Menopause is when you have spent 12 months without your menstrual cycles. Women differ in age in regards to menopause; some reach it at age 40 and some at age 50. Average age in the United States is 51.

Menopause is considered as a biological natural process. Symptoms are physical or emotional and may consist in hot flashes, decrease need for sleep, and low energy level. From lifestyle managements to hormonal therapy, women have choices to alleviate their symptoms.

Symptoms. In general even before the time of menopause, women may experience these following symptoms:

  • Irregular periods
  • Hot flashes
  • Chills
  • Vaginal dryness
  • Sleep disturbances
  • Night sweats
  • Changes in mood
  • Lowered metabolism
  • Decrease in breast fullness

These signs and symptoms differ among women. During irregular periods women may be pregnant and should check for pregnancy test if skipping a period.

When to see a doctor. It is advised to keep up with regular visits with doctors. Some tests are important for your well-being and prevention of diseases. They include mammograms, colonoscopy, pelvic exams, and laboratory tests such as thyroid, lipid, and hormones for some women.

For any vaginal bleeding seek medical advice and mostly after menopause.

Causes.  Menopause can result from:

  • Naturally declining reproductive hormones.
  • Hormones such as estrogens and progesterone decline as the women age from 40 years of age and so on. By age 51, the ovaries stop releasing eggs and there is no more periods, menopause happens.
  • Surgery that removes the ovaries (oophorectomy). Surgical procedure of the ovaries deplete the women from their estrogen and progesterone, which regulate the menstrual cycle, causing immediate menopause.
  • Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. Radiation therapy only affects ovarian function if radiation is directed at the ovaries.
  • Primary ovarian insufficiency. Around age 40 about 1% women may develop a premature menopause. This prematurity results in the failure of the ovaries to produce normal levels of reproductive hormone—primarily ovarian insufficiency—may stem from genetics or autoimmune disorder.
  • Menopause may happen without a cause. In this case, women may need hormonal therapy

Complications. After menopause, your risk of certain medical conditions increases. Examples include:

  • Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of cardiovascular disease increases. It is important to follow up with your doctor and to follow a healthy lifestyle.
  • Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the beginning of menopause, bones may lose their mass and with osteoporosis, fractures can occur.
  • Urinary incontinence. As the tissues of your vagina and urethra become less elastic, women may experience strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). Urinary tract infections may be common in those days.  Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help relieve symptoms of incontinence.
  • Sexual function. Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and decrease sensation during intercourse and even some bleeding, therefore reducing sexual desire and activity.
  • Water-based vaginal moisturizers and lubricants may help. If not enough, many women benefit from the use of local vaginal estrogen treatment, available as a vaginal cream, tablet or ring.
  • Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows. The recommendation is to eat less and exercise more to maintain their current weight.

Diagnosis. Signs and symptoms are usually enough to recognize that menopause has started – If concerns seek medical advice. Under certain circumstances, your doctor may order certain tests such as the hormone levels of:

  • Follicle-stimulating hormone (FSH) and estrogen (estradiol), because your FSH levels increase and estradiol levels decrease as menopause occurs
  • Thyroid-stimulating hormone (TSH), because an underactive thyroid (hypothyroidism) can cause symptoms similar to those of menopause

Treatment. Treatments consist on relieving your signs and symptoms and managing or preventing chronic conditions. Treatments may include:

  • Hormone therapy. Estrogen therapy is the most effective treatment option for relieving menopausal hot flashes. If you still have your uterus, you’ll need progestin in addition to estrogen. Estrogen also helps prevent osteoporosis. Long-term use of hormone therapy may have some cardiovascular and breast cancer risks, but starting hormones around the time of menopause has shown benefits for some women (North American Menopause Society. Talk to your doctor about the benefits and risks of hormone therapy and whether it’s a safe choice for you.
  • Vaginal estrogen. To relieve vaginal dryness, discomfort with intercourse and urinary incontinence, estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring.
  • Low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes.
  • Gabapentin (Gralise, Horizant, Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes.
  • Clonidine (Catapres, Kapvay). Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes.
  • Fezolinetant (Veozah). This medicine is a hormone-free option for treating menopause hot flashes. It works by blocking a pathway in the brain that helps regulate body temperature.
  • Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. Your doctor might prescribe vitamin D supplements to help strengthen bones.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.

Lifestyle and home remedies. Fortunately, many of the signs and symptoms associated with menopause are temporary. Take these steps to help reduce or prevent their effects:

  • Cool hot flashes. Dress in layers, have a cold glass of water or go somewhere cooler.  Try to pinpoint what triggers your hot flashes. For many women, triggers may include hot beverages, caffeine, spicy foods, alcohol, stress, hot weather and even a warm room.
  • Decrease vaginal discomfort. Try an over-the-counter, water-based vaginal lubricant (Astroglide, K-Y jelly, Sliquid, others) or a silicone-based lubricant or moisturizer (Replens, K-Y Liquibeads, Sliquid, others).  You might consider choosing a product that doesn’t contain glycerin, which can cause burning or irritation if you’re sensitive to that chemical. Staying sexually active also helps with vaginal discomfort by increasing blood flow to the vagina.
  • Get enough sleep. Avoid caffeine, which can make it hard to get to sleep, and avoid drinking too much alcohol, which can interrupt sleep. Exercise during the day, although not right before bedtime. If hot flashes disturb your sleep, find a way to manage them, so you can get adequate rest.
  • Practice relaxation techniques. Techniques such as paced and deep breathing, guided imagery, massage and progressive muscle relaxation may help with menopausal symptoms.
  • Strengthen your pelvic floor. Pelvic floor muscle exercises, called Kegel exercises, can improve some forms of urinary incontinence.
  • Eat a balanced diet. Include a variety of fruits, vegetables and whole grains. Limit saturated fats, oils and sugars. Ask your provider if you need calcium or vitamin D supplements to help meet daily requirements.
  • Don’t smoke. Smoking increases your risk of heart disease, stroke, osteoporosis, cancer and a range of other health problems. It may also increase hot flashes and bring on earlier menopause.
  • Exercise regularly. Get regular physical activity or exercise on most days to help protect against heart disease, diabetes, osteoporosis and other conditions associated with aging.

Alternative medicine. Many approaches have been promoted to help manage menopausal symptoms, but only few of them have scientific evidence to back up the claims. Some alternative and complementary remedies that have been or are being studied include:

  • Plant estrogens (phytoestrogens). These estrogens occur naturally in certain foods.  There are two main types of phytoestrogens — isoflavones and lignans. Isoflavones are found in soybeans, lentils, chickpeas and other legumes. Lignans occur in flaxseed, whole grains, and some fruits and vegetables.
  • These plants are not proven to be effective to relieve hot flashes. There is insufficient study to show their effectiveness. Always seek your doctor’s advice.
  • Balanced exercises. Balance exercises such as yoga or tai chi can improve strength and coordination and may help prevent falls that could lead to broken bones. Check with your doctor before starting balance exercises.
  • Acupuncture. Acupuncture may have some temporary benefit in helping to reduce hot flashes but more research is needed.

Talk with your doctor before taking any herbal or dietary supplements for menopausal symptoms.  The FDA does not regulate herbal products, and some can be dangerous or interact with other medications you take, putting your health at risk.

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