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MENOPAUSE FAQS
Most women entering menopause are filled with questions and concerns. We'll try to answer some of the most commonly asked questions relating to menopause here. Feel free to call our office for more information.
What is menopause?
The formal definition of menopause is the last menstrual period. However, during the years building up to menopause, many women's cycles will be irregular, with several months between periods. So it can be difficult to know whether the last period you had was in fact the final one. A rule of thumb is that if you haven't had a period for 12 months, they're probably finished, and your menopause is 'back-dated' to the last period you had.
When can I expect it to arrive?
Most women reach menopause between the ages of 45 and 55, with the average being about 50 or 51 years. But there is a lot of variation - some women reach menopause in their 30s and early 40s, while others keep menstruating until the late 50s. The reasons for early menopause are little known. It's often said that if you start menstruating early, you'll stop early, but research shows this not to be true. The only known indicator is that if you have a family history of early menopause, then you are more likely to also. Cigarette smokers may undergo menopause a little earlier. Eight percent of women will go through menopause before age 40. For example, individuals who have received some types of chemotherapy or who have had their ovaries surgically removed no longer make the hormones necessary for menstruation. Some women have a medical condition called premature ovarian failure which also causes early menopause.
What is perimenopause?
For some women, there will be no warning before menopause- their periods will simply stop. But most will go through a phase of erratic periods before they reach menopause. Periods will get further apart, or occasionally closer together. This phase is called the 'menopausal transition', or 'perimenopause', and it can last for several years. Perimenopause is defined as the time period from when a woman's menses first become irregular until one year after menopause. Perimenopause is when most women will experience the symptoms of menopause.
Should I see a doctor when I begin menopause?
You don't have to make a special appointment for menopause unless you're having trouble with symptoms. You can discuss this at your annual check-up. However, be sure to see your physician if you have prolonged or unusually heavy bleeding, or if you suddenly have a period after going six months or more without one, since these could be symptoms of uterine cancer.
Is there a blood test to determine if I'm in menopause?
In general, the diagnosis of menopause is a clinical one, made when a woman has not had her period for 12 months. When the diagnosis is unclear, however, or when a woman enters menopause early, a test to measure "Follicle-Stimulating Hormone or "FSH" may help. FSH is produced by the pituitary gland. As you approach menopause, your FSH levels increase as your estrogen levels decrease. The higher your FSH level, the more likely you are to be in menopause. The catch is that during perimenopause, which can last several years before menopause, your FSH levels will fluctuate as your estrogen levels fluctuate--from month to month and even from day to day. In this case, your doctor may need to do more than one FSH test to have reliable information.
What are the signs and symptoms of menopause?
In addition to irregular menstrual periods, falling estrogen levels can cause a variety of other symptoms that can last anywhere from a few weeks to several years. Here are the most common:
- hot flashes, night sweats
- insomnia, fatigue
- mood swings, depression, anxiety, irritability, trouble concentrating
- vaginal dryness and inflammation (which may cause soreness or pain during sexual intercourse)
- loss of sexual desire
- joint pain, back pain, headaches
- pounding heartbeat, dizziness, tingling sensation
- thinning scalp hair, increased facial hair
- frequent urination or leakage
What is the difference between "early menopause" and "perimenopause"?
Perimenopause is the time leading up to menopause, when your hormones fluctuate and you notice symptoms. Premature menopause is technically defined as menopause that occurs before the age of 40. You stop ovulating and your periods stop completely years before the "normal" age of menopause. When you're going through early menopause, you'll notice symptoms that are the same as those for women in perimenopause -- hot flashes, changes in your period, night sweats, mood swings and the like. But you'll notice these symptoms at a much younger age -- in your 20s, early 30s, even late teens. Your estrogen levels drop; your FSH levels rise in an effort to jumpstart your ovarian function -- but you stop ovulating and, ultimately, your periods stop altogether decades earlier than usual.
What are hot flashes and is there any relief?
A hot flash is a sudden feeling of being overheated, usually accompanied by sweating and redness in the face. They can be followed by a period of being cold and clammy. When these symptoms occur at night, they are called night sweats. Night sweats can interfere with an individual's sleep, which can then cause fatigue, cognitive impairment, and mood disturbances. Hot flashes are the most common symptom women experience during the years surrounding menopause (and sometimes for many years afterwards). Wearing cotton clothing and layering clothing can help. Cool showers or baths, fans, and air conditioners can also provide relief.
What can be done to relieve pain during sex?
Lowered levels of estrogen not only cause decreased growth of the uterine lining and therefore irregular and, ultimately, cessation of periods, but also cause dryness and thinness of the vaginal wall. These vaginal changes can cause itchiness, burning, and pain with intercourse. Vaginal moisturizers, (e.g., Replens®), used two to three times a week, estrogen vaginal cream or rings will restore vaginal elasticity and moisture after one to three months. Intercourse may also be aided by sexual lubricants.
Everyone says menopausal women are moody. Is it true?
Not really. Lots of women do experience mood swings and depression during menopause, some of them severely, but menopause is not directly responsible. Hormonal fluctuations do make women more vulnerable to stress, so that they might not cope as well with life's ups and downs as they usually do. Depression does occur during menopause, and it needs to be taken seriously (doctors can help with medication or psychological treatments). But it does not seem to be any more common than in other age groups; menopause does not cause depression on its own.
I've had three urinary tract infections since I began menopause. Is this common?
The urethra lining also thins during menopause. This can predispose women to urinary tract infections, in addition to the vaginal dryness mentioned above. Low estrogen levels may possibly contribute to urinary incontinence.
I seem to be more forgetful. Does menopause affect memory?
Many women complain of decreased memory and slowed thought processes during menopause. There is some evidence that estrogen acts at the memory centers of the brain and lowered estrogen levels may impair thought processes. Also, hot flashes can interfere with sleep and this can impair cognition.
Does menopause cause osteoporosis?
Osteoporosis is a "bone thinning" disease. This thinning can result in brittle bones that are susceptible to fracture. We all reach our peak bone mass around age 30. From that time, our bones start getting thinner. Estrogen helps to maintain bone thickness. During menopause, when the estrogen level starts to drop, the bone loss can increase. Calcium, Vitamin D, exercise, and hormone replacement therapy can all help slow bone loss. Medications that slow down or prevent bone loss can also be used.
Is hormone replacement therapy necessary?
Making a decision about HRT is one of the most important health decisions a woman will make in her lifetime. Every woman experiences menopause differently and her treatment should be tailored to treat her specific symptoms. The major benefit of HRT is to treat the hot flashes and other immediate symptoms of menopause. There is a general consensus among researchers that short-term HRT to relieve hot flashes and other temporary menopause-related symptoms is safe, with the benefits during this short time period (up to five years) outweighing the risks. Recent research has found a small risk of increased health risks, including heart attack, strokes, blood clots and breast cancer, after long-term usage in women who took estrogen plus progesterone (the drug commonly prescribed as PremPro). Women who have been on the combination HRT for a number of years should talk to their doctor about tapering off the medication and substituting alternative strategies to deal with menopausal symptoms. Women who are just beginning menopause and considering HRT should take into account the research findings and evaluate their risks versus benefits, as well as treatment alternatives, in consultation with their physician. Remember, any decision about HRT should take into account a women's individual risk for specific conditions that may be harmed or benefited by hormone use.
What are the different hormone replacement therapy regimens?
Women with an intact uterus should receive estrogen in conjunction with a progestin to avoid the risk of endometrial hyperplasia (a condition characterized by overgrowth of the lining of the uterus). Women without a uterus (following a hysterectomy) do not need added progesterone. In the cyclical regimen, estrogen is given daily and either by pill or by a skin patch and a progestin is added for days 1-14 of each month. This method causes cyclic bleeding usually at the end of the progestin administration. This method is generally used in women who are recently postmenopausal. In the second method, the continuous method, women are given estrogen and low-dose progestin daily. If heavy bleeding occurs, an endometrial biopsy or vaginal ultrasound may be done to evaluate the bleeding. In most women, within a year the endometrium will stop growing and bleeding will not occur. There are many different types of estrogens and progestins available. You and your physician can discuss what regimen is the most appropriate for you.
What are the side effects of hormone replacement therapy?
The most common side effects of estrogen therapy are nausea, headaches, breast tenderness, and vaginal bleeding. If these persist, the dose of estrogen may be lowered or hormone replacement therapy can be discontinued. Side effects seen with progestins are breast tenderness, weight gain, edema, PMS-like symptoms, depression, and irritability. If these occurs, changing the frequency of withdrawal bleeding from monthly to every other or every third month might be more acceptable to the patient. However, it is not clear as to whether progestin therapy every other month is as protective against endometrial hyperplasia.
Are there any options other than HRT for managing menopausal symptoms?
Menopausal symptoms can be alleviated without taking hormones in many cases. Lifestyle changes, supplements and other medications can often successfully combat the symptoms and increased health risks associated with the onset of menopause:
- Risk of osteoporosis (bone loss and weakness): weight-bearing exercise, calcium supplements, prescribed medication Fosamax
- Risk of heart disease: stop smoking, eat a diet low in fat, exercise regularly, lipid-lowering drug Lipitor
- Mood swings: get adequate rest, exercise regularly, the herb black cohosh
- Hot flashes: add soy products to your diet, black cohosh, decrease the amount of spicy food, caffeine and alcohol in your diet
- Insomnia: over-the-counter sleep aids like Tylenol PM and Unisom are often helpful and are not addictive
Supplements advertised as "female herbal remedies" vary widely and have not been regulated by the FDA. There are little data on either effectiveness or safety.
My joints ache and hurt all the time since started menopause. Is this related to menopause and what can I do about it?
Aching joints can very definitely be related to perimenopause. Lower levels of estrogen can reduce muscle strength and increase the experience of stress on your joints as well. Over-the-counter non-steroid anti-inflammatory medications like Motrin can often provide relief. Regular exercise, massages, and hormone replacement therapy can also help alleviate symptoms.
Does HRT make you put on weight?
Probably not. Most women do gain weight during midlife, but studies on whether HRT contributes are inconclusive. For every study that suggests HRT causes weight gain, there's another that says it doesn't.
Do I need to use contraception now that I am in menopause?
Once you haven't had a period for a year, you are clinically considered officially "in menopause," and do not need contraception. But if you are in the preimenopause stage and are still having periods - even if they are very irregular - you should still use some form of contraception.
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