Natural menopause generally occurs in women at around 51 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.
Young women with primary ovarian insufficiency (POI) experience symptoms similar to menopause. For women with POI and no contraindications (like breast cancer), the American College of Obstetricians and Gynecologists recommends hormone replacement therapy. This includes the use of prescription estrogen therapy until around age 50 to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy. Some women may require vaginal estrogen in addition to systemic estrogen. Young women with POI should have an annual thyroid exam as they are at increased risk of developing Hashimoto's thyroiditis.
In addition to medical management, women with POI may find the following lifestyle interventions helpful: eat a diet rich in calcium, maintain adequate vitamin D levels, perform weight-bearing exercises, limit caffeine and alcohol intake, and avoid smoking.
During perimenopause and sometimes even postmenopause, women can experience symptoms like hot flashes, night sweats, vaginal dryness, insomnia, trouble focusing, and mood swings. Women may also notice changes in body composition, such as reduced lean mass and increased fat mass, particularly around the abdomen. The majority of these symptoms are a result of hormonal fluctuations, with hot flashes among the most commonly reported.
Vasomotor symptoms (VMS), more commonly known as hot flashes and night sweats, affect roughly 80% of women in their late-forties to mid-fifties. They often begin in perimenopause and peak in the later perimenopause and early postmenopausal years. Hot flashes present as a feeling of intense heat, resulting in sweating and flushing, predominantly around the head, neck, chest, and upper back. The physiology of hot flashes is not fully known, but they are presumed to be linked to low estrogen and elevated luteinizing hormone.
Not all menopausal women experience hot flashes, so there may be other biological mechanisms at play. Some evidence points to a narrowing of the thermal neutral zone during menopause, meaning slight temperature fluctuations can trigger thermoregulatory processes that dissipate heat, resulting in flushing and sweating.
Genitourinary syndrome of menopause (GSM), or vaginal atrophy, results from a loss of estrogen. GSM results in a variety of adverse consequences like vaginal dryness, burning, increased urinary frequency, and recurring bladder infections. For many women, this condition requires long-term management. For moderate to severe cases of GSM, low-dose vaginal estrogen is regarded as the most effective treatment, and for mild cases, non-hormonal topical lubricants are recommended.
The following are some other conditions that commonly occur during menopause:
-Perimenopausal women are 2 to 4 times more likely to suffer from depression, and some women have reported increased episodes of forgetfulness during this time.
-The risk of developing heart disease increases with age, and it increases even more in women after menopause due to declining estrogen and increased blood pressure, LDL-cholesterol, and triglycerides.
-Osteoporosis risk increases in menopause. Bone loss occurs in two phases: the first phase occurs in perimenopause, as bone resorption increases due to estrogen deficiency; the second phase occurs 4 to 8 years after the menopausal transition, when bone formation slows.