Ht Forms And Regimens
HT comes in several forms:
- Oral tablets or pills
- Vaginal ring
- Topical gel or spray
HT pills and skin patches are considered “systemic” therapy because the medication delivered affects the entire body. The risk for blood clots, heart attacks, and certain types of cancers is higher with hormone pills than with skin patches or other transdermal forms.
Vaginal forms of HT are called “local” therapy. Doctors generally prescribe vaginal applications of low-dose estrogen therapy to specifically treat menopausal symptoms such as vaginal dryness and pain during sex. This type of ET is available in a cream, tablet, or ring that is inserted into the vagina.
“Bioidentical” hormone therapy is promoted as a supposedly more natural and safer alternative to commercial prescription hormones. Bioidentical hormones are typically compounded in a pharmacy. Some compounding pharmacies claim that they can customize these formulations based on saliva tests that show a woman’s individual hormone levels.
The FDA and many professional medical associations warn patients that “bioidentical” is a marketing term that has no scientific validity. Formulations sold in these pharmacies have not undergone FDA regulatory scrutiny. Some of these compounds contain estriol, a weak form of estrogen, which has not been approved by the FDA for use in any drug. In addition, saliva tests do not give accurate or realistic results, as a woman’s hormone levels fluctuate throughout the day.
When Does Menopause Usually Start
Every woman is different, but the menopausal transition usually starts between ages 45 and 55, per the NIA. Some women can start as early as 35, while others may not start it until theyre 60, says , M.D., M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School.
Family history is a reasonable predictor, she says. If everyone in the family went through menopause on the early side, there is a good chance you may, too.
When you got your first period could also help predict when you’ll experience perimenopause. According to a 2017 study in the journal Human Reproduction, women who started their menstrual periods at 11 years old or younger had an 80% higher risk of hitting menopause before the age of 40, compared those who got their first period at 12 or 13 years old.
What Are Hot Flashes
Hot flashes can be a pretty unpleasant symptom of perimenopause and menopause. We dont totally understand the cause of hot flashes.
Most people describe a hot flash as a sudden hot feeling that spreads all over your body but mostly the upper body, like your arms, chest, and face. You may also get sweaty, and your fingers may tingle and your heart may beat faster. A typical hot flash usually lasts anywhere from 1 to 5 minutes.
Hot flashes at night are called night sweats. Sometimes they can get so severe that you soak your sheets with sweat.
Hot flashes are super common. More than 3 out of 4 people have them while going through perimenopause and menopause.
Nothing will make hot flashes stop completely, but there are some things you can do to help get some relief. Wearing light, loose clothes, keeping your room cool, drinking cold liquids, and avoiding alcohol and caffeine can help you stay cool.
Prescription hot flash treatments can be helpful, too. Hormone therapy works best to treat hot flashes, but other medicines like SSRIs and SNRIs and clonidine may also help. Research shows that herbs, vitamins, acupuncture, and reflexology dont help with hot flashes.
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What Can I Do To Help Myself
To help you manage hot flushes, simple things like wearing light clothing, using a fan and keeping your bedroom cool could help.
If youre struggling with your mood, consider trying self-help measures like relaxation, getting enough sleep and staying active. Regular physical activity and eating a healthy diet can also help to improve menopausal symptoms.
What Causes The Menopause
The menopause is caused by a change in the balance of the body’s sex hormones, which occurs as you get older.
It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.
Premature or early menopause can occur at any age, and in many cases there’s no clear cause.
Sometimes it’s caused by a treatment such as surgery to remove the ovaries , some breast cancer treatments, chemotherapy or radiotherapy, or it can be brought on by an underlying condition, such as Down’s syndrome or Addison’s disease.
Page last reviewed: 29 August 2018 Next review due: 29 August 2021
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When To See A Doctor
At the onset of perimenopause, a person may wish to schedule regular doctor visits for preventive healthcare.
Around perimenopause, doctors may recommend certain health screenings that sometimes include a colonoscopy, mammogram, and blood tests.
An individual should not hesitate to seek a doctors care and advice to deal with disruptive menopausal symptoms. If vaginal bleeding occurs after menopause, a person should also seek medical attention.
What Are Common Menopause Symptoms
Some common menopause symptoms are:
Irregular periods: Periods becoming shorter, longer, heavier, lighter. Skipping periods.
Hot flashes: A hot flash is a sudden, sometimes intense feeling of heat that rushes to your face and upper body. Hot flashes can be really uncomfortable, but they usually only last a few minutes. They can happen a few times a day, a few times a week, or a few times a month.
Night sweats: Hot flashes that wake you up in the middle of the night.
Sleep problems: You may have insomnia trouble falling asleep or staying asleep. You may also start to wake up much earlier than you used to.
Vaginal changes: The lining of your vagina may become thinner, drier, or less stretchy. This can cause dryness or discomfort during sex.
Urinary or bladder infections: You may have to pee more often or get more frequent urinary tract or bladder infections.
Mood changes: Hormone changes can make you feel anxious, irritable, and tired. Your sex drive might change, too.
Weaker bones: Your bones will probably weaken during menopause. If its really bad, it can lead to osteoporosis after menopause. Getting plenty of calcium and vitamin D, and exercising for at least 30 minutes most days of the week can help you maintain bone health.
Some people may have a long and difficult perimenopause, up to 1012 years. But most people find that the common menopause symptoms are temporary and only last 35 years.
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What Are The Stages Leading Up To Menopause
After puberty, there are three other phases of female fertility:
- Pre-menopause: Women have full ovarian function, regularly produce estrogen and ovulate.
- Perimenopause: The ovaries begin to fluctuate in their ovulation and production of estrogen, which can result in unpredictable menstrual cycles and symptoms.
- Menopause: When the ovaries have shut down. Someone would be in menopause after 12 months without menses.
What Is Menopause Its A Moment In Time
Menopause is a specific point in time. Menopause occurs when periods stop and youve gone 12 consecutive months since having your last period. Once youve hit that moment, you enter post-menopause.
Reaching menopause means that youre no longer able to bear children. Every woman except for those whove had their ovaries removed before puberty will go through menopause.
When does menopause start?
The average menopause age is around 51. But some women experience menopause in their 40s with a small percentage experiencing menopause even younger. Some women may not reach menopause until their 60s.
Theres no way to know your exact menopause age until it happens, but genetics seem to play a strong role. You may get a general idea of when to expect menopause based on when your family members went through it, particularly your mother.
Genetics arent the only thing that can impact when menopause starts. Medical factors can also influence menopause timing. When the ovaries are removed, symptoms will begin to show immediately.
Certain medical conditions like autoimmune diseases have also been associated with early menopause. Women whove undergone treatments like radiation therapy or chemotherapy are also more likely to show symptoms earlier.
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How Often Do I Need To See My Doctor After Menopause
You should still see your healthcare provider for routine gynecological care even though you aren’t menstruating. This includes Pap tests, pelvic exams, breast exams and mammograms. You should continue to schedule annual wellness appointments. Since you are at an increased risk for osteoporosis, providers usually recommend bone density screenings as well. Talk to your healthcare provider to determine how often you should make check-up appointments based on your health history.
Can I Get Pregnant If I Am Perimenopausal
Yes. Despite a decline in fertility during the perimenopause stage, you can still become pregnant. If you do not want to become pregnant, you should use some form of birth control until you reach menopause .
For some women, getting pregnant can be difficult once they are in their late 30s to early 40s due to a drop in fertility. If becoming pregnant is the goal, there are treatments that can help you get pregnant.
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Are My Perimenopausal Symptoms Normal Or Something To Be Concerned About
Irregular periods are common and normal during perimenopause. But other conditions can cause changes in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes:
- Your periods are very heavy, or they have blood clots.
- Your periods last several days longer than usual.
- You spot between periods.
- You have spotting after sex.
- Your periods happen closer together.
When Does Menopause Occur
Although the average age of menopause is 51, menopause can actually happen any time from the 30s to the mid-50s or later. Women who smoke and are underweight tend to have an earlier menopause, while women who are overweight often have a later menopause. Generally, a woman tends to have menopause at about the same age as her mother did.
Menopause can also happen for reasons other than natural reasons. These include:
Premature menopause. Premature menopause may happen when there is ovarian failure before the age of 40. It may be associated with smoking, radiation exposure, chemotherapeutic drugs, or surgery that impairs the ovarian blood supply. Premature ovarian failure is also called primary ovarian insufficiency.
Surgical menopause. Surgical menopause may follow the removal of one or both ovaries, or radiation of the pelvis, including the ovaries, in premenopausal women. This results in an abrupt menopause. These women often have more severe menopausal symptoms than if they were to have menopause naturally.
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What Is Postmenopause
Postmenopause is a term to describe the time after someone has gone through menopause. When you’re in postmenopause, your menstrual period has been gone for longer than 12 consecutive months. At this stage in life, your reproductive years are behind you and you’re no longer ovulating . The menopausal symptoms youve experienced in the past may become milder or go away completely. However, some people continue to experience menopausal symptoms for a decade or longer after menopause.
There are three stages of menopause: perimenopause, menopause and postmenopause.
- Perimenopauseis the time leading up to menopause. It describes a time when hormones start to decline and menstrual cycles become erratic and irregular. You may start to experience side effects of menopause, like hot flashes or vaginal dryness.
- Menopause occurs when youve stopped producing the hormones that cause your menstrual period and have gone without a period for 12 months in a row. Once this has occurred, you enter postmenopause.
- Postmenopause is the time after menopause has occurred. Once this happens, you’re in postmenopause for the rest of your life. People in postmenopause are at an increased risk for certain health conditions like osteoporosis and heart disease.
How Long Do Menopause
Even though menopause marks a point in time in which a woman has not menstruated for 12 months and is no longer ovulating , the symptoms of menopause may persist.
Most women stop having hot flashes within five years following their final menstrual period. However, a report on the management of menstrual symptoms notes that the Penn Ovarian Aging Study found that more than one-third of women continued to have moderate to severe hot flashes for 10 years or more. Women who began having hot flashes as they entered perimenopause had them longer, for an average of 11.6 years. African-American women had a longer duration than white women.
Vaginal dryness, burning, and itchiness also occurs as a result of estrogen deficiency. The difference with this symptom is that it tends to get worse as women get older. In fact, only between one quarter and one third of women in perimenopause or early postmenopause experience vaginal dryness. But as women reach late postmenopause, about half report vaginal dryness.
There are other symptoms that may begin during perimenopause and persist throughout postmenopause. These include:
- Sleep problems
- Cognitive changes such as memory loss
- Muscle and joint pains
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How Do I Stay Healthy After Menopause
It is important to maintain a healthy lifestyle, especially as you age and your risk for certain medical conditions increases. Some ways for people in postmenopause to stay healthy include:
- Exercising regularly. Walking, doing yoga or strength training can help lower your risk for many medical conditions.
- Weight-bearing exercises can strengthen your bones and muscles.
- Eating a healthy diet. Foods like fruits, vegetables, lean meats and whole grains should make up the bulk of your diet. Avoid lots of salt or sugar and limit your consumption of alcohol.
A note from Cleveland Clinic
Going through menopause can be uncomfortable and present new challenges and health concerns. Speak with your healthcare provider about any symptoms you feel or questions you have. They can help make sure you are supported through this time and get the care you need.
Last reviewed by a Cleveland Clinic medical professional on 10/05/2021.
What Causes Postmenopausal Bleeding
Vaginal bleeding during postmenopause isn’t a normal side effect of decreasing hormone levels. In some cases, the dryness in your vagina could cause some light bleeding or spotting after sex. In other cases, it could indicate a condition like endometrial hyperplasia or uterine fibroids, infections like endometritis, or cancer. Contact your healthcare provider if you experience any vaginal bleeding so you can be evaluated.
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What Is Menopause Again
Menopause is a normal part of aging, and its actually a point in time 12 months after a womans last period, according to the National Institute on Aging . During the years leading up to that point, a woman may have changes in her monthly cycle, hot flashes, and other symptoms. This is called the menopausal transition or perimenopause.
During perimenopause, the number of eggs in a womans ovaries start to dwindle down to a precious few, says Jonathan Schaffir, M.D., an ob/gyn from The Ohio State University Wexner Medical Center. Since ovulation, or the release of the egg, triggers periods, once the eggs dwindle, menstruation spaces out and then stops completely.
During perimenopause, the body’s production of estrogen and progesterone vary, the NIA explains. A womans bones become less dense, and her body starts using energy differently. Fat cells also change and women may find that they gain weight more easily than they did before.
While menopause typically happens naturally as a woman ages, it can also happen if a woman has her ovaries surgically removed, says Arianna Sholes-Douglas, M.D., author of The Menopause Myth: What Your Mother, Doctor, And Friends Havent Told You About Life After 35, and the founder of Tula Wellness Center in Tucson, Ariz. Symptoms can also occur even if a woman has her uterus removed but leaves her ovaries intact, she adds.
What Happens If I Have A Hysterectomy
Women may experience menopause for reasons other than as a natural transition. With surgical menopause, via a total hysterectomy, you will experience an immediate and significant change in your hormonal balance. Women whove had partial hysterectomy, when only the uterus is removed, are still likely to go through normal perimenopause and menopause. However, because their periods stop, it may be more difficult to know when these transitions are starting. Surgical removal of the ovaries or significant disruption of the blood supply to the ovaries from surgery, radiation, chemotherapy, or certain medications will most likely result in menopause.
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Treatments For Menopausal Symptoms
Your GP can offer treatments and suggest lifestyle changes if you have severe menopausal symptoms that interfere with your day-to-day life.
- hormone replacement therapy tablets, skin patches, gels and implants that relieve menopausal symptoms by replacing oestrogen
- vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness
- cognitive behavioural therapy a type of talking therapy that can help with low mood and anxiety
- eating a healthy, balanced diet and exercising regularly maintaining a healthy weight and staying fit and strong can improve some menopausal symptoms
Your GP may refer you to a menopause specialist if your symptoms do not improve after trying treatment or if you’re unable to take HRT.
Will My Hot Flashes Stop After Menopause
Some people still experience hot flashes after menopause. Postmenopausal hot flashes are caused by decreased estrogen levels. It is not uncommon to experience a random hot flash for years after menopause. If your hot flashes are bothersome or intensify, speak with your healthcare provider to rule out other causes.
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