Menopause Symptoms, Causes & Treatment Options

Menopause refers to the stopping of the menstrual cycle, also known as the period. Most often, this is the result of the normal aging process, but if it occurs too young, it can be a symptom of disease.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. Real-life Stories
  6. When to Seek Further Consultation
  7. References

What Is Menopause?

Summary

Menopause is the name for the natural process by which the menstrual cycle — or period — stops happening in a woman. Usually, the process is gradual, taking months or years, and occurs from the age of 45 to 55 years.

Menopause is officially diagnosed once a woman stops having a period for 12 consecutive months. If you are undergoing menopause, you will notice a decrease in the number and regularity of your periods until they completely stop. In addition, you may notice a number of symptoms that occur as a result of decreased estrogen levels, such as hot flashes, changes in mood, sleep problems, vaginal dryness, changes in libido, and changes in sexual function [1,2]. Certain medications exist that can decrease these symptoms.

Recommended care

If you experiencing symptoms of menopause that are bothersome to you, you should consult your physician. It is especially important to seek care if you are experiencing symptoms at a time in your life when they are not expected.

Menopause Symptoms

Main symptoms

Symptoms are highly variable, with the exception of hot flashes, which are extremely common:

  • Hot flashes: This is a few minutes of an intensely hot feeling experienced by up to 80% of women during menopause [3]. It may occur for a few years.
  • Sweating
  • Mood lability: Your mood may go up and down rapidly.
  • Depression/irritability

Other symptoms

Some additional symptoms you may experience include:

  • Vaginal dryness
  • Weight gain
  • Decrease in libido
  • Decrease in sexual function: The vaginal opening can become narrower.
  • Joint pain
  • Painful intercourse
  • Low energy
  • Breast pain and a decrease in breast fullness
  • Urinary incontinence: Bedwetting
  • Dry, itchy skin

Complications of menopause

Menopause can increase the risk of other diseases, such as [1]:

  • Osteopenia/osteoporosis: This is a condition where the bones are weaker and more brittle.
  • Cardiovascular disease: The risk of narrowing in the blood vessels that supply the heart is increased after menopause.

Menopause Causes

The vast majority of the time, menopause is caused naturally due to your body running out of eggs in the ovaries. This typically occurs between the ages of 45 to 55, and most often, between 49 and 52 years. There is no relationship between when you started having your period and when you will have menopause. Once you have not had a period for three months, it is very likely that you will have your last period during the following four years.

Before menopause, there is a period called the “menopausal transition” or “perimenopause”, which refers to a gradual decrease in the frequency (number of) and the duration of your period. Eventually, periods will stop happening entirely, and after 12 months of not having a period, menopause is officially diagnosed.

The symptoms of menopause are primarily caused by changes in your hormone levels during perimenopause and menopause [4]. The levels of estrogen and progesterone, two female hormones, are unstable and decrease over time. This decrease in estrogen is responsible for hot flashes, low mood, changing sexual function, and the complications of menopause.

Other causes of missed periods

The stopping of your period can also be caused by other conditions unrelated to natural menopause:

  • Hyperthyroidism
  • Pregnancy
  • Hyperprolactinemia
  • Malnutrition

Other causes of menopause symptoms

Hot flashes and sweating may be caused by other diseases unrelated to menopause, such as:

  • Certain medications
  • Alcohol
  • Anxiety
  • Caffeine
  • Hyperthyroidism
  • Malignancy (tumors)

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Treatment Options, Relief, and Prevention for Menopause

Natural menopause cannot be prevented, it is a process of normal aging. However, the symptoms and complications of menopause can be managed effectively using a number of medications and lifestyle modifications.

Mild hot flash treatments

Hot flashes, the most common (and oftentimes most bothersome) symptom of menopause can be managed [3]. For mild hot flashes:

  • Keep rooms at a lower temperature
  • Wear less clothing or wear natural fabrics that breathe
  • Avoid triggers, such as spicy foods

Severe hot flash treatments

For more severe hot flashes, you can consult your physician.

  • Menopausal hormone therapy (estrogen replacement therapy): This treatment replaces the estrogen lost during menopause, which is very effective but comes with some important risks. It is important to discuss this therapy with your doctor.
  • Tissue-selective estrogen complexes: This is a newer therapy designed to replace decreased estrogen levels with a lower side effect profile than estrogen alone.
  • Selective serotonin reuptake inhibitors (SSRIs): These are commonly used as antidepressants, but also decrease hot flashes. This is the best non-estrogen drug to treat hot flashes.
  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)
  • Clonidine (Catapres)

Sexual function treatment

Vaginal dryness, difficulty with intercourse, and decreased libido can also be medically managed.

  • Vaginal moisturizers (i.e. Replens): These are applied consistently to decrease dryness.
  • Vaginal lubricants (i.e. KY jelly, Astroglide): These are applied preceding intercourse to decrease dryness and friction.
  • Vaginal estrogen cream: This is a local therapy that reintroduces estrogen to the tissues of the vagina without affecting the rest of your body.
  • Estrogen replacement therapy (as above): This therapy can also treat vaginal dryness in addition to hot flashes but is ordinarily not prescribed for vaginal dryness alone.
  • Regular sexual activity: Increasing the amount of sexual activity you have may improve its quality and decrease dryness.

Mood/irritability treatment

Depressed mood can be treated using the following methods:

  • Menopausal hormone therapy (estrogen replacement therapy): This treatment replaces the estrogen lost during menopause, which is very effective but comes with some important risks. It is important to discuss this therapy with your doctor.
  • Tissue-selective estrogen complexes: This is a newer therapy designed to replace decreased estrogen levels with a lower side effect profile than estrogen alone.
  • Selective serotonin reuptake inhibitors (SSRIs): These are typical antidepressants and can also treat hot flashes.

Prevention

Menopause itself cannot be prevented as it is a naturally occurring process in women. However, seeing an obstetrician/gynecologist (OB/GYN) regularly can help ease the menopausal transition. Therapy can be initiated early, which can ease the transition to menopause. In addition, a number of therapies can be started to decrease some of the complications of menopause.

Osteoporosis prevention

Osteoporosis/osteopenia is a condition which refers to decreasing bone density [5]. Decreased bone density can lead to breaks of your bones. The chance of osteopenia increases when menopause takes place. Strategies to prevent osteopenia/osteoporosis, include:

  • Calcium supplementation: Generally 500 to 1000 mg/day with meals
  • Vitamin D supplementation: 800 IU daily
  • Weight-bearing exercise: You should aim for at least 30 minutes three times weekly. This can include walking and does not have to be intense.
  • Stop smoking
  • Bisphosphonates: Drugs such as alendronate or risedronate can increase bone density.
  • Estrogen replacement therapy: This can also delay the onset of osteopenia.

Heart disease prevention

The risk of developing symptomatic heart disease can increase after menopause [6]. Strategies to promote a healthy heart in the peri- and post-menopause period, include:

  • Regular exercise
  • A heart-healthy diet: Such as one high in fruits, vegetables, whole grains, low-fat dairy, poultry, fish and nuts
  • Cholesterol-lowering drugs: If your physician deems them appropriate.

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When to Seek Further Consultation for Menopause

All women should receive care from an OB/GYN. Your OB/GYN can help manage the symptoms of menopause and ensure that you have adequate strategies to stay healthy throughout this phase of your life and beyond. You should seek care with an OB/GYN regardless of whether or not you feel symptoms of menopause.

If you experience infrequent periods or a loss of your period before age 40

You should seek immediate attention if you lose your period before the age of 40, as this can be a sign of another condition.

If you are unsure if you are pregnant

You can still get pregnant during perimenopause. Sometimes, women think that they have undergone menopause because they are not having a period, but it is also possible that they are pregnant. It is worth considering a pregnancy test if you’d like to be sure.

References

  1. Menopause - Symptoms & causes. The Mayo Clinic. Updated Aug. 7, 2017. The Mayo Clinic Link
  2. Takahashi TA, Johnson KM. Menopause. Med Clin North Am. 2015;99(3):521-34. PubMed Link
  3. Hot Flashes. The North American Menopause Society. Menopause.org Link
  4. Santoro N, Brockwell S, Johnston J, et al. Helping midlife women predict the onset of the final menses: SWAN, the Study of Women's Health Across the Nation. Menopause. 2007;14(3 Pt 1):415-24. PubMed Link
  5. Ji MX, Yu Q. Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med. 2015;1(1):9-13. Published 2015 Mar 21. NCBI Link
  6. Menopause and Heart Disease. American Heart Association. Reviewed July 31, 2015. American Heart Association Link

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