Patient education: Menopause (The Basics)

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What is menopause? — Menopause is the time in life when monthly periods naturally stop. At this time, the ovaries stop releasing eggs and stop making the hormones estrogen and progesterone.

Menopause usually occurs between the ages of 45 and 55. The average age is 51.

Menopause does not happen all at once. It is a "transition" that takes years. It can cause symptoms that are difficult for a lot of people. But there are treatments that can help.

How do I know if I am going through menopause? — You might wonder about menopause when your periods start to change. If you are going through menopause, you might:

●Have periods more or less often than usual (for example, every 5 to 6 weeks instead of every 4)

●Have shorter periods than before

●Skip 1 or more periods

●Have symptoms like hot flashes

If you have had a hysterectomy (surgery to remove your uterus), but you still have your ovaries, it might be tough to tell when you are going through menopause. Still, you can have menopause symptoms even if you no longer have a uterus.

If your ovaries were removed before the usual age of menopause, you had what doctors call "surgical menopause." That just means that you went through it early, because your ovaries were removed.

What are the symptoms of menopause? — Some people go through menopause without symptoms. But most have 1 or more of these symptoms:

●Hot flashes – Hot flashes feel like a wave of heat that starts in your chest and face and then moves through your body. Hot flashes usually start happening before you stop having periods.

●Night sweats – When hot flashes happen during sleep, they are called "night sweats." They can make it hard to get a good night's sleep.

●Sleep problems – During the transition to menopause, some people have trouble falling or staying asleep. This can happen even if night sweats are not a problem.

●Vaginal dryness – Menopause can cause the vagina and tissues near the vagina to become dry and thin. This usually starts a few years after menopause. It can be uncomfortable or make sex painful.

●Depression – During the transition to menopause, many people start having symptoms of depression or anxiety. This is more likely if you have had depression before. Depression symptoms include:

•Sadness

•Losing interest in doing things

•Sleeping too much or too little

●Trouble concentrating or remembering things – This might be caused by lack of sleep that often happens at menopause, or by the lack of estrogen. Some experts suspect that estrogen is important for good brain function.

●Headaches – If you get migraine headaches related to your period, these might get worse during menopause.

●Joint pain – Some people have joint aches or pains during and after menopause.

Many of these symptoms get better after menopause. But some people continue to have hot flashes, even for years afterwards.

Should I see a doctor or nurse? — It depends. If your periods start changing and you are 45 or older, you do not need to see your doctor for this reason alone. But you should tell them if you have symptoms that bother you.

For example, see your doctor if you cannot sleep because of night sweats, if it is hard to work because of your hot flashes, or if you feel sad or down and don't seem to enjoy things anymore. If your regular doctor cannot recommend treatments that can help, you might consider looking for a doctor who is a specialist in menopause or women's health. They might have more information about ways to relieve symptoms.

You should also see a doctor or nurse if you:

●Have your period more often than every 3 weeks

●Have very heavy bleeding during your period

●Have bleeding or "spotting" between periods

●Have been through menopause (have gone 12 months without a period) and start bleeding again, even if it's just a spot of blood

Is there a test for menopause? — There is a test that can help tell if you are going through menopause. But doctors usually use this only in people who are too young to be in menopause or who have special circumstances.

Can I still get pregnant? — As long as you are still having periods, even if they do not happen often, it is possible to get pregnant. If you have sex and do not want to get pregnant, use some form of birth control.

If you have not had a period for a full year, it is probably safe to say you have been through menopause and can no longer get pregnant.

How are the symptoms of menopause treated? — There are treatments that can help relieve symptoms.

Treatments for hot flashes include:

●Hormone therapy – The hormone estrogen is the most effective treatment for menopause symptoms. Most people need to take estrogen with another hormone, called progesterone. People who have had a hysterectomy (surgery to remove the uterus) can take estrogen by itself. Experts think that these hormones are effective and safe for most people.

If you want to take hormones, ask your doctor or nurse if it is an option for you. You should not take hormones if you have had breast cancer, a heart attack, a stroke, or a blood clot.

●Antidepressants – Some types of antidepressants can ease hot flashes and depression. Even if you do not have depression, these medicines can still help with hot flashes. They are often used by people who have had breast cancer and cannot take estrogen.

●Anti-seizure medicine – One of the medicines used to prevent seizures seems to help some people with hot flashes, even if they do not have seizures.

Treatments for vaginal dryness include:

●Vaginal estrogen – Vaginal estrogen is any form of estrogen that goes directly into the vagina. It comes in creams, tablets, or a flexible ring. Vaginal estrogen comes in small doses that don't increase the levels of estrogen in other parts of the body very much.

●Other medicines – In most cases, doctors recommend vaginal estrogen. That's because there is more evidence that it helps with vaginal dryness compared with other medicines. But if you do not want to use vaginal estrogen, your doctor can suggest other options. For example:

•You might choose to use a vaginal moisturizer several times a week. Vaginal moisturizers (sample brand names: Replens, K-Y SILK-E) do not contain hormones. They help keep the vagina moist all of the time. You can also add a lubricant (sample brand names: Astroglide, K-Y Jelly) when you have sex.

•In some cases, doctors might suggest another medicine. For example, there is a tablet that you insert into the vagina once a day. There is also a pill that might help some people who cannot use vaginal products.

Some doctors are not used to prescribing hormone therapy for menopause. If you feel that you are not getting the help you need, you might choose to talk to a different doctor who is an expert in menopause treatment. You can ask your doctor or nurse to refer you to someone.

Can I do anything on my own to reduce the symptoms of menopause? — Yes. There are some steps you can try (table 1). But ask your doctor before you take any "natural remedies," especially if you have a history of breast cancer. Things like herbs and supplements are not proven to help, and in some cases, could harm you.

What can I do to protect my bones? — You can:

●Take calcium and vitamin D supplements.

●Be active (physical activity helps keep bones strong).

●Ask your doctor when you should start having bone density tests.

If needed, your doctor can prescribe medicines to help keep your bones strong.

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Patient education: Menopause (The Basics)