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5 Things to Know About Menopause

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Posted by Arleen Ayala-Crespo, MD, FACOG

Everyone who is born with ovaries will experience menopause. It's a normal part of life, not a disease or condition, but it can cause symptoms, such as hot flashes and other changes. And not everyone heading into this transition knows just what to expect.

Menopause occurs 12 months after your last menstrual period. The years preceding this event can bring on many symptoms that can affect you in different ways. Having a sense of what's normal can help you feel your best and make coping easier.

In my gynecology practice, I'm often asked what to expect as menopause approaches. My patients often want to know what changes to expect, when they're likely to begin, and how to cope with symptoms. Here are the top five facts I share with my patients. 

1. The average age of menopause is 52.

A person has officially reached menopause after 12 months without a menstrual period. This occurs, on average, at age 52.

That said, the shift toward menopause happens over several years. This transition, which often begins between ages 45 and 55, is called perimenopause. It usually lasts about seven years, although it may take as long as 14 years. During perimenopause, levels of the hormones estrogen and progesterone start to decrease. This can cause your periods to become less regular and trigger other possible symptoms. 

You might not get a period every month during perimenopause. But it's important to know that you can still get pregnant until your period has stopped for 12 months. I tell my patients who use birth control to continue using it during perimenopause.

Once menstruation has stopped for 12 months, you've officially reached menopause. Because this marks the end of the transition, it's also called postmenopause. Many of my patients find that some symptoms they experience during perimenopause ease up once they're no longer getting a period. But for some, hot flashes and vaginal dryness can continue.  

2. Menopause often starts with a change in your cycles.

Many of my patients first get tipped off that they're entering perimenopause when their menstrual cycles become less regular. Their periods can become lighter or heavier or be spaced closer or further apart.

As your periods become more erratic, you might also notice other perimenopause symptoms. These can vary in intensity from one person to the next. The symptoms of menopause may include

  • Hot flashes. Hot flashes can cause a sudden sensation of heat in your upper body, along with redness, sweating, and flushing. We call them night sweats when they wake you up from sleep. 
  • Sexual changes. The vaginal tissues become drier and thinner during perimenopause, which may cause pain during sex. You might also have less interest in sex or take longer to become aroused. 
  • Reduced bladder control. Sudden urges and bladder leakages may become more common, as can bladder infections. 
  • Trouble sleeping. Many patients find it harder to fall or stay asleep, especially if they're experiencing night sweats. 
  • Mood changes. Feeling more irritable, anxious, or stressed during perimenopause is not unusual. 
  • Weight gain. It's common to gain a few pounds or notice that weight accumulates more easily around your midsection. 

Patients often ask me how a hysterectomy will affect their experience with menopause. My answer depends on the details of the surgery. If the ovaries are left in place, the timing of menopause is usually not affected. Because removing the uterus ends menstruation, patients who've previously had their uterus removed won't experience irregular menstruation as a symptom of perimenopause, but they may notice other menopause symptoms as their hormone levels change. If the ovaries are removed, menopause will begin immediately.

3. Menopause increases the risk for some health problems.

The hormonal shifts brought on by menopause can make you more prone to certain health problems, including:

I like to talk with my patients about these risks so we can talk about steps to protect their health. After menopause, it's even more important to undergo blood pressure, cholesterol, and blood sugar screenings to spot potential heart health risks sooner. Regular height measurements are also crucial to see if a patient is losing bone mass.  

4. Self-care can ease menopause symptoms. 

Healthy habits can be a helpful first step for making menopause symptoms more manageable. Many patients find that simple lifestyle changes can help them feel more like themselves. Some of my favorite strategies are:

  • Regular exercise. Staying active can boost your mood and help you sleep better. Aim for at least 30 minutes of moderate exercise most days of the week. Brisk walking counts!
  • Dietary changes. Cutting back on caffeine and spicy foods may ease hot flashes. Foods that contain naturally occurring plant estrogens, called phytoestrogens, might also be beneficial. Top sources include soybeans, chickpeas, lentils, flaxseeds, whole grains, fruits, and vegetables.  
  • Mind-body techniques, such as yoga or mindfulness meditation. These may improve mood and sleep and help you feel less bothered by physical symptoms like hot flashes.
  • Hypnotherapy. It may reduce hot flashes and improve sleep, research shows.  
  • Support groups. Talking with others experiencing the same things as you can help you feel less alone and give you new ideas for coping. 
  • Quitting smoking. It's one of the best things you can do to protect your overall health, including lowering your risk for heart disease. 

5. Treatment can help control menopause symptoms.

When patients need more support to manage their symptoms, we'll discuss prescription treatment options. Hormone therapy using estrogen or estrogen and progestin is the most effective option for hot flashes. But it can raise the risk of breast cancer, stroke, and blood clots, so it's not right for everyone. 

Low-dose hormonal birth control is another option. It may reduce hot flashes, vaginal dryness, mood swings, and heavy or irregular periods. But hormonal birth control can also increase the risk of blood clots and high blood pressure, so it's important for patients to discuss their personal pros and cons with their doctor. I don't recommend birth control for smoking women, since smoking raises blood clot risk. Blood clots can lead to serious health problems, such as deep vein thrombosis, pulmonary embolism, and stroke. 

To help patients cope with vaginal dryness, I'll often recommend trying over-the-counter products first. Vaginal moisturizers and water-based vaginal lubricants can help make intimacy more comfortable, especially when combined. Prescription vaginal creams, tablets, or rings containing estrogen are the next step to consider. Because they're applied to the skin instead of taken orally, they pose fewer risks than other forms of hormone therapy. I may also recommend other strategies. For example, some of my patients find that certain positions become more comfortable as their body changes during menopause. 

Managing the menopausal transition isn't always easy, but having the right care team can help. To discuss your menopause symptoms or other gynecologic concerns, make an appointment with a Temple gynecologist today. 

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