Causes
Natural menopause reflects the ovaries' gradual decline in hormone production with age. Menopause can also occur earlier for other reasons:- Surgical menopause: Removal of both ovaries causes immediate menopause, often with more abrupt symptoms.
- Cancer treatment: Chemotherapy and pelvic radiation can damage the ovaries.
- Primary ovarian insufficiency: In a small number of women, ovarian function declines before age 40, which deserves its own medical evaluation.
Symptoms
Every woman's experience is different; symptoms may last a few years or considerably longer:- Irregular periods: Cycles that shorten, lengthen, or skip are usually the first sign of perimenopause.
- Hot flashes and night sweats: Sudden waves of heat and flushing, sometimes drenching at night - the most common symptom of the transition.
- Sleep problems: Trouble falling or staying asleep, often worsened by night sweats.
- Mood and memory changes: Irritability, anxiety, low mood, and "brain fog" are common and tend to improve after the transition.
- Other physical changes: New joint aches, headaches, brief heart palpitations, thinning hair, drier skin, and weight that shifts toward the abdomen.
- Vaginal and urinary changes: Dryness, discomfort with intimacy, and urinary irritation - known as genitourinary syndrome of menopause - tend to persist without treatment.
Diagnosis
Menopause is usually diagnosed from age and the menstrual pattern alone; hormone testing is rarely required, because hormone levels fluctuate so widely during perimenopause that a single measurement can be misleading. Because thyroid problems can mimic menopausal symptoms, your physician may check thyroid function to rule out hypothyroidism when the picture is unclear, and may check a blood count if periods have been heavy, since iron-deficiency anemia is easy to miss. Two practical points are worth knowing: pregnancy is still possible until periods have stopped for a full year, so contraception is still needed during perimenopause; and any bleeding that occurs after menopause - even light spotting - is never considered normal and should be evaluated promptly, as should unusually heavy or prolonged bleeding during the transition.Treatment
Treatment is tailored to your symptoms, health history, and preferences:- Hormone therapy: Estrogen (such as conjugated estrogens) is the most effective treatment for hot flashes; women who still have a uterus take it with a progestogen such as norethindrone, or as a combined estrogen-bazedoxifene product, to protect the uterine lining. For healthy women under 60 who are within about ten years of menopause, benefits generally outweigh risks - a decision to make individually with your physician.
- Nonhormonal medications: Certain antidepressants, such as low-dose venlafaxine, reduce hot flashes for women who cannot or prefer not to take estrogen.
- Local vaginal estrogen: Low-dose creams, tablets, or rings treat vaginal and urinary symptoms with minimal absorption into the body.
- Vaginal moisturizers and lubricants: Nonhormonal over-the-counter products - moisturizers used on a regular schedule and lubricants used with intimacy - relieve dryness and are a sensible first step for many women.
- Lifestyle measures: Regular exercise, a cool bedroom, layered clothing, limiting alcohol and caffeine, and not smoking all help - worth emphasizing through St. Petersburg's long warm season.