 2012. Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf12/menohrt/menohrtfinalrs.pdf.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Carla J. Herman, MD, MPH - Geriatric Medicine|
|Last Revised||April 30, 2013|
Last Revised: April 30, 2013
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