What is menopause?

Menopause is the cessation of a woman’s menstruation, a normal and natural transition all women go through as they age. When a woman reaches her early to mid-40s, she may start to notice her period becoming irregular. This is often a sign that her body has started the process of becoming infertile, also referred to as climacteric (change of life). The first phase of a woman’s transition to infertility is marked by occasionally absence of her period. This phase is known as perimenopause. When a woman has not menstruated for 12 months, and the cessation of her menstruation is not due to other health factors, menopause is confirmed and she can no longer become pregnant through natural methods.¹

The Onset of Menopause

There are many elements that play a role in the onset of menopause. These include age, induced menopause, genes, number of pregnancies, cycle length, use of oral contraceptives, the depletion of ova and hormones, and lifestyle factors. Most women experience menopause between the ages of 40 and 58.² American, Canadian, and European women typically experience menopause at the average age of 51. In South America and Asia, menopause occurs earlier age (as early as her mid-40s), which may be due to disadvantageous socioeconomic conditions. It is important to remember that the age women reach menopause varies greatly; any time between her early 40s to early 60s is considered a healthy range.¹

If a woman reaches menopause before the age of 40, she has experiences premature menopause. It is fairly uncommon and only seen in about 1% of women in the United States.² If premature menopause has not been medically induced, it is important to consult a physician because it could be caused by genetic, metabolic, autoimmune, or other undetected conditions. Premature menopausal women undergo the same symptoms as typical menopausal women, but they receive the benefits of estrogen for longer. In turn, they may be at greater risk for certain health problems later in life such as osteoporosis.²

Menopause can be induced. This is when menstruation stops due to the surgical removal of the ovaries (because of medical reasons such as uterine cancer or endometriosis), from chemotherapy or radiation damage to the ovaries, or from certain medications taken to induce menopause when treating certain diseases.³ Women who undergo induced menopause experience the same symptoms as those who go through natural menopause with one exception: it will not be a gradual onset. Thus, it may be helpful to seek the guidance of a certified medical practitioner as the body adjusts to many physical changes.²

Women who have had fewer pregnancies tend to experience menopause at an earlier age. Furthermore, shorter cycles and not using oral contraception tend to lead to earlier menopause.¹

The Biology behind Menopause

Research suggests that women are born with a fixed number of ova (eggs), which are stored in her ovaries. A woman’s ovaries are responsible for the production of the hormones estrogen and progestin. As a women ages, the ovaries slowly decrease the production of estrogen, and the release of ova gradually stops. When a woman’s period has been absent for one year, her ovaries are no longer releasing eggs and have stopped most of their estrogen production.³

Other lifestyle factors can affect when women reach menopause. It has been shown that smoking has an effect on the onset of menopause; in fact, smokers reach menopause as much as two years earlier than non-smokers.² Vegetarianism has also been linked with an earlier onset of menopause. Strenuous exercise, high body mass index, and alcohol consumption, on the other hand, are linked with later menopause.¹

Effects on Fertility

Many women tend to believe that as their periods become irregular and they enter perimenopause, they are no longer fertile. This often leads to a decrease in contraception use, but it is important to note that even when a woman is experiencing perimenopause, it is possible for her to become pregnant. Therefore, women should take the appropriate precautions if they do not wish to become pregnant.

While there is still a possibility of pregnancy, a woman’s fertility declines dramatically after the age of 40, and her chances are low when she is perimenopausal. If a woman wishes to become pregnant naturally during perimenopause, there are many factors that make it difficult. First, because her cycle has become irregular, it is very difficult to predict the time of ovulation (the most fertile window in her cycle). Second, the eggs that are released during ovulation are of poorer quality than they used to be, meaning they often cannot be fertilized. Third, if conception does occur, the risk of birth defects and miscarriage are much higher. In fact, once a woman turns 40, her chances of miscarriage have doubled. Therefore, a woman and her potential partner should consider these factors thoroughly before deciding whether or not to conceive. Today, however, there are many technologies to assist with reproduction as a woman ages and becomes less fertile.⁴

What to Expect

Menopause can be a stressful time for a woman as her body undergoes many changes, and it can be difficult to know how to best embrace the transition. Perimenopause may last for four to eight years, so knowing what to expect can be one way to make the experience easier.

Hot Flashes

One of the most common and bothersome symptoms experienced by perimenopausal women is hot flashes. Hot flashes are episodes of rapid reddening and warming of the skin, and tend to last one to five minutes. The body experiences a quick “flash” of heat, and is often accompanied by sweating and rapid heartbeat. Hot flashes can be followed by headaches and fatigue. They may occur during the day or night (if they occur at night they may be treated as night sweats). There is much variation in the duration of this symptom. Some women only experience them for a couple years; others have them for decades. Hot flashes also vary in severity, but most women can get relief from simple lifestyle changes.

• Avoid warm rooms, hot drinks, hot foods, alcohol, caffeine, cigarettes, and heavy clothing. Choose lighter, breathable fabrics and dress in layers.
• Keep cooling sprays and/or gels close nearby to soothe the body.
• Avoid excess stress. Practice stress-relieving activities such as yoga and meditation; make sure to get adequate sleep; and exercise regularly.
• When experiencing a hot flash, try “paced respiration” slow deep abdominal breaths, in through the nose and out through the mouth. Five seconds in, and five seconds out.
• Try to stay cool at night. Wear light and breathable pajamas, use light and layered bedding that can easily be removed, have a fan nearby, sleep with a chill pack under the pillow. If hot flashes interfere with your sleeping, have a cool sip of water, and practice methods that facilitate falling back to sleep (such as meditation and breathing techniques).²

Sexual Desire

Many menopausal women report a decline in sexual desire and sexual arousal. This may occur due to a variety of factors, only a fraction of which are biological. Other factors, which often have a larger impact on sexual desire and function than menopause, may include relationship issues, attitudes toward sex and aging, general health, and cultural background.¹ The most common physical change seen in menopausal women is the thinning and drying of the vaginal walls, also known as vaginal atrophy, which can make sex painful. It is often experiences as vaginal tightness during sex and can be accompanied by feelings of pain, burning, and soreness. Most women can find effective relief by incorporating personal lubricants into their sex life.²

Women who view the transition as one of fertility to infertility and view intercourse primarily as a means of reproduction may experience some cognitive dissonance and a loss of interest in sex. However, most women also embrace the emotional and recreational purposes of sex and view the transition as liberating. They welcome menopause because it removes the fear of unplanned pregnancy and the need for contraception. Please note that the risk of contracting Sexually Transmitted Infections (STI’s) is always present, so a barrier method of contraception is still advised.¹

Mood Changes

Some women experience emotional changes as part of menopause. These emotional changes can include irritability, feelings of sadness, lack of motivation, anxiety, aggression, difficulty concentrating, fatigue, and mood swings. Although these emotional changes often occur during menopause, they are not always caused by it. Two most commonly emotional symptoms of menopause are irritability and feelings of sadness. Different strategies can be implemented to ease these changing feelings and include the following:

• Exercise and maintain a healthy diet
• Practice stress-relieving activities such as yoga, meditation, and rhythmic breathing.
• Avoid alcohol.
• Find a creative hobby that can promote feelings of achievement.
• Stay connected with friends and family and nurture those relationships.⁵

Long-Term Health Effects

Most physical symptoms and side effects caused by menopause gradually diminish over time; however, some are long-term. Due to the lowered estrogen levels in menopausal women, they are at increased risk for osteoporosis, cardiovascular disease, and other skin and hair changes.¹

Osteoporosis

The most serious is osteoporosis, which is the loss of bone density or the thinning of the mineral structure of the bones. It makes menopausal women more prone to fractures and vertebral compression. In some women, the loss of bone density leads to spinal fractures that, in turn, can lead to an increasingly hunched posture. Exercise, good nutrition, supplements (such as calcium and vitamin D), and certain drugs (the most common osteoporosis medications being bisphosphonates) can help prevent this process.¹

Cardiovascular Disease

Risk of cardiovascular disease is another long-term health effect noticed in menopausal women. This is due to changes in their blood lipid (fat) chemistry.¹

Effects on Skin and Hair

Menopause can affect a woman’s skin and hair. Her skin may lose its thickness, elasticity, hydration, and fat content.¹ Postmenopausal women may also start to notice skin and hair changes due to the decrease in estrogen and increase of androgen in their bodies. Some side effects, which are often not widely known as symptoms of postmenopause, include hirsutism (excessive hair growth on areas where it is normally minimal), facial hair, alopecia (sudden hair loss or bald spots), skin atrophy (thin and wrinkled skin) and slackness of facial skin. As a woman’s skin and hair are often linked to her femininity or feelings of femininity these disorders may cause significant anxiety as well as lowered self-esteem.⁶

Treatment

Hormone Therapy

To minimize the effects of menopause, some women undergo menopausal hormone therapy. This involves taking sex hormones or other drugs to compensate for the loss of her own ovarian hormones. Most commonly, women take a combination of estrogen (to alleviate symptoms such as hot flashes and vaginal dryness) and progestin (to counteract a side effect caused by the estrogen, an increased risk of endometrial cancer). If a woman has undergone hysterectomy, she does not need the additional progestin to protect herself from endometrial cancer. Menopausal hormone therapy is very helpful for women who have severe menopausal symptoms, and it can greatly increase their quality of life. However, treatment should only occur for short-term relief as long-term use has been linked to an increased risk for cardiovascular disease and breast cancer. New research suggests that these risks are only increased when a woman is over the age of 60; until then, she may use menopausal hormone therapy for as long as she and her physician see fit to relieve menopausal symptoms.¹

Natural Treatments

There are also natural treatment methods available today. A common one is the consumption of isoflavones (a plant-derived molecule similar to estrogen most commonly found in soybeans). If taken alone, the data regarding any health benefits are inconclusive. Nevertheless, clinicians still recommend consuming foods that contain isoflavones due to their believed cardiovascular benefits.⁷

Other natural methods include lifestyle changes. Practicing yoga has been found to alleviate menopausal symptoms. Furthermore, maintaining a healthy lifestyle by exercising regularly, keeping a healthy weight, avoiding cigarettes and alcohol, and ingesting a healthy calcium-rich diet can reduce menopausal symptoms as well as postmenopausal health risks.¹ Overall, it seems that a positive attitude toward menopause generally leads to less severe symptoms.

References

1. Baldwin, J., Baldwin J., and Levay, S. (2015). Discovering Human Sexuality (3rd ed.). Sunderland, MA: Sinauer Associates Inc.
2. “North American Menopause Society (NAMS) – Focused on Providing Physicians, Practitioners & Women Menopause Information, Help & Treatment Insights.” North American Menopause Society (NAMS) – Focused on Providing Physicians, Practitioners & Women Menopause Information, Help & Treatment Insights. Web. 25 May 2015.
3. “What Is Menopause? Causes, Symptoms, What Happens.” WebMD. WebMD. Web. 25 May 2015.
4. “Doctor, Can I Still Get Pregnant?” Doctor, Can I Still Get Pregnant? Web. 25 May 2015.
5. “Menopause, Emotions, Depression, Moodiness, and More.” WebMD. WebMD. Web. 25 May 2015.
6. . Blume-Peytavi, U., Atkin, S., Gieler, U., and Grimalt, R. “Hair, skin, hormones and menopause – current status/knowledge on the management of hair disorders in menopausal women.” Skin Academy, 22. 3 (2012): 310-8. PubMed. Web. 25 May. 2015.
7. “The Role of Isoflavones in Menopausal Health: Consensus Opinion of The North American Menopause Society.” National Center for Biotechnology Information. U.S. National Library of Medicine, 1 July 2000: 215-29. PubMed. Web. 25 May 2015.

Last Updated: 27 May 2015.