menopauseA normal natural event defined by a women’s final menstrual period and confirmed after 12 months of no menstrual bleeding with no other cause.Menopause is a normal, natural event defined by a woman’s final menstrual period and confirmed after 12 months of no menstrual bleeding. The menopausal transition affects each woman uniquely and in various ways. perimenopauseAlso referred to as the menopause transition, the time frame “around menopause”. It can begin several years before menopause and ends when menopause is reached (after 12 months of no menstrual bleeding).Perimenopause, also referred to as the menopause transition, is the time frame “around menopause”. It can begin several years before menopause and ends once a woman reaches menopause. In perimenopause, some women can have changes in the timing, frequency, and volume of bleeding of their periods, get night sweats, have hot flashes, mood swings and have other symptoms. Other women have minimal or no symptoms. Medication or healthy lifestyle changes can help address bothersome symptoms when they are present.

For most women, menopause occurs between ages of 40 and 58 with an average age of 51. Symptoms of menopause can be mild, moderate, or severe, and last on average between 7 and 12 years. For some patients, vasomotor symptoms may persist beyond 12 years.

Stages of Menopause

Perimenopause

Perimenopause is the time surrounding your final menstrual period. During this time, the ovaries become less predictable in how they release eggs and produce hormones such as estrogenAny of a group of steroid hormones which promote the development and maintenance of female characteristics of the body. Such hormones are also used in oral contraceptives or menopausal hormone therapies.estrogen and progesterone, which for some causes bothersome symptoms. Perimenopause typically begins in the mid- to late 40s, though the timing varies by individual and symptoms may begin in the mid- to late 30s. The duration of perimenopause averages about four years but can extend up to a decade before the final transition to menopause.

Menopause

Menopause is diagnosed when a woman has gone 12 months in a row without a period with no other identifiable cause. Factors that affect the start of menopause include:

• Family history
• Never giving birth
• Smoking
• Chemotherapy or radiation
• Prior ovarian surgery
• Body composition and metabolic health

Post-menopause

Post-menopause refers to the time frame after menopause occurs. Once menopause is over, you can’t get pregnant, and you won’t have a period. If you experience bleeding after menopause, you should call your doctor as soon as possible. This may indicate a serious problem. During post-menopause, some symptoms (such as hot flashes) usually gradually decline, but because of decreased estrogen production, risks for other conditions increase, including vaginal dryness, urinary incontinence, heart disease, and osteoporosis. Post-menopausal women can have:

• Hot flashes and night sweats
• Vaginal dryness and sexual discomfort
• Depression
• Changes in sex drive
• Insomnia
• Dry skin
• Weight changes
• Hair loss
• Urinary incontinence

Signs and Symptoms

During perimenopause, you might have irregular periods. Your periods can:

• Be shorter or longer
• Occur more frequently or less frequently
• Have heavier or lighter bleeding

You may also experience some of the other symptoms that are common in menopause.

During menopause, you can have:

• Hot Flashes. Your hot flashes are the result of changes in estrogen levels. They are often described as a sudden warmth and flushing that may be associated with sweating, a sensation your heart is racing, or shivering afterwards. Hot flashes usually last 1-5 minutes but can be as short as 30 seconds or last longer than 10 minutes.
• Night sweats: Very similar to hot flashes but occur during sleep. They may be severe enough to wake someone from sleep. 
• Urinary symptoms. You might have a sudden urge to urinate, or you might have bladder leakage during simple activities like sneezing or bending over. You may also experience more frequent urinary tract infections.
• Sleep. You might struggle with:
  • Falling asleep
  • Staying asleep
  • Waking up too early
• Vaginal Health and Sexuality. Less estrogen during perimenopause and menopause may make the vagina drier and thin vaginal tissue. You might find sexual intercourse uncomfortable. You might also be less interested in sexual activities.
• Mood Changes. You may experience more mood swings than usual or worsening anxiety or depressive symptoms, particularly during perimenopause. These mood changes can be related to hormonal changes, but also impacted by other factors such as midlife stressors and family changes.

Treatment

There are options that may help relieve menopausal symptoms. These include:

Systemic Hormone Therapy

• Menopausal hormone therapy. Estrogen and progesterone (if you have a uterusAlso known as the womb, the uterus is the female reproductive organ where a baby grows. uterus) can be administered in a variety of ways to treat symptoms such as hot flashes and night swears.

Local Hormone Therapy

• Medication, such as low-dose vaginal estrogen or vaginal dehydroepiandrosterone, applied only to the vaginal tissue to address symptoms such as vaginal dryness, pain with sex, recurrent urinary tract infections, and urinary urgency.

Non-hormonal

• Medications that target neurokinin receptors, which play a role in vasomotor symptoms during menopause.
• Antidepressants or Gabapentin which can help with hot flashes and night sweats as well as mood symptoms.
• Vaginal moisturizers or lubricants.
• There is insufficient evidence to recommend most supplements, nutraceuticals, or diets to treat menopausal symptoms.