Menopause

Last Updated: January 15, 2023

Menopause is the stage of life when menses permanently cease, and the reproductive system no longer performs functions related to fertility. A woman is considered to have entered menopause after menses have stopped for 12 months.

Menopause falls under theWomen’s Healthcategory.

What is menopause?

Natural menopause is when menses permanently cease because the ovaries stop producing estrogen and progesterone. It generally occurs in women after 45 years of age with no pathological or physiological cause, but early menopause can result from surgery, chemotherapy, radiotherapy, or primary ovarian insufficiency. Perimenopause is the transitional phase into menopause and may last between 4 to 8 years.[1]

What are the main signs and symptoms of menopause?

Hot flashes, night sweats, vaginal dryness, insomnia, trouble focusing, and mood swings are the primary symptoms women experience during the transition into and sometimes throughout menopause. Women can also experience changes in body composition. The main sign of menopause is a lack of menstruation.

How is menopause diagnosed?

Menopause is clinically diagnosed after 12 months of amenorrhea (lack of mentruation) without other causes, such as surgical removal of the ovaries, chemotherapy or radiotherapy, or primary ovarian insufficiency. It usually occurs after 45 years of age and is considered abnormal if it occurs prior to 40 years of age. Blood and urine tests can be conducted to detect changes in hormone levels.[2]

What are some of the main medical treatments for menopause?

The main medical treatments for menopause symptoms include both nonhormonal and hormonal (hormone replacement therapy (HRT)) options. Treatment is usually individualized based on the types of symptoms being managed, personal and family medical history, age, and personal preference.

For vaginal symptoms, such as dryness, burning, and pain during intercourse, nonhormonal options like vaginal moisturizers and lubricants can be helpful for less severe symptoms. When symptoms are more severe, locally applied estrogen medications can be effective; however, local treatments will not improve other menopause symptoms like hot flashes.[3]

When systemic symptoms are present (e.g., hot flashes, night sweats, sleep disturbances, low mood), systemic HRT that provides estrogen, with or without progesterone, is the most effective option. This can be taken in a variety of ways (e.g., oral pill, skin patch or gel, vaginal ring), all of which carry their own risks and benefits. HRT may also reduce the risk of osteoporosis, type 2 diabetes, and colorectal cancer.[4][5][6] For people unable or unwilling to take HRT, non-hormonal options, like antidepressants, may also help to reduce hot flashes and improve mood.[7]

Despite the benefits of HRT, there are risks associated with this treatment, and it is not appropriate for everyone. For most women who start HRT within 10 years of menopause or before age 60, the benefits generally outweigh the risks.[7]

Have any supplements been studied for menopause?

A number of botanical and other nutritional supplements have been investigated for the treatment of menopausal symptoms. Black cohosh, red clover, omega-3 fatty acids, dehydroepiandrosterone (DHEA), evening primrose oil, Vitex agnus-castus, soy isoflavones and St. John's wort are among the variety of supplements purported to reduce menopausal symptoms.

How could diet affect menopause?

Hormone changes during menopause can negatively affect lipid and glucose metabolism. The American Heart Association recommends women consume a diet rich in fruits, vegetables, high-fiber whole grains, and oily fish, and that they limit saturated fat, cholesterol, alcohol, sodium, and sugar and avoid trans-fatty acids.

Are there any other treatments for menopause?

Exercise like yoga may be particularly helpful for vasomotor and psychological symptoms.[8] Strength and resistance training are especially important for maintaining muscle mass and bone mineral density, especially when combined with high-impact exercises like jumping, skipping, and jogging.[9]

What causes menopause?

Menopause is a natural condition that occurs as women age. Over time, a woman’s ovarian follicles and granulosa cells diminish. Given these cells are the main producers of estradiol and inhibin[10] (a hormone that tells the pituitary gland to make less follicle-stimulating hormone), the body’s hormonal balance shifts toward lower estrogen and progesterone levels and increased follicle-stimulating hormone and luteinizing hormone levels. This hormonal profile results in irregular menstrual cycles, which ultimately stop altogether.

Hormonal variations across a woman's lifetime

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