Understanding Menopause

STAGES OF MENOPAUSE

Premature Menopause

What is Premature Menopause?

Premature menopause is menopause that happens before the age of 40 — whether it is natural or induced. Women who enter menopause early get symptoms similar to those of natural menopause, like hot flashes, emotional problems, vaginal dryness, and decreased sex drive. For some women with early menopause, these symptoms are severe. Also, women who have early menopause tend to get weaker bones faster than women who enter menopause later in life. This raises their chances of getting osteoporosis and breaking a bone. Premature menopause can happen for the following reasons:

Chromosome defects. Defects in the chromosomes can cause premature menopause. For example, women with Turner's syndrome are born without a second X chromosome or born without part of the chromosome. The ovaries don't form normally, and early menopause results.
Genetics. Women with a family history of premature menopause are more likely to have early menopause themselves.
Autoimmune diseases. The body's immune system, which normally fights off diseases, mistakenly attacks a part of its own reproductive system. This hurts the ovaries and prevents them from making female hormones. Thyroid disease and rheumatoid arthritis are two diseases in which this can happen.
Surgery to remove the ovaries. Surgical removal of both ovaries, also called a bilateral oophorectomy [OH-uh-fuh-REK-tuh-mee], puts a woman into menopause right away. She will no longer have periods, and hormones decline rapidly. She may have menopausal symptoms right away, like hot flashes and diminished sexual desire. Women who have a hysterectomy, but have their ovaries left in place, will not have induced menopause because their ovaries will continue to make hormones. But because their uterus is removed, they no longer have their periods and cannot get pregnant. They might have hot flashes since the surgery can sometimes disturb the blood supply to the ovaries. Later on, they might have natural menopause a year or two earlier than expected.
Chemotherapy or pelvic radiation treatments for cancer. Cancer chemotherapy or pelvic radiation therapy for reproductive system cancers can cause ovarian damage. Women may stop getting their periods, have fertility problems, or lose their fertility. This can happen right away or take several months. With cancer treatment, the chances of going into menopause depend on the type of chemotherapy used, how much was used, and the age of the woman when she gets treatment. The younger a woman is, the less likely she will go into menopause.

How to Find Out if You Have Premature Menopause

Your doctor will ask you if you've had changes typical of menopause, like hot flashes, irregular periods, sleep problems, and vaginal dryness. Normally, menopause is confirmed when a woman hasn't had her period for 12 months in a row.

However, with certain types of premature menopause, these signs may not be enough for a diagnosis. A blood test that measures follicle-stimulating hormone (FSH) can be done. Your ovaries use this hormone to make estrogen. FSH levels rise when the ovaries stop making estrogen. When FSH levels are higher than normal, you've reached menopause. However, your estrogen levels vary daily, so you may need this test more than once to know for sure.

You may also have a test for levels of estradiol (a type of estrogen) and luteinizing hormone (LH). Estradiol levels fall when the ovaries fail. Levels lower than normal are a sign of menopause. LH is a hormone that triggers ovulation. If you test above normal levels, you've gone through menopause.

Perimenopause

What is Perimenopause?

Perimenopause marks the time when your body begins the transition to menopause. It includes the years leading up to menopause — anywhere from two to eight years — plus the first year after your final period. There is no way to tell in advance how long it will last OR how long it will take you to go through it. It's a natural part of aging that signals the ending of your reproductive years.

Signs and Symptoms

Perimenopause causes changes in your body that you may or may not notice. For most women, the discomforts associated with perimenopause are minimal and manageable. Some things you might experience in the perimenopause years include:

Changes in your menstrual cycle (longer or shorter periods, heavier or lighter periods, or missed periods)
Hot flashes (sudden rush of heat from your chest to your head)
Night sweats (hot flashes that happen while you sleep)
Vaginal dryness
Sleep problems
Mood changes (mood swings, sadness, or irritability)
Pain during sex
More urinary infections
Urinary incontinence
Less interest in sex
Increase in body fat around your waist
Problems with concentration and memory

You can’t always tell if physical or emotional changes are related to menopause, the normal aging process, or something else. But by monitoring your menstrual cycle and recording your signs and symptoms for several months, you'll gain a better understanding of the changes occurring during this time. You will also have valuable information to discuss with your doctor should you have a concern.

Oral contraceptives (birth control pills) are often the treatment of choice to relieve perimenopausal symptoms — even if you don't need them for birth control. Today's low-dose pills regulate periods and stop or reduce hot flashes, vaginal dryness, and premenstrual syndrome.

Making lifestyle changes may help ease the discomfort of your symptoms and keep you healthy in the long run.

Good nutrition. Because your risk of osteoporosis (bone disease) and heart disease increases at this time, a healthy eating plan is more important than ever. Adopt a low-fat, high-fiber eating plan that is rich in fruits, vegetables, and whole grains. Add calcium-rich foods or take a calcium supplement. Limit alcohol or caffeine, which can affect sleep. If you smoke, try to quit.
Regular exercise. Regular physical activity helps keep your weight down, improves your sleep, strengthens your bones, and elevates your mood. Try to exercise for 30 minutes or more on most days of the week.
Stress reduction. Practiced regularly, stress reduction techniques such as meditation or yoga can help you relax and tolerate your symptoms more easily.

Pregnancy and Perimenopause

If you're still having periods, even if they are not regular, you can get pregnant. Talk to your doctor about your options for birth control. Keep in mind that some methods of birth control, like birth control pills, shots, implants, or diaphragms will not protect you from sexually transmitted infections (STIs), including HIV.

Sexual Health and Perimenopause

Many aging women enjoy an active sex life. Yet, many women are not aware of their risk of getting sexually transmitted infections (STIs), including HIV. If you have more than one sexual partner or have started a new sexual relationship, talk with your partner about using condoms before having sex. Latex condoms used correctly and every time you have any type of sexual contact offer the best protection against STIs. Dental dams (used for oral sex) and female condoms also can help protect you from some STIs.

Menopause

What is Menopause?

Menopause is a normal change in a woman's life when her period stops. It is often called the "change of life." During perimenopause, a woman's body slowly makes less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row, and there are no other causes for this change. As you near menopause, you may have symptoms from the changes your body is making. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms. You can feel better by learning all you can about menopause, and talking with your doctor about your health and your symptoms. If you want to treat your symptoms, your doctor can tell you more about your options and help you make the best treatment choices.

Symptoms of Menopause

Every woman's period will stop at menopause. Some women have no other symptoms. But many women notice changes in body, mind, and mood at this stage of life. We don’t always know if these changes are related to menopause, aging, or both. Some changes you might notice include:

Changes in your period. The time between periods and the flow from month to month may be different.
Abnormal bleeding or "spotting." This is common as you near menopause. But if your periods have stopped for 12 months in a row, and you still have "spotting," you should talk to your doctor to rule out serious causes, like cancer.
Night sweats. Hot flashes that occur while a woman is sleeping and cause her to perspire. They can make it hard to get a good night’s sleep.
Sleeping problems. Lack of sleep can affect your mood, health, and ability to cope with everyday stress.
Vaginal changes. The vagina may become dry and thin, and sex and vaginal exams may be painful. You also might get more vaginal infections.
Thinning of your bones. This may lead to loss of height and bone breaks (osteoporosis).
Emotional changes. May include mood swings, sadness, tearfulness, and irritability. Although menopause does not cause depression, women are at a higher risk of depression in the years leading up to menopause. Some researchers think that the decrease in estrogen levels plays a role in the onset of depression in some women. Also, lack of sleep can strain a woman’s emotional health.
Urinary problems. You may have leaking, burning or pain when urinating, or leaking when sneezing, coughing, or laughing.
Problems with memory and staying focused. You may notice you are more forgetful or have trouble concentrating.
Sex drive decreases. You may have less interest in sex and changes in sexual response.
Weight fluctuation. Weight gain or increase in body fat around your waist.
Hair loss or thinning. Hair thinning or loss is a problem for some women.

Symptom Relief

Many women are able to cope with minor discomforts of menopause. Try these tips:

Hot flashes. Keep track of when hot flashes happen. You might be able to identify a pattern or triggers, which you can avoid. Dress in layers and keep a fan in your home or workplace. If lifestyle changes don’t seem to help, ask your doctor about menopausal hormone therapy or nonhormonal prescription drugs. Research has found that nonhormonal prescription drugs, such as antidepressants, help hot flashes in some women.
Vaginal dryness. Try an over-the-counter water-based vaginal lubricant. Prescription estrogen replacement creams and tablets also can help restore moisture and tissue health. If you have spotting or bleeding while using estrogen creams, you should see your doctor.
Problems sleeping. One of the best ways to get a good night's sleep is to get at least 30 minutes of physical activity on most days of the week. But avoid physical activity close to bedtime. Also avoid alcohol, caffeine, large meals, and working right before bedtime. You might want to drink something warm, such as herb tea or warm milk, before bedtime. Keeping your bedroom cool and dark also can help. Avoid napping during the day and try to go to bed and get up at the same times every day.
Memory problems. Some women complain about problems with memory and concentration. But there is no proof that menopause causes memory problems. Try to get enough sleep and engage in physical and social activity. If forgetfulness or other mental problems worry you or are affecting your everyday functioning, talk to your doctor.
Mood swings. Try to get enough sleep and be physically active. Set limits for yourself, and look for positive ways to ease daily stress. Think about going to a support group for women who are going through the same thing as you, or getting counseling to talk through your problems and fears. Talk to your doctor if mood swings are causing you distress. Medicines might help. For instance, menopausal hormone therapy might help if mood swings are related to disrupted sleep caused by night sweats. Also, your doctor can look out for signs of depression, which is a serious illness that needs treatment.

Eating Right and Physical Activity

You can feel better by having a healthy lifestyle — don't smoke, eat a variety of foods low in saturated fat, trans fat, and cholesterol. Include grains, especially whole grains and a variety of dark green leafy vegetables, deeply colored fruit, and dry beans and peas in your eating plan. Also, maintain a healthy weight and be physically active for at least 30 minutes a day.

Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight.

To lower the risk of chronic disease, get at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week.
To help manage body weight and prevent gradual, unhealthy body weight gain, get about 60 minutes of moderate- to vigorous-intensity activity on most days of the week, while not exceeding caloric intake requirements.
To keep weight loss off, get at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with their doctor before participating in this level of activity.

Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.

Menopause Resources

Government Agencies

womenshealth.gov, OWH, HHS *
8270 Willow Oaks Corporate Drive
Fairfax, VA 22031
Phone: (800) 994-9662
TDD: (888) 220-5446
FAX: (703) 663-6942
www.womenshealth.gov/menopause
Office on Women's Health, HHS
200 Independence Avenue, SW, Room 712E
Washington, DC 20201
Phone: (202) 690-7650
FAX (202) 205-2631
http://www.womenshealth.gov/owh
Administration on Aging, HHS
1 Massachusetts Avenue
Washington, DC 20201
Phone: (202) 619-0724
Eldercare locator: (800) 677-1116
http://www.aoa.dhhs.gov
Agency for Health Care Research and Quality *
540 Gaither Road, Suite 2000
Rockville, MD 20850
Phone: (800) 358-9295
TDD: (888) 586-6340
http://www.ahrq.gov
National Cancer Institute, NIH, HHS *
Building 31, Room 10A31
6116 Executive Boulevard, Room 3036A
Bethesda, MD 20892-8322
Phone: (800) 422-6237
TTY: (800) 332-8615
http://www.cancer.gov
National Center for Complementary and Alternative Medicine, NIH, HHS *
PO Box 7923
Gaithersburg, MD 20898
Phone: (888) 644-6226
TTY: (866) 464-3615
Fax: (866) 464-3616
http://nccam.nih.gov
National Heart, Lung, and Blood Institute, NIH, HHS *
PO Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
TTY: (240) 629-3255
Fax (240) 629-3246
http://www.nhlbi.nih.gov
National Institute on Aging, NIH, HHS *
Public Information Office
Building 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD 20892
Phone: (800) 222-2225
TTY: (800) 222-4225
FAX (301) 496-1072
http://www.nia.nih.gov
National Institute of Child Health and Human Development, NIH, HHS *
Information Resource Center
PO Box 3006
Rockville, MD 20847
Phone: (800) 370-2943
TTY: (888) 320-6942
FAX (301) 984-1473
http://www.nichd.nih.gov
National Institute of Mental Health, NIH, HHS *
Public Information and Communications Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: (866) 615-6464
TTY: (866) 415-8051
FAX (301) 443-4279
http://www.nimh.nih.gov
National Mental Health Information Center, SAMHSA, HHS *
PO Box 42557
Washington, DC 20015
Phone: (800) 789-2647
TDD: (866) 889-2647
Fax (240) 221-4295
http://www.mentalhealth.samhsa.gov
Office of Research on Women's Health, NIH, HHS
6707 Democracy Blvd. Suite 400
Bethesda, MD 20892-5484
Phone: (301) 402-1770
FAX (301) 402-1798
http://orwh.od.nih.gov/index.html
Office of Women's Health, CDC, HHS
1600 Clifton Road, NE, MS E-89
Atlanta, GA 30333
Phone: (404) 498-2300
Fax: (404) 498-2370
http://www.cdc.gov/women/
Office of Women's Health, FDA, HHS
5600 Fishers Lane
Rockville, MD 20857
Phone: (888) 463-6332
http://www.fda.gov/womens/default.htm
Osteoporosis and Related Bone Diseases National Resource Center, NIH, HHS *
2 AMS Circle
Bethesda, MD 20892-3676
Phone: (800) 624-2663
TTY: (202) 466-4315
Fax: (202) 293-4315
http://www.osteo.org

Private Organizations

American Association of Clinical Endocrinologists (AACE)
245 Riverside Ave, Suite 200
Jacksonville, FL 32202
Phone: (904) 353-7878
http://www.aace.com
American College of Obstetricians and Gynecologists (ACOG) (Offers Publications in Spanish)
409 12th St., S.W., PO Box 96920
Washington, DC 20090-6920
Phone: (202) 638-5577
http://www.acog.org
American Menopause Foundation, Inc. (Offers publications in Spanish)
350 5th Avenue, Suite 2822
New York, NY 10118
Phone: (212) 714-2398
http://www.americanmenopause.org
Association of Women's Health, Obstetric and Neonatal Nurses
2000 L Street, NW, Suite 740
Washington, D.C. 20036
Phone: (800) 673-8499
http://www.awhonn.org
Black Women's Health Imperative
1420 K Street, N.W. Suite 1000
Washington, DC 20005
Phone: (202) 548-4000
Fax: (202) 543-9743
http://www.blackwomenshealth.org
Boston Women's Health Book Collective (Offers publications in Spanish)
34 Plympton Street
Boston, MA 02118
Phone: (617) 451-3666
Fax: (617) 451-3664
http://www.ourbodiesourselves.org
Hormone Foundation *
8401 Connecticut Avenue, Suite 900
Chevy Chase, MD 20815-5817
Phone: (800) 467-6663
http://www.hormone.org
The Jean Mayer USDA Human Nutrition Research Center on Aging
Tufts University, 711 Washington Street
Boston, MA 02111-1524
Phone: (617) 556-3000
FAX (617) 556-3344
http://hnrc.tufts.edu
National Center on Women and Aging
The Heller School for Social Policy and Management
MS 035
Brandeis University
Waltham, MA 02454-9110
Phone: (800) 929-1995
http://www.heller.brandeis.edu/national/
National Osteoporosis Foundation (NOF)
1232 22nd Street, NW
Washington, DC 20037-1202
Phone: (800) 223- 9994
http://www.nof.org
National Women's Health Network
514 10th Street, NW, Suite 400
Washington, DC 20004
Phone: (202) 628-7814
http://www.nwhn.org
North American Menopause Society (NAMS) (Offers publications in Spanish)
PO Box 94527
Cleveland, OH 44101
Phone: (440) 442-7550
http://www.menopause.org
Planned Parenthood Federation of America *
434 West 33rd Street
New York, NY 10001
Phone: (800) 230-7526
http://www.plannedparenthood.org