Menopause: What changes during the 'change'?
7/25/2019 by Dr. Denise Dupras
Menopause is the time in a woman's life when she stops having monthly periods. It's often referred to as the "change of life" and marks the transition between a woman's childbearing and non-childbearing years. Menopause is a natural part of aging and happens because of the gradual loss of estrogen, a hormone primarily produced in the ovaries.
What are the signs and symptoms of menopause?
As estrogen production declines, women often develop irregular periods, hot flashes, night sweats, mood swings and fatigue. These symptoms usually develop three to five years before a woman's last period — a time referred to as perimenopause.
Menopause usually occurs between the ages of 45 and 55, with an average age of 51. If a woman is 45 or older and stops menstruating completely for one year, it's assumed she's in menopause. Lab testing isn't needed to confirm menopause. If a woman is under 45 and stops having periods or thinks she may be having menopause symptoms, then she should talk with her doctor to determine if any testing is needed. She may need testing to see if it's menopause or another problem causing her symptoms. A woman should also contact her care team if:
- She's having really bothersome menopausal symptoms that are interfering with her activities
- She's experiencing heavy bleeding during her period or between periods
- She starts bleeding again after entering menopause
Menopause affects all women regardless of race or socioeconomic background, but it's an experience unique to every woman. Some women have more estrogen-deficiency related symptoms and find menopause extremely bothersome, while others may have few or no symptoms.
What are the health concerns for women in menopause?
Reduced levels of estrogen after menopause can lead to health problems. The most common is osteoporosis — thinning of the bones — which increases risk of fractures. Postmenopausal women are at risk for other health problems, including heart disease, stroke and cancer, but the relationship to changes in estrogen levels is not clear.
What are the treatment options for menopausal symptoms?
Medical treatments available by prescription include hormone replacement therapy, antidepressants and anti-seizure medications.
- Estrogen replacement. It's safe for most healthy women, and it's the most effective treatment. Typically, hormone replacement therapy is recommended for up to five years. It's not recommended for women with a history of breast cancer, heart disease or stroke. Progesterone treatment will also be needed if a woman still has a uterus.
- Antidepressants. Some types can help ease hot flashes and other menopausal symptoms — even in women who are not depressed.
- Anti-seizure medications. These have effectively treated hot flashes in some women.
- Natural remedies. Some may not be safe, so a woman should talk with her care team before taking them, especially if she has a history of breast cancer.
- Smoking. Women who smoke should quit, since smoking intensifies hot flashes.
Menopause is a normal part of a woman's life and doesn't always need to be treated, unless symptoms are particularly bothersome. If you have questions about "the change" and how it may affect you, talk with your care team.
Dr. Denise Dupras is a general internist in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). She completed her MD-PhD at Mayo Medical School and her residency in Internal Medicine at Mayo Clinic's campus in Rochester. Her interests include medical education and evidence-based medicine.