Menopause

Menopause is a normal change in a woman’s life when her period stops. During menopause, a woman’s body slowly makes less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row (and there are no other causes for this change). As you near menopause you may have symptoms from the changes in your body. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms. You can feel better by learning all you can about menopause, and talking with your doctor about your health and your symptoms. If you want to treat your symptoms, he or she can teach you more about your options and help you make the best treatment choices.

Symptoms of Menopause
For every woman, monthly periods will stop at menopause. Some women may not have any other symptoms. But as you near menopause, you may have:

	Changes in your period—the time between periods and the flow from month to month may be different.
	Abnormal bleeding or “spotting". If your periods have stopped for 12 months in a row and you still have “spotting,” you should report this symptom to your doctor to rule out serious causes, such as cancer.
	Hot flashes—getting warm in the face, neck and chest.
	Night sweats and sleeping problems.
	Vaginal changes—the vagina may become dry and thin, and sex and vaginal exams may be painful. You also might experience more vaginal infections.
	Thinning of your bones—this may lead to loss of height and bone breaks (osteoporosis).
	Mood changes.
	Urinary problems—such as leaking, burning or pain when urinating, or leaking when sneezing, coughing or laughing.
	Problems with concentration or memory.
	Less interest in sex and changes in sexual response.
	Weight gain or increase in body fat around your waist.
	Hair thinning or loss.

Premature Menopause
Premature menopause is menopause that happens before the age of 40—whether it is natural or induced. Some women have premature menopause because of:

	family history (genes)
	medical treatments, such as surgery to remove the ovaries
	cancer treatments, such as chemotherapy or radiation to the pelvic area

Postmenopause
The term postmenopause refers to the years beyond menopause. It is the period past the time at which you have not had a period for 12 months in a row — whether your menopause was natural or induced.

Depression and Menopause
Many women in perimenopause and menopause feel depressed and irritable. Some researchers believe that the decrease in estrogen triggers changes in your brain, causing depression. Others think that other symptoms you're having, such as sleep problems, hot flashes, night sweats, and fatigue cause these feelings. Or, it could be a combination of hormone changes and symptoms. But these symptoms also can have causes that are unrelated to menopause. If you are having these symptoms and they are interfering with your quality of life, it is important that you discuss them with your doctor. Talk openly with your doctor about the other things going on in your life that might be adding to your feelings.

Bleeding After Menopause
Changes in bleeding are normal as you near menopause. There are also other common causes of bleeding in the years after menopause. The decline in your body's estrogen levels can cause tissues lining the vagina to become thin, dry, and less elastic. Sometimes this lining can become broken or easily inflamed and bleed. It can also become injured during sex or even during a pelvic exam. Once you've reached menopause, though, you should report any bleeding that you have to your doctor. Uterine bleeding after menopause could be a sign of other health problems. Other things that can cause abnormal bleeding include:

	fibroids
	the use of birth control pills
	a hormonal imbalance
	non-cancerous growths in the lining of the uterus

Treatment for the Symptoms of Menopause
For some women, many of their menopause symptoms will go away over time without treatment. Other women will choose treatment to address their symptoms and to prevent bone loss that can happen near menopause. Treatments may include prescription drugs that contain the hormones your ovaries stop making around the time of menopause. Hormone therapy can contain estrogen alone or estrogen with progestin (for a woman who still has her uterus). Estrogen therapy usually is taken by pill, skin patch, as a cream or gel, or is delivered through an intrauterine device (IUD) or vaginal ring.

For more information about hormone therapy, including benefits and risks, speak with your doctor.

Other Ways to Relieve Symptoms

	Hot flashes—Try to avoid a hot environment, eating or drinking hot or spicy foods, alcohol, caffeine and stress. Dress in layers and keep a fan in your home or workplace. Regular exercise may also relieve hot flashes and other symptoms. Ask your doctor about taking an antidepressant medicine. There is proof that these can be helpful for some women.
	Vaginal dryness—Use an over-the-counter vaginal lubricant. Your doctor may also prescribe prescription estrogen replacement cream.
	Problems sleeping—One of the best ways to get a good night's sleep is to get at least 30 minutes of physical activity on most days of the week, but avoid a lot of exercise close to bedtime. Also avoid alcohol, caffeine, large meals and working right before bedtime. You might want to drink something warm, such as herb tea or warm milk, before bedtime. Try to keep your bedroom at a comfortable temperature. Avoid napping during the day and try to go to bed and get up at the same times every day.
	Memory problems—Ask your doctor about mental exercises you can do to improve your memory. Try to get enough sleep and be physically active.
	Mood swings—Try to get enough sleep and be physically active. Ask your doctor about relaxation exercises you can do. Ask your doctor about taking an antidepressant medicine. There is proof that these can be helpful. Think about going to a support group for women who are experiencing the same things or seek counseling to talk through your problems and fears.

The source for the above information on menopause was the US Department of Health and Human Services, Office on Women’s Health, www.4women.gov/faq/perimenopause.htm

You can find out more about menopause by contacting the National Women's Health Information Center at 800-994-WOMAN (9662).