Understanding Menopause: Symptoms, Risks, and Treatment Options

Written By Adama Diarra, DO, FACP

Menopause is a natural phase in life that signifies the end of a woman’s menstrual cycles. In the absence of factors that may adversely affect the ovaries—such as surgery to remove the ovaries, pelvic radiation, certain chemotherapy treatments, infections, or autoimmune diseases—menopause typically occurs between the ages of 45 and 55. It is officially diagnosed after 12 consecutive months without a menstrual period, marking the end of fertility. While menopause is a normal biological process, it can bring about a range of physical and emotional symptoms, as well as long-term health changes.

In this blog, we’ll explore what menopause is, how it affects women, what factors can make symptoms more intense, and how it can be treated with both lifestyle changes and medications.

What is Menopause?

Menopause occurs when the ovaries stop producing eggs and the levels of hormones like estrogen and progesterone decrease. These hormones are crucial for regulating menstruation and reproduction. As hormone levels fluctuate and eventually decline, the body goes through several changes.

Menopause happens in three stages:

  • Perimenopause: Perimenopause is the transitional phase leading up to menopause, when hormone levels start to fluctuate, causing irregular periods and early menopausal symptoms. It can begin several years before menopause. Many women notice subtle changes in their bodies during this time, though pinpointing the right diagnosis can be challenging. In my experience, the key to accurate diagnosis is listening carefully. Often, if you simply allow the patient to speak, they will provide the insights needed to understand what's happening.

  • Menopause: Menopause is officially diagnosed when a woman has gone 12 consecutive months without a period, marking the end of menstruation and fertility. Unfortunately, it often takes over a year of follow-up, especially in women experiencing disabling symptoms like hot flashes or mental health changes, before we can make a formal diagnosis based on current guidelines. While hormone testing can be helpful, I’ve found that hormone levels are often unreliable for diagnosing menopause. This is because hormone levels, particularly estrogen and follicle-stimulating hormone (FSH), can fluctuate significantly during perimenopause, making it difficult to get a clear picture from a single test. These fluctuations mean that hormone levels are not always a definitive indicator of menopause, and the diagnosis is often based more on symptom patterns and the length of time since the last period.

  • Postmenopause: The stage after menopause, when symptoms may ease for some women, but the risk for certain health conditions, like osteoporosis, increases due to the continued low levels of estrogen.

When Does Menopause Occur?

The average age for menopause is 51, but it can happen anytime between 45 and 55. In some cases, menopause may occur earlier due to medical treatments like chemotherapy, surgery to remove the ovaries, or other health conditions, such as autoimmune disorders.

How Does Menopause Affect Women?

Menopause affects every woman differently, but there are common symptoms associated with the hormonal changes that occur. These symptoms can range from mild to severe and may include:

  • Hot flashes: Sudden feelings of warmth, often in the upper body, which can lead to sweating.

  • Night sweats: Hot flashes that occur during sleep, often disturbing rest.

  • Mood changes: Anxiety, irritability, or feelings of sadness can arise as hormone levels fluctuate.

  • Vaginal dryness: Thinning of the vaginal tissues can lead to discomfort during intercourse.

  • Decreased libido: Many women report a reduced interest in sex.

  • Sleep disturbances: Difficulty falling asleep or staying asleep is common.

  • Memory problems or difficulty concentrating: Some women experience what is known as “brain fog.”

The intensity and duration of these symptoms can vary from woman to woman.

Risk Factors That Can Worsen Symptoms

Certain factors can influence how severe menopause symptoms are. These include:

  • Smoking: Women who smoke tend to experience menopause earlier and have more intense symptoms, such as hot flashes.

  • Body weight: Women who are overweight may experience more frequent or severe hot flashes.

  • Stress: High stress levels can exacerbate symptoms like anxiety, mood swings, and sleep disturbances.

  • Family history: If your mother or sisters had severe menopause symptoms, you may experience something similar.

  • Health conditions: Conditions like autoimmune diseases or thyroid disorders can worsen symptoms of menopause.

Potential Health Complications of Untreated Menopause

While menopause itself is not a disease, leaving its symptoms or related conditions untreated can lead to long-term health issues, including:

  • Osteoporosis: The decrease in estrogen can lead to bone density loss, making bones more fragile and increasing the risk of fractures.

  • Cardiovascular disease: Low estrogen levels may raise the risk of heart disease, particularly in postmenopausal women.

  • Weight gain: Hormonal changes can lead to an increase in abdominal fat, raising the risk for diabetes and metabolic syndrome.

  • Urinary incontinence: The tissues of the bladder and urethra lose elasticity, leading to leakage during physical activities such as laughing or coughing.

  • Mental health challenges: Untreated menopause symptoms, especially sleep disturbances and mood changes, can contribute to depression and anxiety.

Diagnosis and Early Detection

Early detection of menopausal symptoms through routine medical visits is crucial. An annual exam provides an opportunity for your doctor to discuss symptoms, review your medical history, and assess any changes in your body’s hormone levels. Blood tests may be performed to check hormone levels and rule out other conditions that could be contributing to symptoms.

Treatment Options for Menopause

Every woman’s experience with menopause is unique, and so are her treatment needs. The goal of treatment is to manage symptoms and reduce the risk of long-term health issues. Treatment approaches include lifestyle changes, hormone replacement therapy (HRT), and non-hormonal medications.

1. Lifestyle Interventions

  • Exercise: Regular physical activity helps to reduce weight gain, strengthen bones, and improve mood. Weight-bearing exercises like walking, jogging, and resistance training are particularly beneficial for bone health.

  • Diet: A balanced diet rich in calcium, vitamin D, and phytoestrogens (plant-based estrogens found in foods like soy) can help support bone health and reduce hot flashes.

  • Stress management: Practices such as yoga, meditation, and deep breathing exercises can help manage stress and alleviate symptoms like anxiety and sleep disturbances.

  • Smoking cessation: Quitting smoking can reduce the severity of hot flashes and other symptoms, while also lowering the risk of osteoporosis and heart disease.

2. Medications for Menopause

Hormone-Based Treatments

  • Hormone Replacement Therapy (HRT): HRT involves supplementing the body with estrogen (and sometimes progesterone) to relieve symptoms like hot flashes, night sweats, and vaginal dryness. HRT can be delivered via pills, patches, gels, or creams. However, long-term use of HRT can increase the risk of breast cancer, stroke, and blood clots, so it is typically recommended for the shortest duration possible.

  • Local Estrogen Therapy: For women experiencing vaginal dryness and discomfort, low-dose estrogen creams, rings, or tablets can be used directly in the vaginal area to relieve symptoms without the higher risks associated with systemic HRT.

Non-Hormonal Treatments

  • Selective Serotonin Reuptake Inhibitors (SSRIs): Certain antidepressants, such as paroxetine and escitalopram, are FDA-approved for managing hot flashes. These medications can help regulate mood and reduce the frequency of hot flashes.

  • Gabapentin: Originally developed for treating seizures, gabapentin has been found to reduce hot flashes, particularly in women who cannot take hormone therapy.

  • Clonidine: A medication used to treat high blood pressure, clonidine can also help reduce hot flashes for some women.

Personalized Care for Every Woman

It’s important to remember that menopause treatment is not one-size-fits-all. Each woman’s experience is different, and treatment plans should be tailored to her specific symptoms, health risks, and preferences. Your healthcare provider can work with you to determine the most appropriate course of action, whether that involves lifestyle changes, medications, or a combination of both.

Conclusion

Menopause is a natural part of aging, but its symptoms and potential health risks should not be ignored. With early diagnosis, personalized treatment, and ongoing management, women can reduce the discomfort of menopause and prevent long-term health complications. If you are experiencing symptoms or nearing menopause, it’s essential to consult with your healthcare provider for guidance on managing this transition. By taking action early, you can ensure that this phase of life is as comfortable and healthy as possible.

References

  • North American Menopause Society (NAMS). "Menopause Practice: A Clinician’s Guide."

  • Shifren, J.L., Gass, M.L.S. "The North American Menopause Society Recommendations for Clinical Care of Midlife Women."

  • American College of Obstetricians and Gynecologists. "Practice Bulletin No. 141: Management of Menopausal Symptoms."

  • Kaunitz, A.M., Manson, J.E. "Management of Menopausal Symptoms." New England Journal of Medicine, 2015.