Understanding The Menopausal Transition
Menopause is a point in time 12 months after a woman’s last period. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause.
The menopausal transition most often begins between ages 45 and 55. It usually lasts about seven years but can be as long as 14 years. The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity. During perimenopause, the body’s production of estrogen and progesterone, two hormones made by the ovaries, varies greatly.
The menopausal transition affects each woman uniquely and in various ways. The body begins to use energy differently, fat cells change, and women may gain weight more easily. You may experience changes in your bone or heart health, your body shape and composition, or your physical function.
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What Can I Do About Hot Flashes
Hot flashes occur from a decrease in estrogen levels. In response to this, your glands release higher amounts of other hormones that affect the brain’s thermostat, causing your body temperature to fluctuate. Hormone therapy has been shown to relieve some of the discomfort of hot flashes for many women. However, the decision to start using these hormones should be made only after you and your healthcare provider have evaluated your risk versus benefit ratio.
To learn more about women’s health, and specifically hormone therapy, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the Women’s Health Initiative in 1991. The hormone trial had 2 studies: the estrogen-plus-progestin study of women with a uterus and the estrogen-alone study of women without a uterus. Both studies ended early when the research showed that hormone therapy did not help prevent heart disease and it increased risk for some medical problems. Follow-up studies found an increased risk of heart disease in women who took estrogen-plus-progestin therapy, especially those who started hormone therapy more than 10 years after menopause.
The WHI recommends that women follow the FDA advice on hormone therapy. It states that hormone therapy should not be taken to prevent heart disease.
Practical suggestions for coping with hot flashes include:
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On Average Menopause Begins Around Age 52
Kathi Valeii is a freelance writer covering the intersections of health, parenting, and social justice.
Menopause occurs after a person stops having their period for 12 consecutive months. It naturally happens for many people when they are between the ages of 40 and 58. In the United States, the average age for menopause to start is 52 years.
Certain factors, like never having children and smoking, can make it more likely that menopause will occur earlier.
Before menopause, declining estrogen levels can cause people who menstruate to experience premenopausal symptoms. Menstrual changes, hot flashes, vaginal dryness, sleep problems, and other symptoms are the result of hormonal shifts that are taking place during this time, which is called perimenopause.
Perimenopause can last from two to eight years. On average, people experience perimenopause for four years before menopause begins.
While many people go through menopause in their early fifties, there are a number of unique factors that determine at what age a person will start menopause, as well as what their experience will be like.
What About Menopause Symptoms In Their 30s
Although not common, it is possible for women to experience what is known as premature menopause or early menopause.
Premature menopause is menopause that happens before the age of 40, meaning the perimenopause transition occurs in a woman’s 30s. Likewise, early menopause is menopause that happens between the ages of 40 and 45, also signifying that symptoms can occur up to a decade before then. It occurs in 5 percent of women.4
Both can be caused by family history cancer treatments – like chemotherapy surgical removal of the ovaries and various health conditions, such as autoimmune diseases, thyroid disorders, chronic fatigue syndrome, and more.
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How Will Menopause Affect Me
Menopause affects every woman differently. Most women get some hot flushes and/or night sweats but are able to manage these without treatment. Around 20 per cent of women have symptoms which are troublesome and/or prolonged and these women may consider treatment. The experience of menopause and symptoms differ in women from different ethnic groups, for example, for some Asian women, body and joint aches and pains are the most troublesome symptom.
Factors that may affect your experience of menopause
- Your age at menopause. Younger women who were not expecting to go through menopause may have more difficulty than women at the average age.
- What you are expecting of menopause. Women who expect to have troublesome menopausal symptoms are more likely to experience troublesome symptoms when they go through menopause. So, a positive and informed approach to menopause may help.
- Many women are relieved that they no longer have menstrual periods and are no longer fertile.
What’s The First Sign Of Perimenopause
The first perimenopause sign is typically a disruption of your menstrual cycle. For many women, your period starts earlier or later than normal. For example, if your menstrual cycle has always been 28 days, during perimenopause, your period could come as early as 21 or as late as 35 days. Some women start skipping months entirely and then experience heavier-than-normal periods when they do have them.
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At What Age Does A Woman Typically Reach Menopause
The average age of menopause is 51 years old. However, there is no way to predict when an individual woman will have menopause or begin having symptoms suggestive of menopause. The age at which a woman starts having menstrual periods is also not related to the age of menopause onset. Most women reach menopause between the ages of 45 and 55, but menopause may occur as earlier as ages 30s or 40s, or may not occur until a woman reaches her 60s. As a rough “rule of thumb,” women tend to undergo menopause at an age similar to that of their mothers.
Symptoms and signs related to the menopausal transition such as irregularities in the menstrual cycle, can begin up to 10 years prior to the last menstrual period.
Are Women Who Arent Experiencing Menopausal Symptoms Still Fertile
No matter when you experience natural menopause, your chances of getting pregnant after the age of 40 are low, says Faubion. But you can still become pregnant as youre transitioning to menopause, and you still need to use if you don’t want to conceive, she adds.
Streicher confirms, saying, and menopause are not the same thing there are plenty of women who are pumping out and menstruating and are not fertile. If youre sexually active, its important to consult with your doctor before making any decisions about birth control to avoid unwanted pregnancy.
On the other hand, dont assume that just because you are still menstruating that you can . Women who are concerned that they may have trouble conceiving or think they may experience menopause early and still want children should discuss options such as egg freezing with their doctor, says Streicher.
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How Can You Alleviate Perimenopausal Symptoms
Some women deal with the symptoms of perimenopause, and some women seek treatment for specific health concerns. Women with heavy bleeding, periods that last longer than seven days, spotting between periods or cycles that are less than 21 days should contact a doctor.
Typically, perimenopause is a gradual transition, and no particular test indicates what is happening to the body. Hormone therapy, vaginal estrogen treatments and antidepressants can help treat perimenopausal symptoms.
Start by identifying what’s bothering you most and then working with your doctor to address it. There are steps you can take to feel better. Lifestyle changes that can make a big impact in easing perimenopausal symptoms and improving your overall health include:
How Is Premature Menopause Diagnosed
To diagnose premature menopause, your doctor will most likely perform a physical exam and draw blood to rule out other conditions, such as pregnancy and thyroid disease. They may also order a test to measure your estradiol levels. Low levels of estradiol, a form of estrogen, can indicate that your ovaries are starting to fail. When estradiol levels are below 30, it may signal that you are in menopause.
However, the most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone . FSH causes your ovaries to produce estrogen. When your ovaries slow down their production of estrogen, your levels of FSH increase. When your FSH levels rise above 40 mIU/mL, it usually indicates that you are in menopause.
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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.
Selective Estrogen Receptor Modulators
SERMs are a category of drugs, either synthetically produced or derived from a botanical source, that act selectively as agonists or antagonists on the estrogen receptors throughout the body. The most commonly prescribed SERMs are raloxifene and tamoxifen. Raloxifene exhibits oestrogen agonist activity on bone and lipids, and antagonist activity on breast and the endometrium. Tamoxifen is in widespread use for treatment of hormone sensitive breast cancer. Raloxifene prevents vertebral fractures in postmenopausal, osteoporotic women and reduces the risk of invasive breast cancer.
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Treating Postmenopause Symptoms Age 60+
Postmenopause treatments for symptom relief first revolve around the enactment of lifestyle adjustments alongside the use of alternative medicine for ideal effects.
Lifestyle adjustments. An improved diet rich in phytoestrogens and the three macronutrients – lean protein, complex carbs, and healthy fats – is key for postmenopausal nutrition. Also, aging women should aim for regular, weight-bearing exercise to encourage optimal muscle mass and weight as well as practicing wholesome habits for endocrine health.
Alternative medicine. Phytoestrogenic herbal supplements – such as black cohosh or red clover – as well as hormone-regulating supplements, like Macafem, are two well-renowned options for promoting hormonal health well into a woman’s postmenopausal years.
Postmenopause women should work with their doctors to develop a treatment plan that works best for them. If non-invasive measures do not provide relief, HRT may be recommended.
How Postmenopause Affects The Body
We dont fully appreciate the natural hormone estrogen until its gone. This humble hormone is essential for maintaining health throughout a womans body not just the reproductive system. With a decrease in estrogen, your bodys major systems can be affected too.
Heres how estrogen relates to the rest of your body once youre postmenopause.
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Pros & Cons Of Replacing Hormones
Since menopause is caused by a decrease in estrogen and progesterone, why not just replace them and continue on? Hormone replacement therapy is an option for many women who wish to combat the health risks that increase during their postmenopausal years. But this therapy may have its own risks.
Benefits: Estrogen therapy may relieve hot flashes, night sweats, vaginal dryness and protect against bone loss.
Risks: Estrogen-only therapy may increase your risk of breast and uterine cancer, stroke, heart disease, and deep vein thrombosis. Combine hormone therapy could cause an increased risk of breast cancer, stroke, heart disease, deep vein thrombosis, and gallbladder disease.
Talk to your doctor about the right approach to managing your health changes after menopause.
How Is Premature Menopause And Primary Ovarian Insufficiency Treated
Management of the condition can vary depending on why menopause started earlier than normal. Given the health risks associated with early menopause, hormone replacement therapy is routinely recommended to all women with premature menopause or primary ovarian insufficiency, unless there is a compelling reason it cant be used. There is a lot of confusion about the safety of hormone therapies. Many of the risks of hormone therapy used after natural menopause are not thought to apply to women who have premature menopause. It is important to discuss the pros and cons of hormone therapy with your doctor. Some healthcare providers have additional certification in the management of menopause, and these providers will be a valuable resource when receiving conflicting information about the safety of hormone therapy.
How Long Does Menopause Last
Menopause is a single point in time and not a process it is the time point in at which a woman’s last period ends. Of course, a woman will not know when that time point has occurred until she has been 12 consecutive months without a period. The symptoms of menopause, on the other hand, may begin years before the actual menopause occurs and may persist for some years afterward as well.
Can Menopause Be Treated
Menopause is a natural process that your body goes through. In some cases, you may not need any treatment for menopause. When discussing treatment for menopause with your provider, its about treating the symptoms of menopause that disrupt your life. There are many different types of treatments for the symptoms of menopause. The main types of treatment for menopause are:
It’s important to talk to your healthcare provider while you are going through menopause to craft a treatment plan that works for you. Every person is different and has unique needs.
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What Are The Symptoms Of Menopause
You may be transitioning into menopause if you begin experiencing some or all of the following symptoms:
- Hot flashes .
- Night sweats and/or cold flashes.
These symptoms can be a sign that the ovaries are producing less estrogen or a sign of increased fluctuations in hormone levels. Not all people get all of these symptoms. However, those affected with new symptoms of racing heart, urinary changes, headaches or other new medical problems should make sure there is no other cause for these symptoms.
Can Menopause Affect Sleep
Some people may experience trouble sleeping through the night and insomnia during menopause. Insomnia is an inability to fall asleep or stay asleep at night. This can be a normal side effect of menopause itself, or it could be due to another symptom of menopause. Hot flashes are a common culprit of sleepless nights during menopause.
If hot flashes keep you awake at night, try:
- Staying cool at night by wearing loose clothing.
- Keeping your bedroom well-ventilated.
Avoiding certain foods and behaviors that trigger your hot flashes. If spicy food typically sets off a hot flash, avoid eating anything spicy before bed.
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What Are The Signs And Symptoms Of Menopause
Estrogen is used by many parts of a womanâs body. As levels of estrogen decrease, you could have various symptoms. Many women experience mild symptoms that can be treated by lifestyle changes such as avoiding caffeine or carrying a portable fan. Some women donât require any treatment at all, but for others, symptoms can be more severe. The severity of symptoms varies greatly around the world and by race and ethnicity.
Here are the most common changes you might notice at midlife. Some may be part of aging rather than directly related to menopause.
Change in your period. This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed more or less than usual. These are all normal changes, but to make sure there isnât a problem, see your doctor if:
- Your periods happen very close together.
- You have heavy bleeding.
- Your periods last more than a week.
- Your periods resume after no bleeding for more than a year.
Bladder control. A loss of bladder control is called incontinence. You may have a sudden urge to urinate, or urine may leak during exercise, sneezing, or laughing. The first step in treating incontinence is to see a doctor. Bladder infections also can occur in midlife.
Common Ages To Experience Symptoms
According to the Office on Womens Health , the average age for menopause in the U.S. is 52 years, and it usually occurs between the ages of 48 and 58 years. It may happen earlier if the person has never had children or if they smoke. Birthing parents and their children assigned female at birth often experience it around the same age.
The changes usually begin in the late 40s, and periods stop on average around 4 years later, but the transition can last between 2 and 8 years. When there has been no menstruation for 12 months, menopause occurs.
Sometimes menopause happens early. Doctors call it premature menopause if it develops before the age of 5% of females.
Symptoms such as hot flashes can start before menopause and may continue for several years after, but each person is different.
What Does This Mean For Women Of Color
You may be experiencing perimenopause symptoms sooner than you expected to. Now is a good time to find a gynecologist who specializes in menopause who can help you through this transition. For many women, perimenopause is a critical opportunity to make some lifestyle changes to support your health through the latter half of your life. Its time to start putting yourself first, so you can serve as the elder your community needs.
The North American Menopause Society has a directory of menopause practitioners by location, where you can find a NAMS-certified menopause practitioner in your area.
See our list of sources for further resources.