Menopause has long been considered a taboo topic. Our mothers called it “the change of life” and didn’t talk about it. But every menstruating woman and person assigned female at birth (AFAB) will go through menopause. That’s approximately half of all Americans.
According to a recent study, nearly one-third of those surveyed never sought out information about menopause before experiencing it, and 45% didn’t know the difference between menopause and perimenopause.
At Atlantic Health, we believe knowledge is power, so we’re talking about it.
Dr. Neelam Sharma, an obstetrician-gynecologist with Atlantic Health System, explains the three stages of menopause, when it typically happens, what signs to look out for, and what treatment options are available to you. “Menopause is a natural part of aging,” says Dr. Sharma. “It’s a transition in life, not a disease. It shouldn’t be feared.”
Learn the facts so you can enter this next phase of life empowered and informed.
What is Menopause?
The clinical definition of menopause is the point in time when you haven’t had a period for 12 consecutive months, marking the end of your menstrual cycle.
Your menstrual cycle begins in puberty. As you age, your cycle slows down and your ovaries begin to make less estrogen and progesterone (sex hormones) until it eventually stops producing these hormones completely.
Menopause is a natural part of aging and happens in three stages: perimenopause, menopause and postmenopause.
Perimenopause
The time leading up to menopause is called perimenopause. It usually starts in your 40s and can last anywhere from 3-10 years, until you reach the point of menopause when your ovaries stop releasing eggs.
During perimenopause, your estrogen levels drop and your periods become irregular. Other symptoms, like hot flashes, may also begin.
Menopause
Menopause is a point in time when you are no longer releasing eggs and your estrogen and progesterone levels are decreasing. It is diagnosed after you’ve gone a full year (12 straight months) without a menstrual period. “It’s a retrospective diagnosis,” explains Dr. Sharma.
Typically, blood work isn’t needed to diagnose menopause, but in some cases, doctors will confirm the diagnosis through lab work. High FSH (follicle-stimulating hormone) levels and low estradiol (a type of estrogen) levels signal menopause.
Postmenopause
The final stage of menopause is called postmenopause. This is the period after you’ve reached menopause, and you remain here for the rest of your life. At this point, your menopausal symptoms will improve, but they may linger for up to a decade.
When Does Menopause Start?
Everyone is different. Perimenopause usually begins in your 40s and lasts up until menopause. Menopause typically happens in your 40s or 50s. The average age in the United States is 51.
A few caveats: If you’ve had your ovaries removed surgically, you’ll go through menopause immediately. Some cancer therapies, like chemotherapy or radiation, may also induce menopause, and a very small percentage (1%) experience premature menopause (occurring before age 40) due to genetic factors or an autoimmune disease.
Common Symptoms
Many of us entering perimenopause begin to experience symptoms caused by changing hormone levels. These can be intense or mild.
Some women experience hot flashes and night sweats. Others find that the hair on their head is thinning, but now they have chin hair. Everyone is different, and nothing is wrong with you.
Some common signs that you’re in the menopause transition include:
- Irregular periods
- Hot flashes (vasomotor symptoms)
- Night sweats and sleep issues
- Vaginal dryness
- Bladder control issues (stress incontinence and urgency incontinence)
- Mood swings, irritability or mild depression
- Brain fog/trouble concentrating
- Dry skin and eyes
- Thinning hair
- New facial hair growth
- Weight gain
As common as these signs are, Dr. Sharma cautions that not all symptoms are caused solely by menopause. “Hormonal changes do play a significant role, but we need to look at other areas of your life, too,” she says. “The timing of menopause overlaps with other changes in our personal and professional lives, which can contribute to some issues, like irritability and forgetfulness.”
Postmenopause Health Risks
Once you’re postmenopausal, you may be at a higher risk for uterine cancer (which usually presents as postmenopausal bleeding or spotting) and ovarian cancer (which often has nonspecific symptoms such as pelvic pain or pressure, with or without bloating).
You’re also at an increased risk for osteoporosis and heart disease because both conditions are influenced by estrogen levels.
“Bone density is directly related to estrogen levels. Osteoporosis and osteopenia (the precursor to osteoporosis) occur when your bones become less dense and more fragile — something that may happen in postmenopause because you are no longer producing estrogen, which protects your bones,” explains Dr. Sharma.
A loss of estrogen can also increase your blood pressure and cholesterol, increasing your risk for coronary artery disease.
“I advise all postmenopausal women to talk to their OB-GYN to assess their level of risk based on other health factors, and to have a DEXA scan within 1-5 years after menopause to check their bone density,” says Dr. Sharma. “Because each person is different, you should work with your OB-GYN to get a personalized care plan that is tailored to your unique needs.”
Treatment Options
Menopause doesn’t require treatment, but if your symptoms are interrupting your life or making you miserable, you don’t have to suffer. You have options.
- Hormone replacement therapy (HRT) can boost hormone levels and decrease hot flashes.
- Non-hormonal treatments like Clonidine (a blood pressure medication) and Paroxetine (an SSRI) and simple actions like wearing layers and lowering the temperature in your house can also reduce hot flashes.
- Vaginal estrogen in a ring or gel, another hormonal therapy, can relieve vaginal dryness.
- Lifestyle changes (exercise, diet, meditation, yoga) can improve mood and help you stave off weight gain.
- Supplements, like calcium and vitamin D, can help prevent osteopenia and osteoporosis, while other products may help with sleep, mood and concentration.*
- Special lotions and other products can provide relief from dry skin and thinning hair.
*NOTE: Dr. Sharma cautions her patients when it comes to using over-the-counter medicines and health products that claim to be nonhormonal estrogen supplements as an aid for symptom relief. These, she says, can cause a thickening of the uterine lining and/or postmenopausal bleeding.
But the number one way to improve your symptoms, according to Dr. Sharma, is to shift your perspective about this phase of life. “Accepting that menopause is a life change, not a disease, is key. Once you understand that and believe it, it becomes easier.”
Be Proactive About Your Health
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