MENOPAUSE

Natural menopause is not brought on by any type of medical or surgical treatment. The process is gradual and has three stages:

• Perimenopause. This is a term sometimes used and means “the time around menopause.” It is often used to refer to the menopausal transitional period. It is not officially a medical term, but is sometimes used to explain certain aspects of the menopause transition in lay terms. At this stage, many women have menopause symptoms.
• Menopause. This is the point when it’s been a year since a woman last had her last menstrual period. At this stage, the ovaries have stopped releasing eggs and making most of their estrogen.
• Postmenopause. These are the years after menopause. During this stage, menopausal symptoms such as hot flashes ease for most women. But health risks related to the loss of estrogen rise as the woman ages.

Symptoms

Most women approaching menopause will have hot flashes, a sudden feeling of warmth that spreads over the upper body, often with blushing and some sweating. The severity of hot flashes varies from mild in most women to severe in others.

Other common symptoms around the time of menopause include:

• Irregular or skipped periods
• Insomnia
• Mood swings
• Fatigue
• Depression
• Irritability
• Racing heart
• Headaches
• Joint and muscle aches and pains
• Changes in libido (sex drive)
• Vaginal dryness
• Bladder control problems

Not all women get all of these symptoms.

DIAGNOSIS

Your age, your history of menstrual periods, your symptoms, and the results of your pelvic exam will tell your doctor whether you are near or at menopause. If possible, bring a calendar or journal of your periods and symptoms.

If you have severe symptoms, if your doctor suspects another medical condition, or if you have a medical condition that makes a diagnosis difficult, your doctor may do one or more of the following blood tests:

• A pregnancy test is done if there is a chance that you are pregnant. (This can also be a urine test.)
• A follicle-stimulating hormone (FSH) test can be used to confirm whether you have reached menopause. FSH levels increase during perimenopause and are high after menopause.
• An estrogen test is sometimes done to see how low estrogen has dropped after menopause.
• A thyroid-stimulating hormone test is used to see whether irregular menstrual periods or perimenopause-like symptoms are being caused by a thyroid problem.

If you have had no menstrual periods for 1 year, this is a good time to have a full physical exam, with particular focus on your heart health and risk factors for osteoporosis.

RECOMMENDED MEDICATIONS

Menopause requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. Treatments may include:

• Hormone therapy. Estrogen therapy remains, by far, the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. If you still have your uterus, you’ll need progestin in addition to estrogen. Estrogen also helps prevent bone loss. And hormone therapy may benefit your heart if started within five years after your last menstrual period.
• Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring.
• Low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes.
• Gabapentin (Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can’t use estrogen therapy and in those who also have migraines.
• Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.