Menopause: Stages and How to Manage Symptoms
What is menopause?
A woman’s natural ovarian activity declines with age. Menopause is a stage in a woman’s life when monthly menstruation (your period) has completely stopped.
To reach menopause, a woman has to go 12 months straight without a period. The average age that this transition happens is around 51, but it can happen from age 40 to 58.
Being in menopause means a woman is no longer ovulating and is unable to become pregnant naturally. As a woman stops ovulating, levels of the hormones estrogen and progesterone begin to decline. That sets off a wide range of physical, emotional, and cognitive (brain) symptoms that make day-to-day life difficult and hard to predict.
Many women learn coping strategies to deal with some of the symptoms but when symptoms are too disruptive or hard to tolerate, there are medications and lifestyle changes that often help.
For a woman to be considered in menopause she has to go 12 months without a period. If a woman has no period for six months and then it returns, even if for just one month, the clock starts again. —Dr. Jessica White-Videa
Many women entering menopause get hot flashes (sudden intense bursts of heat that cause sweat and possibly a red, flushed face), night sweats, vaginal dryness, and other changes to the body. It can also cause mood swings, insomnia, and difficulty concentrating.
Symptoms (both physical and emotional) range from minor to major. Women may experience few, some, or many. Among the possible effects:
- Hot flashes
- Night sweats
- Vaginal dryness
- Pain during intercourse
- Weight gain, especially in the midsection
- Noticeable mood swings
- Decreased sex drive
- Dry skin
- Trouble falling asleep and/or staying asleep
- Depression (mild to severe)
- Difficulty concentrating or focusing
- Trouble remembering things
- Increase in vaginal infections, such as yeast infections or bacterial vaginosis
How long does menopause last?
Menopause is actually divided into three stages.
- Perimenopause is the first stage and it can last for 4 to 8 years. It begins when women notice changes in the frequency of their periods or the flow. Some women have no other symptoms, while others start to have hot flashes, night sweats, and other menopausal symptoms. If you start to experience any of these symptoms, you may need to see a doctor to help rule out other causes, such as fibroids or hypothyroidism.
- Menopause is when a woman has her final period, and it is confirmed after she has gone 12 months without a period.
- Postmenopause is the final stage and lasts for the rest of her life. Women may still experience hot flashes and other symptoms during this stage. However, on average, symptoms last for 4 to 5 years.
Menopause occurs when the ovaries stop releasing eggs, which eventually causes a woman’s menstrual cycle to stop. As the ovaries stop functioning, they release less and less of the hormones estrogen and progesterone. The decline in hormones leads to the symptoms.
Experts have found that women who smoke or have undergone chemotherapy, pelvic radiation, or ovarian surgery may start menopause earlier than the average age.
Transitioning to menopause can be a very difficult time period. Many women feel alone and isolated. It can also coincide with other major stressors in our life such as caring for elderly parents, children about to start college, etc. Be open and honest with your doctor about how you are feeling. —Dr. White-Videa
Some women will only have mild symptoms and not feel they need any treatments or adjustments to their lifestyle. Others may experience severe symptoms that can negatively impact their lifestyle, mental health, work, and relationships.
Women with mild symptoms may opt to do nothing, or try lifestyle modifications or alternative treatments. Those with more severe symptoms may want to see a doctor to discuss treatments.
If you are experiencing troublesome symptoms, there are a range of treatment options including hormone replacement, antidepressants, and alternative remedies.
- Hormone replacement therapy (HRT). HRT is a combination of estrogen and progesterone or estrogen alone, depending on a woman’s medical history. It is taken as pills, patches, or creams. HRT is usually started when symptoms become hard to tolerate. Your doctor will prescribe the lowest dose necessary to reduce your symptoms, and for the shortest period of time. It’s important to talk to your doctor about the benefits and risks of HRT. For some women, HRT may increase their risk of certain cancers, like breast cancer. It also may increase the risk of getting blood clots, heart attacks, strokes, and gallbladder disease.
- Antidepressants may help with hot flashes and with depression.
- Natural remedies, like flaxseed, black cohosh, soy, and a range of herbs are sometimes used by women to treat symptoms. There’s limited evidence that these remedies are helpful. Talk to your doctor if you decide to try them to make sure they are not going to cause more harm than good.
Any woman who enters menopause before age 40 is considered to be in early menopause. (Also known as premature ovarian failure or premature ovarian insufficiency.)
If your period stops before age 40, see your doctor. They will do testing to rule out other reasons your periods stopped too soon, such as genetic abnormalities or autoimmune diseases.
Early menopause also increases the risk for health issues such as osteoporosis and cardiovascular (heart) disease. You may be given HRT to lower these risks. It’s important to see your doctor regularly to monitor your health and any symptoms you are experiencing.
I had a patient who, due to her symptoms, could not tolerate intercourse or even a gynecological exam. We were able to offer her minimally invasive laser treatment of her vagina. It had a huge impact on her life and in her marriage. Unfortunately, this treatment option is often underutilized, as it is not covered by most insurance companies and not yet FDA approved. —Dr. White-Videa
Check in with your doctor if you continue to have bothersome symptoms and your medications are not helping. Talk with your doctor about other options.
You may need to adjust the dose of your medications as well. It’s important to go for your routine doctor visits and recommended cancer screenings to monitor your health while on HRT.
Any woman who is postmenopausal and experiences vaginal bleeding or spotting should see a doctor to determine the cause of the bleeding.
Each woman’s experience of menopause is different. For some women, it can be a very difficult transition with life-disrupting symptoms. And not all women with severe symptoms are able to take HRT for health reasons (and some may not want to). Still others may have mild symptoms that can be minimized with lifestyle approaches. Here are a few tips to help reduce and deal with symptoms, especially hot flashes.
- Dress in layers. When you start to get a hot flash, you can remove a layer or two to help feel more comfortable.
- Try to identify your triggers for hot flashes. For some women, it is linked to stress or alcohol. If you can limit these triggers, you may notice fewer and less intense hot flashes.
- Relaxation techniques and exercise are good ways to deal with symptoms such as stress, concentration issues, mood swings, and weight gain.
- Quit smoking if you smoke. Smoking can worsen symptoms and lead to an earlier menopause.