What is menopause?

Menopause, a normal and natural event, is the end of menstruation. It is usually confirmed when you have not had a period for 12 months in a row (with other causes for this change ruled out). Menopause starts when your body's level of the hormone estrogen falls permanently to very low levels and your menstrual periods stop for good. Menopause is also known as "the change of life."

This change in your body usually doesn't happen all at once. There is a transition period before menopause called perimenopause, when your body starts making less of the female hormones estrogen and progesterone. During this time, you can have symptoms such as hot flashes and mood swings, and you may or may not have a period. These changes usually begin between the ages of 45 and 55, with the average at about age 51. A few women reach natural menopause as early as their 30s (which is called premature menopause) and as late as their 60s. Women who smoke or who used to smoke can reach menopause one to two years earlier than nonsmokers.

Many women wonder and worry about what will happen when they reach menopause, but in fact, it can be a positive experience! Even though some women have frustrating symptoms and health problems throughout perimenopause and after menopause, it is a chance for all women to focus more on themselves and make changes that will improve their health. The first step is to learn all you can about the physical and emotional changes that may be ahead of you.

I will be having a hysterectomy to remove both my uterus and my ovaries, and I am only 37. Will I go into menopause?

Sometimes, younger women need a hysterectomy (surgery to remove the uterus and ovaries) to treat health problems such as endometriosis or cancer. After your surgery, you will enter into what is known as induced or surgical menopause. This is menopause that happens to your body right away, and it is brought on by the surgery. You will no longer have periods. Since your ovaries will be removed, you may have many menopausal symptoms right away, instead of gradually. You can talk with your health care provider (HCP) about how to best manage these symptoms.

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 they cannot bear children. They also might have hot flashes since the surgery can sometimes disturb the blood supply to the ovaries. Later on, they also might have natural menopause a year or two earlier than expected.

What is premature menopause?

Premature menopause is menopause that happens before the age of 40 — whether it is natural or induced. Some women have premature menopause because of:

family history (genes)
medical treatments, such as surgery to remove the ovaries
cancer treatments, such as chemotherapy or radiation to the pelvic area
Having premature menopause puts a woman at more risk for osteoporosis later in her life. It also may be a source of great distress, since many women younger than 40 still want to have children. Women who still want to become pregnant can talk with their HCP about donor egg programs.

What is postmenopause?

The term postmenopause refers to all the years beyond menopause. It is the period past the time at which you have not had a period for 12 months in a row — whether your menopause was natural or induced.

What are the symptoms of menopause?

Some women may have frustrating symptoms that start during perimenopause and continue once they have reached menopause. Hot flashes have become the hallmark symptom of menopause. Hot flashes are a feeling of sudden flush or warmth, often followed by sweating. They can cause serious discomfort and sleepless nights for some women.

Other symptoms that can start in perimenopause, but also might continue once you reach menopause include:

night sweats (hot flashes that happen while you sleep)

sleep problems

mood changes (mood swings, depression, irritability)

******* problems, including ******* dryness and irritation that can cause pain during sex and pelvic exams, and frequent ******* infections

urinary problems, including burning or pain when urinating, or leaking when sneezing, coughing, or laughing

problems with concentration or memory

less interest in sex and changes in sexual response

weight gain

hair thinning or loss

"spotting" and abnormal bleeding (although this is common in perimenopause, once you've reached menopause you should report any uterine bleeding to your HCP to rule out serious causes, such as cancer)

I've reached menopause, but I still have been feeling so depressed and irritable. I'm just not myself. Will these feelings ever go away?

Many women in perimenopause and menopause feel depressed and irritable. Some researchers believe that the decrease in estrogen triggers changes in your brain, causing depression. Others think that other symptoms you're having, such as sleep problems, hot flashes, night sweats, and fatigue cause these feelings. Or, it could be a combination of hormone changes and symptoms. But these symptoms also can have causes that are unrelated to menopause. If you are having these symptoms, and you think they are interfering with your quality of life, it is important to discuss them with your HCP. Talk openly with your HCP about the other things going on in your life that might be adding to your feelings. Other things that could cause depression and/or anxiety include:

having depression during your lifetime before menopause
feeling negative about menopause and getting older
increased stress
having severe menopause symptoms
smoking
not being physically active
not being happy in your relationship or not being in a relationship
not having a job
not having enough money
low self-esteem (how you feel about yourself)
not having the social support you need
regretful that you can't have children anymore
If you need treatment for these symptoms, you and your HCP can work together to find a treatment that is best for you.

I've reached menopause and haven't had my period for a few years now. But, the other day I had some bleeding off and on. Should I be concerned?

Changes in bleeding are normal as you near menopause. There are also other common causes of bleeding in the years after menopause. The decline in your body's estrogen levels can cause tissues lining the vagina to become thin, dry, and less elastic. Sometimes this lining can become broken or easily inflamed and bleed. It can also become injured during sex or even during a pelvic exam.

Once you've reached menopause, though, you should report any bleeding that you have to your HCP. Uterine bleeding after menopause could be a sign of other health problems. Other things that can cause abnormal bleeding include:

fibroids
the use of birth control pills
a hormonal imbalance
non-cancerous growths in the lining of the uterus
What is hormone therapy (HT) for menopause?

Hormone therapy (HT) for menopause, formerly referred to as HRT, refers to the use of prescription drugs to "replace" the hormones that the ovaries stop making around the time of menopause. For many years, to relieve menopausal symptoms, health care providers prescribed what was called estrogen replacement therapy (ERT). Because taking a medicine that just has estrogen raises the risk of endometrial cancer (cancer in the lining of the uterus), only women who do not have a uterus can take estrogen (ERT) alone safely. ERT usually is taken by pill or skin patch.

Hormone therapy (HT) generally refers to using a combination of hormones (estrogen and progestin) to treat menopausal symptoms. Using both hormones lowers the risk of endometrial cancer. HT is most always taken by pill. HT may be a safe and effective way of managing menopausal symptoms if taken for only a short period of time, but researchers continue to study the long- and short-term effects of HT on women's health. HT is generally NOT recommended for women who have the following health problems:

******* bleeding of unknown cause
suspected breast cancer or a history of breast cancer
history of endometrial cancer
history of heart disease
history of or active venous thrombosis (blood clots in the veins in the legs or in the lungs)
chronic disease of the liver
The National Institutes of Health's (NIH) Women's Health Initiative (WHI) study is looking at the effects of HT on diseases such as breast cancer, cardiovascular disease, osteoporosis, and colorectal cancer. In July 2002, NIH stopped a major part of this study early because they found an increased risk of breast cancer, stroke, heart attacks, and blood clots (in the lungs) from combined HT. In May 2003, the WHI found HT also increases a woman's risk for dementia (severe confusion and decline in memory), including Alzheimer's disease. These findings have taught us that a woman should not take HT for the purpose of preventing heart disease or to help protect against dementia or memory loss.

Because there are both benefits and risks linked to taking HT, every woman should consider these in relation to her own health and thoroughly discuss these issues with her HCP. If you decide to use HT, use it at the lowest dose that helps and for the shortest time needed. Click here for more information on HT.

For more information on the WHI study results and on the risks and benefits of HT, go to http://www.nhlbi.nih.gov/health/women/index.htm.

Are there treatments other than hormone therapy (HT) to ease the symptoms of menopause?

Some women decide not to take hormone therapy (HT) or estrogen replacement therapy (ERT) to relieve the symptoms of menopause, and turn to herbal products or to certain estrogen-like chemicals in plants (called phytoestrogens) for help. There are many over-the-counter and herbal products that claim to help women with menopausal symptoms, but there is limited, and sometimes conflicting, research on the safety and success of them. Discuss herbal products with your HCP before taking them. You also should tell your provider if you are taking any other medicines, since some of the herbal products can have harmful interactions with other drugs.

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