Menopause is the point at which menstrual periods have stopped for 12 consecutive months, marking the natural end of the reproductive years. In the United States it occurs at an average age of about 51. The transition leading up to it - perimenopause - can begin several years earlier, as the ovaries gradually produce less estrogen and hormone levels fluctuate. Menopause is a normal life stage, not an illness, but its symptoms can significantly affect quality of life and are very treatable. 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.

Long-Term Health: After menopause, the loss of estrogen accelerates bone loss - from osteopenia toward osteoporosis - and cardiovascular risk gradually rises, making this an important time to review bone density screening, blood pressure, and cholesterol. Adequate calcium and vitamin D, weight-bearing and resistance exercise, and not smoking protect the skeleton, while staying current with recommended screenings - mammograms, colon cancer testing, and diabetes and lipid checks - matters more after menopause than before it. You do not have to simply endure this transition. The internal-medicine team at Zimmer Medical Group can match the right therapy to your symptoms and long-term health goals - schedule a visit to talk through your options.

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Menopause & Perimenopause

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