The Complete Guide to Everything You Need to Know About Menopause

Medical Reviewer: Carolyn Swenson, MD, Brittany Risher
Photo credit: Getty Images

From Prevention

Table of Contents
Causes | Symptoms | Diagnosis | Treatment | Complications

Menopause: An overview

Often, the first thing that comes to mind when someone hears the word “menopause” is hot flashes. And yes, those bothersome, sudden moments of feeling flushed are a key symptom of this time when a woman’s menstrual cycles end. But there’s a lot more to menopause—and you don’t have to dread it. “Women don’t have to suffer from the symptoms. There are options out there,” says Ann Cha, MD, a board-certified OB/GYN in Johns Creek, Georgia.

Stages of menopause

The terms perimenopause, menopause, and post-menopause all refer to the time surrounding the end of a woman’s reproductive years. They’re often used interchangeably, but they’re different.

The first stage is perimenopause, which typically occurs in a woman’s 40s (or sometimes in her 30s, which is considered to be premature ovarian failure) when her ovaries gradually begin to produce less estrogen. The stage lasts an average of four years but can span anywhere from two to eight years. During this time, a woman can experience hot flashes, irregular periods, difficulty sleeping, vaginal dryness, and changes in sexual desire. The drop in estrogen also increases the risk of osteoporosis and heart disease.[1][2]

Once a woman has her last period, she’s reached menopause. After 12 months without a cycle, she is considered postmenopausal. Every woman will go through menopause, either naturally or as a result of cancer treatments that affect the ovaries, or a surgery in which they’re removed.[5][6]

What are the causes and risk factors of menopause and early menopause?

Menopause typically occurs as a woman’s body naturally begins to produce less estrogen and progesterone. However, some women go through menopause early due to:

[3][4]

What are the symptoms of menopause?

Symptoms of menopause will vary from person to person. However, some of the most common side effects of “the change” include:


When your symptoms become difficult to contend with on your own, a doctor can help you manage and treat them, says women’s health expert Jennifer Wider, MD.

[5]

How is menopause diagnosed?

Even before you begin to experience your first hot flash, “it is wise for all women to discuss perimenopause and menopause with their doctors, so they understand what to look for and what to expect,” Dr. Wider says. When it actually comes time, most often, women can tell they’re going through perimenopause—the time leading up to menopause. “Exhibiting symptoms of menopause is usually all it takes for a doctor to make the diagnosis,” Dr. Wider says. Doctors determine a woman is menopausal when she’s had her last period. After a year without a period, a woman is postmenopausal.

While blood work isn’t necessary for a diagnosis, sometimes your healthcare provider may check your levels of follicle-stimulating hormone (FSH), which increases in the years leading up to, and during, menopause. They may also check your levels of estradiol, which decreases, to confirm menopause.[6] A doctor may also test your thyroid hormone levels to rule out thyroid disease, as some menopause symptoms are similar to those of thyroid issues, Dr. Wider explains.

When you see your doctor, come prepared to discuss the symptoms you’re having and any treatments you’ve tried, from herbal supplements to mind-body practices to dietary changes. Also, know your family health history. Some menopause treatments come with health risks and may be best to avoid if, say, breast cancer runs in your family.

How is menopause treated?

“Menopause itself isn’t treated, but the symptoms can be managed and treated successfully,” Dr. Wider says. “Finding the right treatment depends on the symptoms and sometimes a little trial and error.”

Some women choose to forgo any treatments, as their symptoms are not severe enough to need anything.[8] However, others may choose from medications, lifestyle changes, natural remedies, or a combination of any of the three. “These options are not always easy,” Dr. Cha says. “For example, if you practice mindfulness or self-care, those aren’t as easy as taking a pill. But when you take care of yourself, you improve your long-term health.”

Here are some of the most common treatment options. Ask your doctor which options they feel are best—and safest—for you:

Medications

  • Hormone therapy: Taking estrogen or estrogen plus progesterone via a pill or skin patch can help with hot flashes, vaginal dryness, and other symptoms. However, hormone therapy comes with an increased risk of some cancers, blood clots, and stroke, and isn’t right for everyone.[9]
  • Low-dose selective serotonin reuptake inhibitors (SSRIs): These antidepressants may help reduce the frequency and severity of hot flashes.[10]
  • Estrogen cream: Applying topical estrogen to the vagina via a ring, tablet, or cream may help remedy vaginal dryness.[11]

Lifestyle changes

  • Dressing in layers: Many women find this helps with hot flashes, as you can remove and add layers as your body temperature fluctuates.
  • Prioritizing sleep: Good sleep hygiene may increase the chance of getting adequate, restful slumber even if you’re affected by night sweats.[12]
  • Relaxation techniques: Deep breathing practices, meditation, and other mindfulness practices may help alleviate menopause symptoms.[13]

Natural remedies

  • Supplements: Soy isoflavone supplements may reduce the frequency and severity of hot flashes.[14] However, soy foods do not appear to be effective.[15]
  • Lubricant: Over-the-counter lube can help with vaginal dryness and make sex less painful.
  • Acupuncture: Research is inconclusive, but this ancient practice may reduce menopause symptoms such as hot flashes, insomnia, and mood swings.[17]
  • Cognitive-behavioral therapy (CBT): Dr. Wider recommends therapy for any mood issues. Studies also notes that CBT may reduce depressive feelings and improve sleep.[19]

Remember: It’s important to discuss your personal and family health history with your doctor before choosing any treatment.


Complications of menopause

Estrogen isn’t only important for reproductive health. It also helps with blood flow, bone growth, and bladder health.[20][21][22] So the decrease in estrogen that occurs with menopause increases the risk of other health conditions such as:


Talk to your doctor about your options for monitoring and treating any conditions that arise due to menopause. “Monitoring cholesterol and blood pressure, as well as calcium and vitamin D levels, is vital in postmenopausal women,” Dr. Wider says. Some women may also need to take calcium and/or vitamin D supplements to support bone health. And of course, being active has numerous benefits for your health beyond helping to manage weight.

[23][24][25][26][27]

Sources

[1] https://www.womenshealth.gov/menopause/menopause-basics#4

[2] https://www.womenshealth.gov/menopause/menopause-symptoms-and-relief ; https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

[3] https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 ; https://www.womenshealth.gov/menopause/early-or-premature-menopause

[4] https://academic.oup.com/aje/article/187/4/696/4080179

[5] https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/symptoms ; https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

[6] https://my.clevelandclinic.org/health/diseases/15224-menopause-perimenopause-and-postmenopause/diagnosis-and-tests

[7] https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

[8] https://www.womenshealth.gov/menopause/menopause-treatment

[9] https://www.womenshealth.gov/menopause/menopause-treatment

; https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482277/

[11] https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401 ; https://www.womenshealth.gov/menopause/menopause-treatment#3

[12] https://www.nia.nih.gov/health/sleep-problems-and-menopause-what-can-i-do

[13] https://newsnetwork.mayoclinic.org/discussion/mindfulness-may-ease-menopausal-symptoms/ ; https://www.nia.nih.gov/health/hot-flashes-what-can-i-do ; https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5713750/ ; https://nccih.nih.gov/health/soy/ataglance.htm

[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981010/

[16] https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401 ; https://www.womenshealth.gov/menopause/menopause-treatment ; https://www.hormone.org/diseases-and-conditions/menopause/menopause-treatment/bioidentical-hormones ; https://nccih.nih.gov/health/blackcohosh/ataglance.htm

[17] https://nccih.nih.gov/health/menopause/menopausesymptoms#hed3 ; https://www.hormone.org/diseases-and-conditions/menopause/menopause-treatment/alternative-medicine-for-menopause-treatment ; https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

[18] https://www.ncbi.nlm.nih.gov/pubmed/19169169 ; https://www.ajog.org/article/S0002-9378(13)02015-2/fulltext#sec3 ; https://nccih.nih.gov/health/menopause/menopausesymptoms#hed3 ; https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

[19] https://www.ncbi.nlm.nih.gov/pubmed/24149919 ; https://journals.lww.com/menopausejournal/Citation/2019/09000/Cognitive_behavior_therapy_for_menopausal_symptoms.6.aspx ; https://www.bmj.com/content/351/bmj.h5746/rr-0

[20] https://my.clevelandclinic.org/health/articles/16979-estrogen--hormones

[21] https://www.ncbi.nlm.nih.gov/pubmed/8865143

[22] https://www.ncbi.nlm.nih.gov/pubmed/8355926

[23] https://www.womenshealth.gov/menopause/menopause-and-your-health/#4 ; https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

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