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Menopause

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Definition

Menopause is the time when a woman's menstrual period ends. Menopause is considered complete when a woman has been without her period for one year. Menopause can occur any time between ages 40 and 60. On average, it occurs at age 51.
Menopause is gradual. The period of time leading up to complete menopause is called perimenopause. Premature menopause occurs before the age of 40. Menopause can also be surgically induced when the ovaries are removed.
Menopause is a natural process. Treatment is used to reduce the symptoms associated with menopause.

Causes

Menopause is caused by a gradual decrease in a hormone called estrogen. Estrogen is released by the ovaries. The decrease in estrogen eventually stops the ovaries from releasing eggs.

Risk Factors

Menopause is a natural process associated with aging.

Symptoms

Symptoms may include:
  • Irregular menstrual periods
  • Hot flashes and night sweats
  • Disturbed sleep patterns, which may progress to insomnia
  • Mood changes, which may include irritability, anxiety or depression
  • Vaginal dryness and pain with sexual intercourse
  • Dry skin
  • Decreased interest in sex
  • Frequent urination or leaking of urine

Diagnosis

Your doctor will ask you about your symptoms and medical history. A physical exam will be done.
Natural menopause is diagnosed when a woman has not had a menstrual period for 12 consecutive months. Menopause may need to be confirmed if it was caused by a surgical procedure. A blood test may be done to look for follicle-stimulating hormone (FSH). High levels of FSH may indicate menopause.

Treatment

Menopause is a natural part of life. It does not necessarily require treatment. However, symptoms and health risks associated with low estrogen can be treated. These include hot flashes, vaginal dryness, and osteoporosis, which is a loss of bone mass.
Osteoporosis in Hip
Osteoporosis
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Hormone Replacement Therapy (HRT)

Types of hormone replacement therapies include:
  • Estrogens
  • Progesterone
  • Combinations of estrogen and progesterone
  • Low amounts of male hormones
HRT is available as tablets, gels, skin patches, vaginal rings, vaginal tablets, injections, and pellets inserted into the skin.
There are a number of possible risks associated with HRT, such as:

Healthful Diet

A healthful diet during menopause can improve your sense of well-being. It may also reduce the risk of heart disease, osteoporosis, and certain cancers. The diet should be low in fat. It should include plenty of fruits, vegetables, and whole grains. Your diet should also include enough calcium and vitamin D.

Limit Caffeine and Alcohol

Caffeine and alcohol may increase your symptoms of anxiety and insomnia. They can also increase your loss of calcium. If you drink alcohol, only drink in moderation. Moderation is 1-2 drinks per day.

Quit Smoking

Smoking can increase the risk of early menopause, heart disease, and osteoporosis.

Regular Exercise

Weight-bearing exercises like walking and climbing stairs, and strength exercises may also decrease your risk of osteoporosis.

Stress Management

Stress management may help ease tension, anxiety, and other menopausal symptoms. Deep breathing, massage, warm baths, and quiet music are examples of relaxation techniques.

Over-the-Counter Products

Vaginal moisturizers and vaginal lubricants are used to help vaginal dryness.

Nonhormonal Medications for Hot Flashes

  • Medication may be prescribed to reduce symptoms of hot flashes including:
    • Certain blood pressure medications
    • Antiseizure medications
  • Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)

Prevention

Menopause is a natural biologic event that does not need to be prevented.

RESOURCES

Healthy Women http://www.healthywomen.org

The North American Menopause Society http://www.menopause.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Women's Health Matters http://www.womenshealthmatters.ca

References

Menopause. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated January 15, 2013. Accessed April 18, 2013.

Menopause. Planned Parenthood Federation of America website. Available at: http://www.plannedparenthood.org/health-topics/womens-health/menopause-4807.htm. Accessed April 18, 2013.

Menopause 101: A primer for the perimenopausal. North American Menopause Society website. Available at: http://www.menopause.org/for-women/menopauseflashes/menopause-101-a-primer-for-the-perimenopausal. Accessed April 18, 2013.

9/30/2008 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Jacobson BC, Moy B, et al. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168:1798-1804.

1/30/2009 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. Am J Obstet Gynecol. 2008;199:455-466.

1/30/2009 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Kaszkin-Bettag M, Ventskovskiy BM, et al. Confirmation of the efficacy of ERr 731 in perimenopausal women with menopausal symptoms. Altern Ther Health Med. 2009;15:24-34.

4/14/2009 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Archer DF, Dupont CM, et al; Study 319 Investigators. Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: a double-blind, randomized, placebo-controlled trial of efficacy and safety. Am J Obstet Gynecol. 2009;200:238.e1-238.e10. Epub 2009 Jan 24.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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