Menopause

1. Menopause Overview
2. Healthy Living After Menopause
3. Menopause & Hormones
4. View All

Menopause Explained

Menopause, or the “change of life,” is different for each woman. For example, hot flashes and sleep problems may trouble your sister. Meanwhile, you are enjoying a new sense of freedom and energy. And your best friend might hardly be aware of a change at all.

What Is Menopause?

Menopause is a normal part of life, just like puberty. It is the time of your last period, but symptoms can begin several years earlier. Some symptoms of menopause can last for months or years after. Changing levels of estrogen and progesterone, which are two female hormones made in your ovaries, might lead to these symptoms.
This time of change is known as the menopausal transition, but it is also called perimenopause by many women and their doctors. It can begin several years before your last menstrual period. Perimenopause lasts for 1 year after your last period. After a full year without a period, you can say you have been “through menopause.” Postmenopause follows menopause and lasts the rest of your life.
The average age of a woman having her last period, menopause, is 51. But, some women have their last period in their forties, and some have it later in their fifties.
Smoking can lead to early menopause. So can some types of operations. For example, surgery to remove your uterus (called a hysterectomy) will make your periods stop, and that’s menopause. But you might not have menopause symptoms like hot flashes right then because if your ovaries are untouched, they still make hormones. In time, when your ovaries start to make less estrogen, menopause symptoms could start. But, sometimes both ovaries are removed (called an oophorectomy), usually along with your uterus. That’s menopause too. In this case, menopause symptoms can start right away, no matter what age you are, because your body has lost its main supply of estrogen.

Symptoms & Signs of Menopause

What Are the Signs of Menopause?

Women may have different signs or symptoms at menopause. That’s because estrogen is used by many parts of your body. So, as you have less estrogen, you could have various symptoms. Here are the most common changes you might notice at midlife. Some may be part of aging rather than menopause.
Change in your period. This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed less than usual or more. These are all normal changes, but to make sure there isn’t a problem, see your doctor if:

• Your periods come very close together
• You have heavy bleeding
• You have spotting
• Your periods last more than a week

Hot flashes. Many women have hot flashes around the time of menopause. They may be related to changing estrogen levels. Hot flashes may last a few years after menopause. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Flashes can be very mild or strong enough to wake you from your sleep (called night sweats). Most hot flashes last between 30 seconds and 10 minutes.
Problems with your vagina and bladder. Changing estrogen levels can cause your genital area to get drier and thinner. This could make sexual intercourse uncomfortable. Or, you could have more vaginal or urinary infections. Some women find it hard to hold their urine long enough to get to the bathroom. Sometimes urine leaks during exercise, sneezing, coughing, laughing, or running.
Sleep. Around mid life, some women start having trouble getting a good night’s sleep. Maybe you can’t fall asleep easily, or you wake too early. Night sweats might wake you up. You might have trouble falling back to sleep if you wake during the night.
Sex. You may find that your feelings about sex are changing. You could be less interested. Or, you could feel freer and sexier after menopause. After 1 full year without a period, you can no longer become pregnant. But remember, you could still be at risk for sexually transmitted diseases (STDs), such as gonorrhea or even HIV/AIDS. You increase your risk for an STD if you are having sex with more than one person or with someone who is having sex with others. If so, make sure your partner uses a condom each time you have sex.
Mood changes. You might find yourself more moody or irritable around the time of menopause. Scientists don’t know why this happens. It’s possible that stress, family changes such as growing children or aging parents, a history of depression, or feeling tired could be causing these mood changes.
Your body seems different. Your waist could get larger. You could lose muscle and gain fat. Your skin could get thinner. You might have memory problems, and your joints and muscles could feel stiff and achy. Are these a result of having less estrogen or just related to growing older? Experts don’t know the answer.

What About My Heart and Bones?

Two common health problems can start to happen at menopause, and you might not even notice.
Osteoporosis. Day in and day out, your body is busy breaking down old bone and replacing it with new healthy bone. Estrogen helps control bone loss, and losing estrogen around the time of menopause causes women to lose more bone than is replaced. In time, bones can become weak and break easily. This condition is called osteoporosis. Talk to your doctor to see if you should have a bone density test to find out if you are at risk. Your doctor can also suggest ways to prevent or treat osteoporosis.
Heart disease. After menopause, women are more likely to have heart disease. Changes in estrogen levels may be part of the cause. But, so is getting older. As you age, you may gain weight and develop other problems, like high blood pressure. These could put you at greater risk for heart disease. Be sure to have your blood pressure and levels of triglycerides, fasting blood glucose, and LDL, HDL, and total cholesterol checked regularly. Talk to your health care provider to find out what you should do to protect your heart.

Post Menopausal Healthy Living

How Can I Stay Healthy After Menopause?

Staying healthy after menopause may mean making some lifestyle changes.

• Don’t smoke. If you do use any type of tobacco, stop-it’s never too late to benefit from quitting smoking.
• Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals.
• Make sure you get enough calcium and vitamin D-in your diet or with vitamin/mineral supplements.
• Learn what your healthy weight is, and try to stay there.
• Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health.

Other things to remember:

• Take medicine if your doctor prescribes it for you, especially if it is for health problems you cannot see or feel-for example, high blood pressure, high cholesterol, or osteoporosis.
• Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort.
• Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed.

Menopause is not a disease that has to be treated. But you might need help if symptoms like hot flashes bother you. Here are some ideas that have helped some women:

• Try to keep track of when hot flashes happen-a diary can help. You might be able to use this information to find out what triggers your flashes and then avoid those triggers.
• When a hot flash starts, try to go somewhere cool.
• If night sweats wake you, sleep in a cool room or with a fan on.
• Dress in layers that you can take off if you get too warm.
• Use sheets and clothing that let your skin “breathe.”
• Have a cold drink (water or juice) when a flash is starting.

You could also talk to your doctor about whether there are any medicines to manage hot flashes. A few drugs that are approved for other uses, for example, certain anti-depressants, seem to be helpful to some women.

Post Menopausal Hormones

What About Those Lost Hormones?

These days you hear a lot about whether you should use hormones to help relieve some menopause symptoms. It’s hard to know what to do, although there is some information to help you.
During perimenopause, some doctors suggest birth control pills to help with very heavy, frequent, or unpredictable menstrual periods. These pills might also help with symptoms like hot flashes, as well as prevent pregnancy.
If you are bothered by symptoms like hot flashes, night sweats, or vaginal dryness, your doctor might suggest taking estrogen (as well as progesterone, if you still have a uterus). This is known as menopausal hormone therapy (MHT). Some people still call it hormone replacement therapy or HRT. Taking these hormones will probably help with menopause symptoms. It also can prevent the bone loss that can happen at menopause.
Menopausal hormone therapy has risks. That is why the U.S. Food and Drug Administration suggests that women who want to try MHT to manage their hot flashes or vaginal dryness use the lowest dose that works for the shortest time it’s needed. Your symptoms may come back when you stop taking hormones.
Right now, there is a lot still to learn about taking hormones. See For More Information to find out how to get a copy of NIA’s free, more detailed tip sheet, Hormones and Menopause {LINK}. It has the most current information on menopausal hormone therapy.

Do Phytoestrogens Help?

Phytoestrogens are estrogen-like substances found in some cereals, vegetables, legumes (including soy), and herbs. They might work in the body like a weak form of estrogen. Researchers are trying to discover whether phytoestrogens relieve some symptoms of menopause and if they might also carry some risks. Be sure to tell your doctor if you decide to try eating a lot more foods that contain phytoestrogens or to try using an herbal supplement. Any food or over-the-counter product that you use for its drug-like effects could change how other prescribed drugs work or cause an overdose.

How Do I Decide What to Do?

If you are having bothersome symptoms, talk to your health care provider for help deciding how to best manage menopause. You can see a gynecologist, geriatrician, general practitioner, or internist. Make sure the doctor knows your medical history and your family medical history. This includes whether you are at risk for heart disease, osteoporosis, and breast cancer.
It may be helpful to remember that your decision is never final. You can-and should-review it with your doctor during your yearly checkup. Your needs may change over time, and so might what we know about menopause.

Hormones and Menopause

Cathy had been waking up during the night feeling hot and sweaty. That left her tired all day. Then she began to feel hot on and off during the day also, so she went to see her doctor. The doctor told her she was having hot flashes-a sign that she was going through perimenopause, the time around menopause. Her doctor talked about different ways to control the symptoms. One was using estrogen for a short time. Cathy and her doctor talked about the risks, as well as the benefits. Cathy said she remembered something in the news about using hormones around menopause. She was uncertain. What’s a woman to do?
A hormone is a chemical substance made by a gland or organ to regulate various body functions. To help control the symptoms of menopause some women can take hormones, called menopausal hormone therapy (MHT). MHT used to be called hormone replacement therapy or HRT. Some women should not use MHT. There are many things to learn about hormones before you make the choice that is right for you.
Cathy’s doctor told her to call back for a prescription if she decided to try using hormones to control her symptoms. After reading pamphlets from her doctor’s office, Cathy talked to her friends. Lily, who had surgery to remove her uterus and ovaries, has been taking estrogen since the operation. Sandy said she’s had a few hot flashes, but isn’t really uncomfortable enough to want treatment. Melissa’s doctor thinks she should not use estrogen because her younger sister has breast cancer. Each friend had a different story. Cathy needed more information.

Which hormones are used for menopause?

Cathy has a lot of questions, starting with the basics-what is menopausal hormone therapy?
During perimenopause, the months or years right before menopause, levels of two female hormones, estrogen and progesterone, in a woman’s body go up and down irregularly. This happens as the ovaries struggle to keep up with the needs of an aging woman’s body. The symptoms of menopause might result from these changing hormone levels. After menopause, when a woman’s ovaries make much less estrogen and progesterone, the symptoms of menopause may continue. Menopausal hormone therapy may help control these symptoms. A woman whose uterus has been removed can use estrogen alone to control her symptoms. But a woman who still has a uterus must take progesterone or a progestin (synthetic progesterone) along with the estrogen. This will prevent unwanted thickening of the lining of the uterus and also reduce the risk of cancer of the uterus, an uncommon, but possible result of using estrogen alone.

Why take these hormones? Why not?

Cathy’s doctor said the plus side of taking estrogen is that it is the most effective treatment for hot flashes, night sweats, and vaginal dryness. And it will help keep her bones strong. Cathy thought that those certainly seemed like good reasons to use MHT. But she wondered, is there a down side?
Menopause is a normal part of aging. It is not a disease or something that has to be treated. Women may decide to use menopausal hormone therapy because of its benefits, but there are also side effects and risks to consider. Two benefits of menopausal hormone therapy are:

• treating some of the bothersome symptoms of menopause
• preventing or treating osteoporosis

But for some women there are noticeable side effects:

• breast tenderness
• spotting or a return of monthly periods
• cramping
• bloating

By changing the type or amount of the hormones, the way they are taken, or the timing of the doses, your doctor may be able to control these side effects. Or, over time, they may go away on their own.
For some women there are also serious risks (see chart). These risks are why you need to think a lot before deciding to use menopausal hormone therapy.
Although the risks are small for any one woman, you need to take them into account. Much of the following chart on benefits and risks is based on one important clinical trial, the Women’s Health Initiative (WHI). This study looked at estrogen (conjugated equine estrogens) used alone or with a particular progestin (medroxyprogesterone acetate). Some other types of estrogen, progesterone, or progestin may have been tested in smaller clinical trials to see if they have an effect on heart disease, breast cancer, or dementia. Others have not.
Because the average age of women participating in the trial was 63, more than 10 years past the average age of menopause, some experts now question whether the WHI results apply to women around the time of menopause. The WHI study found that in every 10,000 women using estrogen plus progestin, there would be 7 more heart attacks than in every 10,000 women not using these hormones. Other research has suggested that if MHT is begun around the time of menopause, it might not increase the risk of heart disease as much as in older women in the WHI. This is a subject for further study.

Benefits and Risks of Menopausal Hormone Therapy

Here is what scientists can say right now about the benefits and risks of MHT. Remember – which hormones you use, the way you take them, and the dose might affect these benefits and risks.
Women with a Uterus
Estrogen + Progestin Women Without a Uterus*
Estrogen Only
BENEFITS
Relieves hot flashes/night sweats Yes Yes
Relieves hot flashes/night sweats Yes Yes
Relieves vaginal dryness Yes Yes
Reduces risk of bone fractures Yes Yes
Improves cholesterol levels Yes Yes
Reduces risk of colon cancer Yes Don’t know
RISKS
Increases risk of stroke Yes Yes
Increases risk of serious blood clots Yes Yes
Increases risk of heart attack Yes No
Increases risk of breast cancer Yes Possibly
Increases risk of dementia, when begun by women age 65 and older Yes Yes
Unpleasant side effects, such as bloating and tender breasts Yes Yes
Pill form can raise level of triglycerides (a type of fat in the blood) Yes Yes
* Women who have had a hysterectomy have had their uterus removed.

How would I use the hormones?

Cathy’s friend Lily takes her estrogen in pill form, but Cathy has trouble swallowing pills. She hasn’t yet decided whether or not to use hormones, but if they only come as a pill, that would be part of her decision.
Estrogen comes in many forms and dosages. You could use a skin patch or vaginal tablet or cream, take a pill, or get an implant, shot, or vaginal ring insert. Progesterone or progestin is often taken as a pill, sometimes in the same pill as the estrogen. It also comes as a patch, shot, IUD (intrauterine device), vaginal gel, or suppository.
The form your doctor suggests may depend on your symptoms. For example, patches or pills can relieve hot flashes, night sweats, and vaginal dryness. They will also slow or prevent bone loss and help delay osteoporosis while you are using them. Other forms- vaginal creams, tablets, or rings-are used for vaginal dryness. The vaginal ring insert might also help some urinary tract symptoms. But, the dose found in these other forms is probably too low to relieve hot flashes.

What are “natural hormones?”

Cathy’s friend Susan thinks she is not at risk for side effects from menopausal hormone therapy because she uses “natural hormones” to treat her hot flashes and night sweats. Cathy asked her doctor about them.
The natural hormones Susan uses are estrogen and progesterone made from plants such as soy or yams. Some people also call them bioidentical hormones because they are supposed to be chemically the same as the hormones naturally made by a woman’s body. So-called natural hormones are put together (compounded) by a compounding pharmacist. This pharmacist follows a formula decided on by your doctor.
Drug companies also make estrogens and progesterone from plants like soy and yams. Some of these are also chemically identical to the hormones made by your body. You get these from any pharmacy with a prescription from your doctor.

One difference between the natural hormones prepared by a compounding pharmacist and those made by a drug company is that the compounded natural hormones are not regulated and approved by the U.S. Food and Drug Administration (FDA). So, we don’t know much about how safe or effective they are or how the quality varies from batch to batch. Hormones made by drug companies are regulated and approved by the FDA.

There are also “natural” treatments for the symptoms of menopause that are available over-the-counter, without a prescription. Some of these are made from soy or yams. They are not regulated or approved by the FDA.

Cathy’s doctor told her that there is very little reliable scientific information from clinical trials about the safety of bioidentical hormones, how well they control the symptoms of menopause, and whether they are as good or better to use than FDA-approved estrogens, progesterone, and progestins.

What’s right for me during menopause?

There is no “one size fits all” answer for all women who are trying to decide whether to use menopausal hormone therapy (MHT). You have to look at your own needs and weigh your own risks.
Ask yourself and your doctor these questions:

• How much are you bothered by menopausal symptoms such as hot flashes or vaginal dryness? Like many women your hot flashes or night sweats will likely go away over time, but vaginal dryness may not. MHT can help if your symptoms are troubling you.
• Are you at risk for developing osteoporosis? Estrogen might protect bone mass while you use it. However, there are other drugs that can protect your bones without the same risks as MHT.
• Do you have a history of heart disease? Using estrogen and progestin can increase your risk.
• Do you or others in your family have a history of breast cancer? If you have a family history of breast cancer, check with your doctor about your risk.
• Do you have a history of gall bladder disease or high levels of triglycerides? Some experts think that using a patch will not make your triglyceride (a type of fat in the blood)level go up or increase your chance of gall bladder problems. Using an estrogen pill might.
• Do you have liver disease or a history of stroke or blood clots in your veins? MHT might not be safe for you to use.

Then, like Cathy, talk to your doctor about how best to treat or prevent your symptoms or the diseases for which you are at risk. Ask about your other choices. Remember, these too may have risks and benefits. If you decide to use MHT, the FDA suggests that you use the lowest dose that works for the shortest time needed.
If you are already using menopausal hormone therapy and think you would like to stop, first ask your health care provider how to do that. Some doctors suggest tapering off slowly.
Whatever decision you make now about using MHT is not final. You can start or end the treatment at any time. If you stop, some of your risks will probably lessen over time, but so will the benefits. Discuss your decision about menopausal hormone therapy each year with your doctor at your annual checkup.

Unanswered Questions About Menopause

Don’t forget at your checkup to ask your doctor about any new study results. Research on menopause is ongoing. Scientists are looking for answers to questions such as:

• How long can a woman safely use menopausal hormone therapy?
• Are some types of estrogen or progesterone safer than others?
• Is one form of such hormone therapy (patch, pill, or cream, for example) better than another?
• Is MHT safer if you start it around the time of menopause instead of when you are older?

For now, we know that each woman is different, and the decision for each one will probably also be different. But, almost every study gives women and their doctors more information to answer the question: Is menopausal hormone therapy right for me?

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