What is the menopause?
Menopause is the medical term used to describe the period when a woman stops making the female hormones estrogen and progesterone, and therefore stops having menstrual periods. Women reach menopause – marked by 12 consecutive months without periods – at an average age of 51. That applies only to natural menopause – some women go through surgical or induced menopause, when the ovaries are removed, or impaired as a result of chemotherapy. For smokers, the process begins about 2-5 years earlier than average.
How do I know if I am menopausal?
From 2 to 10 years before menopause, women are in a state called “perimenopause” (meaning “around menopause”). During those years, the menstrual cycle varies – periods seem to come less or more often, and the amount of blood flow changes and women often notice some of the menopausal symptoms listed below. But when menstural periods stop completely for 12 months, a woman can assume she is menopausal. This is often associated with some or all of the follow symptoms:
- hot flushes/night sweats
- difficulty sleeping
- development or worsening of urinary incontinence and other bladder problems
- vaginal dryness or infections
- pain with sexual relations
- change in migraine headache frequency or intensity
- “spotting” or bleeding
That list looks daunting, but not every woman experiences every symptom. Some sail through menopause barely noting any of them. If these do trouble you, tell your healthcare provider, first, because she can help you find relief, and second, because some of these symptoms, like unexpected bleeding, may need to be checked out to make sure they’re not due to a separate problem.
Many women notice other changes around this time – weight gain, thinning hair, depression or moodiness, diminished interest in sex – which they blame on menopause. In fact, they are the result of aging or other factors. Remember that many of those changes can be interrelated with the symptoms of menopause. For example, a woman whose sleep is repeatedly disturbed by night sweats can certainly become moody. And pain with intercourse can lead to diminished sexual desire.
Some menopausal women have problems that cause continued bleeding. When bleeding is present in the face of the preceding symptoms or after the age of 52, you should review these symptoms with your provider, who can confirm your menopausal status by measuring your follicle-stimulating hormone (FSH) levels through a simple blood test. If your levels are elevated, you are most likely at the menopause.
If you’ve had a hysterectomy but your ovaries were not removed, you won’t have the absence of menstrual periods to signal menopause. Hot flushes and other symptoms will be a sign, but an FSH measurement will confirm that you’ve reached menopause.
An important note: even if you find yourself skipping periods or experiencing some of these symptoms of menopause, it is still possible to become pregnant. To avoid an unplanned pregnancy, continue to use a reliable birth control method until your doctor confirms that your are no longer fertile.
What’s my next step?
You may not be old, but you’re not so young that you can take your health for granted, so this is a good time to look at your risk factors for heart disease, osteoporosis, and cancer. You and your provider can discuss what you can do to safeguard your health now and in the years ahead. Your provider may order a number of tests, if only to get a baseline against which future results can be compared. These tests may include:
- a mammogram
- blood tests (to measure triglycerides and cholesterol, both LDL and HDL)
- a bone density scan (particularly if you have risk factors for osteoporosis)
- thyroid screen
Talk to your provider about your options for dealing with the short-term problems of menopause, like hot flushes, as well as long-term health issues. Hormone therapy is an effective way to prevent or reduce menopausal symptoms and protect you from osteoporosis, and potentially other disorders. If you’re not a candidate for hormone therapy, your provider can recommend other approaches that will suit your needs.
Patient information brought to you by Contemporary OB/GYN, Thomson Medical Economics.
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