What is menopause and when will it start? While some people call the time leading up to their last period ‘menopause’, menopause is actually when your period stops permanently. The process of menopause usually starts when a woman is around 45 years old and is a natural part of aging whereby the ovaries slowly stop producing hormones, such as estrogen.
The process of menopause can cause symptoms such as hot flashes, night sweats, and insomnia. Fortunately, there are several treatment options available to make this transitional period more comfortable.
Read on to explore menopause, learn about the signs and symptoms, and discover helpful ways to soothe your body during this time.
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What is menopause?
Menopause is a natural part of every woman's life when she has her final menstrual period. While the process leading up to menopause may take several months or years (perimenopause), menopause itself means that your cycles have ended.
When you reach menopause, you are no longer ovulating each month and the production of estrogen and progesterone ceases.
When you have not had a menstrual period for over 12 consecutive months, you are considered to be postmenopausal.
When does menopause start?
Menopause generally begins between the ages of 45 and 55.
Before your final period, you will enter a transitional stage (perimenopause) where you’ll experience hormonal symptoms and irregular periods. This stage can last between two and eight years.
About 1 in 20 women globally experience early menopause, which can happen between the ages of 40 and 45. Women in some areas of the world are more likely to experience early menopause, including women in parts of Latin America and Asia.
Premature menopause is when a woman becomes menopausal at 40 years of age or younger. Premature menopause only occurs in 1 in 100 women and is usually driven by external factors, like chemotherapy or pelvic radiation treatments for cancer, or if there’s a family history.
What are the stages of menopause?
Menopause won’t happen overnight—in fact, for most women, the process of reaching menopause will last about four years.
Menopause is divided into three stages:
- Perimenopause: this begins several years before menopause, as the ovaries begin to slowly make less estrogen.
- Menopause: this happens when you have not had a period in one year. At this stage, your ovaries will have stopped releasing eggs and making most of their estrogen.
- Postmenopause: this occurs when you have not had a period for more than 12 consecutive months. While symptoms such as hot flashes usually ease during this time, the loss of estrogen may cause other health risks.
Common symptoms of menopause
While every woman's experience of menopause is unique, changing hormone levels can cause some common symptoms for most people, like hot flashes.
Several factors can influence your experience of menopausal symptoms. For example, if menopause occurs over a shorter period of time, you may experience a greater severity in symptoms.
Illnesses that affect the ovaries, such as ovarian cancer, and lifestyle factors, such as smoking, can also often increase the severity and duration of symptoms.
The most common symptoms of menopause include:
- Hot flashes: these are sudden rushes of heat in your face and upper body, followed by chills and clamminess. They may last several seconds or minutes. 75% of menopausal women say they experience hot flashes — making them the most commonly reported symptom of menopause.
- Night sweats: these are hot flashes that occur during the night. They can cause you to sweat and disturb your sleep.
- Insomnia: low levels of progesterone in the body during menopause can make it difficult for you to fall asleep or stay asleep at night.
- Emotional changes: menopause can cause mood swings, anxiety, depression, and irritability.
- Vaginal dryness: changes in hormones, like estrogen, can cause vaginal tissue to become thinner and dryer leading to general discomfort and pain during sex.
Additional symptoms of menopause
Other common symptoms of menopause include:
- Dry skin, eyes, or mouth
- Hair thinning or loss
- Weight gain
- Cognitive difficulties
- Skeletal pain
- Difficulty concentrating
- Sore or tender breasts
- Reduced muscle mass
Possible complications of menopause
While menopause is a natural and normal process, it may lead to complications such as:
- Heart and blood vessel diseases: the risk of cardiovascular diseases increases as estrogen levels fall. It is important to eat a healthy diet and exercise to protect your cardiovascular system.
- Osteoporosis: this condition causes bones to become brittle and increases the chance of fractures. The decrease in bone density during menopause may put you at risk of spine, hip, and wrist fractures.
- Urinary incontinence: the inability to control urination during menopause is thought to be caused by the reduced elasticity of your vagina and urethra. You may also be at a higher risk of urinary tract infections.
- Dyspareunia, or painful intercourse: painful sex may occur as a result of decreased moisture and loss of elasticity of the vagina. Water-based lubricants may help to reduce pain and increase comfort.
How long does menopause last?
The symptoms of perimenopause (the time leading up to menopause) lasts around four to eight years.
Menopausal symptoms usually last another four years and about 1 in 10 women will experience menopausal symptoms for 12 years or more (phew!).
What causes menopause?
Menopause is a natural part of aging that occurs as the ovaries produce less reproductive hormones, including:
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
These hormones work together to control your period and help your ovaries release an egg during ovulation. The reduction in reproductive hormones is associated with the natural ending of menstruation.
Premature menopause may be due to:
- Premature ovarian failure: this is when your ovaries prematurely stop releasing eggs. It is not currently known why this occurs.
- Surgical menopause: this is when surgery, such as the removal of the ovaries for medical reasons in treating cancer or endometriosis may trigger menopause. Induced menopause may also be the result of pelvic radiation or chemotherapy damage to the ovaries, or in severe cases of injury.
Wondering if menopause has begun? While testing for menopause is not usually required, there are several signs that this process has started.
An early sign of perimenopause is a disruption of your normal menstrual cycle. Your period may come earlier or later than usual, you may skip months, or experience heavier menses. Additionally, symptoms such as hot flashes are a good sign that menopause is on its way.
In some cases, your doctor may order a blood test to assess your level of hormones and diagnose menopause.
Hormone tests for menopause include:
- Follicle-stimulating hormone (FSH) and estradiol (a form of estrogen): the level of FSH increases and estradiol decreases during menopause. An elevated level of FSH in the blood may confirm menopause.
- Thyroid-stimulating hormone: testing for this hormone can detect low thyroid activity (hypothyroidism), which can cause similar symptoms to menopause.
Additional blood tests often used to confirm menopause include:
- Blood lipid profile
- Kidney function test
- Liver function test
- Hormone tests – for testosterone, progesterone, and prolactin.
Saliva tests and over-the-counter urine tests are also available to test FSH levels. However, they are generally less reliable since levels of FSH rise and fall during the menstrual cycle.
While menopause is completely natural, it doesn’t mean it’s particularly enjoyable for a lot of people.
According to a 2013 study, women experiencing menopausal symptoms reported significantly lower quality of life and significantly higher work impairment and healthcare utilization than women without menopausal symptoms.
If you’re struggling with menopause, talk to your doctor or a healthcare professional about finding a treatment that will work for you.
There several treatment options for menopause that can offer relief for many of the symptoms. These include:
1. Hormone replacement therapy
Hormone replacement therapy is an effective treatment for relieving hot flashes.
This treatment replaces hormones, such as estrogen, that your body is no longer producing in menopause. Hormone replacement may also help with:
- Vaginal symptoms
- Night sweats
- Bone weakening
Treatments like this can come with side-effects, like an increased risk of heart disease and cancer. Fortunately, you can take a low dose to minimize the risk.
It is important to discuss the benefits and risks associated with hormone replacement therapy with your doctor before starting treatment.
Several non-hormone medications are approved for menopause, including:
- Selective serotonin reuptake inhibitors (SSRIs): an antidepressant, such as paroxetine, that is approved for hot flashes, anxiety, and depression.
- Gabapentin: a nerve drug use for hot flashes in menopause.
- Clonidine: a blood pressure drug that can help with hot flashes.
- Selective estrogen receptor modulators (SERMs): a medication that can mimic and block estrogen's effects. This is commonly used to treat hot flashes and vaginal dryness, as well as infertility and hormone-responsive cancers.
- Over-the-counter medicines: at-home treatments for menopause symptoms include vaginal moisturizers and lubricants.
- Sleep medications: insomnia in menopause can be eased with medications like melatonin.
- Ospemifene: this is an oral medication that can help treat vaginal dryness and painful intercourse.
3. Vitamins and supplements
Increasing your intake of vitamins or nutritional supplements can help minimize the symptoms and potential complications of menopause, like osteoporosis.
- Vitamin D promotes healthy bone renewal, restores hormonal balance, and helps to relieve menopausal symptoms with aging, which is associated with a reduced ability to absorb vitamin D.
Vitamin D is produced by the body in response to sun exposure. To get your recommended daily dose of 600 international units (IU), spend 15-20 minutes outdoors per day. You can also take a supplement or eat foods high in vitamin D such as sardines, tuna, and salmon.
Other natural supplements and nutrients that may help limit menopause symptoms include:
- Soy: this is about one third as potent as estrogen in reducing hot flashes. Further, long-term soy consumption has been shown to reduce menopause-related inflammation.
- Flaxseed: in ground form, this may help with menopausal symptoms. One recent study showed 40 grams of flaxseed consumed daily may be similar to hormone therapy in reducing hot flashes and sleeping problems.
- St John’s wort: Derived from a wild flowering plant, Hypericum perforatum, the leaves and flowers are harvested and brewed in a tea, or taken in a pill form. It has been used historically to treat menopausal mood swings and reduce depression and anxiety. Scientific studies show St John’s wort is effective for treating mild depression but works no better than a placebo for treating severe depression.
- Ginseng: The root of this traditional Chinese herb may promote health during menopause. It has been shown to help reduce the occurrence and severity of hot flashes and night sweats during menopause. One study found ginseng can lower the risk of cardiovascular disease in menopausal women.
4. Lifestyle changes
There are several lifestyle changes that may help to ease symptoms of menopause. These include:
- Exercising regularly and eating a healthy diet to manage your weight, as obesity may worsen symptoms of menopause.
- Staying socially and mentally active to avoid cognitive decline associated with menopause.
- Limiting alcohol and smoking, as these habits may increase your risk of hot flashes and other complications.
- Taking care of your skin by applying moisturizer daily to reduce dryness. Avoid swimming and bathing excessively and use a medically-approved vaginal moisturizer to care for vaginal tissue.
Mind-body therapies for menopause
If you’d rather avoid the potential risks of hormone replacement therapy, there are several mind-body treatments available that have been clinically proven to reduce the symptoms of menopause.
Hypnotherapy involves focused relaxation and visualization in an absorbed state of attention. It has been used in medicine to treat various conditions such as irritable bowel syndrome (IBS) and smoking addiction.
Hypnotherapy can help you manage and reduce the symptoms of menopause. A hypnotherapist will often use cool imagery to counteract the hot flashes during menopause.
Several studies have shown that yoga is effective and safe for reducing menopausal symptoms. Women have also reported stretching and relaxation techniques in yoga may help elevate and stabilize mood and improve quality of life during menopause.
You can try a gentle yoga class once or twice a week to begin practicing. Once you have mastered the basics, you can practice more often at home.
Acupuncture may provide relief from menopausal symptoms.
One meta-study has shown that acupuncture reduces the severity, but not frequency, of hot flashes. However, some researchers argue that acupuncture benefits for menopause are purely the result of the placebo effect.
Sex after menopause
Menopause may affect some aspects of your sex life, though some women don’t notice any changes at all.
The most common changes in menopause include:
- Vaginal tissue becomes thinner and dryer due to lower hormone levels. This condition is called vaginal atrophy and may lead to pain during intercourse. You may also notice vaginal bleeding after menopause due to a lack of lubrication during sex.
- Lower sex drive due to reduced reproductive hormone levels. It may take longer to become aroused.
- Emotional changes that may make you feel stressed or irritable, and less aroused.
While a decrease in libido can be normal as you get older, if you are frustrated by changes to your sexual health talk to your doctor. They can offer advice and treatments to help get your sex life back on track.
Is sex painful after menopause?
1 in 5 women, not taking hormone replacement therapy, will experience painful sex after menopause.
Falling levels of estrogen can cause changes to the vaginal tissue, which may make it more susceptible to bleeding, tears, or pain during intercourse.
Your doctor can help you identify several ways to improve your sexual health during menopause, such as:
- Exercising: physical activity boosts energy levels, lifts mood, and improves body image – all of which can increase sex drive.
- Increasing sexual activity: if you choose to have sex regularly, it can increase blood flow to your vagina and keep the tissues healthy.
- Pelvic floor exercises: these can help to increase blood flow to the vagina and strengthen the muscles involved in orgasm.
- Allow more time to become aroused: natural moisture from being aroused can help lubricate tissues and make sex less painful.
- Choosing the right lubricant: Silicone-based lubricants offer longer-lasting lubrication and won't dry out during intercourse.
Can you get pregnant after menopause?
In short, yes. During perimenopause, your ovaries are beginning to produce less estrogen and progesterone and fertility is declining.
However, because your ovaries are still releasing eggs, you can still get pregnant at this time.
Once you are postmenopausal, your hormonal levels will fall and your ovaries will stop releasing eggs. When this happens, you can no longer fall pregnant.
The Wrap Up
Menopause is the natural end of a woman’s menstrual cycle and fertility that comes with age. Many women experience symptoms of menopause in the years before and during menopause, most commonly hot flashes, mood swings, and sleeping difficulties.
You may benefit from various treatments, such as hormone replacement therapy, if menopausal symptoms are interfering with your quality of life. However, many symptoms of menopause can be managed with lifestyle changes and mind-body therapies such as hypnotherapy. Your doctor can help you find the right strategies to manage menopause and reduce your symptoms.