How Do You Know if You are Undergoing Menopause?
Menopause is diagnosed once you’ve gone twelve months without a menstrual period, and generally occurs sometime in your 40s or 50s. In Australia, the average age is 51, though it is not unheard of for women to experience menopause earlier or later in life; roughly one percent of women even undergo menopause before age 40. Though it is a natural biological process, the sudden onset of its symptoms can be uncomfortable, confusing, and emotionally taxing. In the months or years leading up to your eventual menopause, you might experience any of the following signs and symptoms:
These signs vary greatly from woman to woman, and you may experience all of the above, or only a few. Most likely, you will at least experience some irregularity in your periods before they end. Skipping periods during this time is common and expected, and it may be several months between periods altogether— it is for this reason that it takes a full year of missed periods to diagnose that menopause is complete. Despite irregular periods, pregnancy is still possible, so if you have skipped a period but aren’t certain you’ve started the transition to menopause, consider taking a pregnancy test to be safe.
What Are the Causes of Menopause?
Menopause usually occurs through a natural decline in reproductive hormones. As you approach your late 30s, your ovaries slowly begin making less oestrogen and progesterone, and your fertility declines. Through your 40s, your menstrual periods might change length, becoming shorter or longer, heavier or lighter, more or less frequent. Eventually, typically by your early 50s, your ovaries will stop releasing eggs and your periods will cease. This, however, is not the only cause. Less common causes include:
- Oophorectomy, or surgery that removes the ovaries. This might be done to remove cancerous growths, or particularly large and invasive ovarian cysts. Without your ovaries to produce reproductive hormones to regulate the menstrual cycle, you will undergo immediate menopause. The symptoms might be rather severe, as hormonal changes have occurred very abruptly rather than gradually over many years. It is worth noting that a hysterectomy, or removal of the uterus, usually doesn’t have this effect. Although you will no longer have periods, your ovaries can still release eggs and regulate hormone levels.
- Chemotherapy or radiation therapy. These cancer therapies might induce menopause, causing symptoms such as hot flashes during or shortly after treatment. The halt to menstruation and fertility is not always permanent following chemotherapy, and other birth control methods might still be used if desired. Radiation therapy only affects the tissue it is directed at, so if you are receiving radiation therapy on your breast tissues or your head and neck, it will not affect menopause; only if it is directed at the ovaries.
- Primary ovarian insufficiency. About 1% of women will experience premature menopause, the ending of menstruation before age 40. This may result from the ovaries failing to produce normal levels of oestrogen and progesterone, which can stem from genetic issues or autoimmune disease. But it is also often that no cause can be found. For these women, hormone therapy is typically recommended until the age of natural menopause to protect the brain, heart, and bones.
What Can You Do to Treat Menopause and its Effects?
After undergoing menopause, your risk of certain illnesses or medical conditions will increase. These can include:
- Unexpected weight gain. This is a result of your metabolism slowing, and may be managed through a change to diet and exercise.
- A change in sexual function. You might experience vaginal dryness, or a loss of elasticity in the vulva and labia, which can cause discomfort or affect your libido. This can usually be rectified with lubricants or moisturisers, but if this is not enough, you may benefit from local oestrogen treatments. See the linked article for more information here.
- Urinary incontinence. As your vaginal tissues lose elasticity, you might experience much more frequent desires to urinate, followed by an involuntary loss of urine. You may also experience infections of the urinary tract more often. This problem can be eased by strengthening your pelvic floor muscles, or undergoing hormone therapy.
- Osteoporosis. This is a loss of bone density, causing them to become weaker and more susceptible to fracture. During the first few years of menopause, this loss of density can be quite rapid. You might be prescribed medications that help prevent or lessen this, or vitamin D supplements to continue strengthening your bones.
- Cardiovascular disease. When your oestrogen levels decline, your risk of heart and blood vessel disease increases. It is important to take this seriously, as heart disease is the leading cause of death in both women and men. Ask your doctor for advice on how to protect your heart or reduce cholesterol and blood pressure. You will also need to ensure you get regular exercise and eat a healthy diet.
Menopause itself requires no medical attention, and so treatments generally focus on relieving your symptoms or managing chronic conditions that can occur with continued aging. These might include:
- Hormone therapy. Depending on your medical history, your doctor might recommend low doses of oestrogen to provide symptom relief for you. If you still have a uterus, you will be prescribed progestin as well. These help prevent bone loss associated with osteoporosis. Long-term use of hormone therapy might carry increased risks of cardiovascular problems or breast cancer, but starting this therapy around the beginning of menopause has shown benefits. Discuss the risks and benefits of this therapy with your healthcare professional to decide whether it is the right choice for you.
- Vaginal oestrogen. To relieve issues like vaginal dryness or discomfort, you might be recommended an oestrogen cream, tablet or insertable rubber ring. This can also help with painful intercourse and some urinary symptoms.
- Low dose antidepressants. Certain drugs classed as selective serotonin reuptake inhibitors (or SSRIs) may decrease hot flashes associated with menopause. These can be useful for women who cannot take oestrogen for health reasons, or those who also need treatment for a mood disorder.
- Gabapentin. A drug used to treat seizures, it also has been shown to relieve hot flashes in menopausal women. Like SSRIs, this drug is also useful for those who cannot use oestrogen therapy, and those who have hot flashes during the night time.
- Clonidine. A pill or patch typically used to treat high blood pressure, this drug might also provide relief from hot flashes.
Menopause is a natural, expected part of growing older, and is nothing to be afraid or embarrassed about. Discuss your concerns with your partner and health professionals, including the risks and benefits of treatments and recommended lifestyle changes. Every woman goes through menopause, but it is different for everyone— don’t be afraid to ask about other options, or seek clarification if what you are experiencing is confusing or unexpected.
For more information on Menopause, view The Royal Australian and New Zealand College of Obstetricians and Gynecologists guidelines.
If you are experiencing the symptoms of Menopause, make an appointment with Dr.Nicole Stamatopoulos here.