What Is Menopause and the Menopausal Transition?

That said, menopause doesn’t just suddenly happen. It comes on the heels of perimenopause, the transitional phase leading up to menopause. Perimenopause can last several years. During those years, the levels of the hormones estrogen, progesterone, and testosterone drop off, which may bring a series of side effects. It’s also possible to induce menopause by removing the ovaries or by administering chemotherapy.

Types of Menopause

Perimenopause

Erratic periods are common in perimenopause, as is spotting between cycles, shorter cycles, lighter or heavier cycles, and even missed cycles. Perimenopause happens in two stages: Early-stage perimenopause is when your menstrual cycle starts to become unpredictable. Over the span of a few months, you may get your period a week or more later than during your usual cycle. Late-stage perimenopause occurs when you start having two months between cycles.

Premature or Early Menopause

Signs and Symptoms of Menopause

Each experience with menopause is unique; you may have all of the following symptoms or just a few of them. The intensity of symptoms may be relatively mild or severe enough to affect quality of life. In many cases, periods first become irregular and possibly heavier or lighter. But for some people, periods can just stop suddenly. If that happens to you, see your doctor to make sure no other issues are at play.

Here are common symptoms of menopause:

• Hot flashes
• Night sweats
• Weight gain and slower metabolism
• Mood changes, including symptoms of depression and anxiety
• Sleep problems
• Hair loss, brittle nails, dry eyes and mouth, and skin issues
• Genitourinary syndrome of menopause, which includes genital dryness, irritation, sexual dysfunction, and urinary issues

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• Sexual issues, including a drop in libido, vaginal dryness, and pain upon penetration
• Memory and cognitive issues, perhaps related to hormone changes, sleep disruptions, mood changes, and hot flashes

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Causes and Risk Factors That Can Affect the Timing of Menopause

The following details may contribute to determining the timing of menopause:

• Giving Birth and Breastfeeding Women who have given birth and women who spent months exclusively breastfeeding may be less likely to experience early onset menopause.
• Surgery, Chemotherapy, Genetics Removal of the ovaries (surgical menopause), ovarian failure due to chemotherapy, and some genetic or endocrine issues will bring on menopause.
• Medical Conditions Women who smoke or have certain medical conditions, such as autoimmune diseases, thyroid disease, or Crohn’s disease, have a higher risk of early menopause.
• Cycle Length Women with menstrual cycles fewer than 25 days are likely to reach menopause earlier.
• Trauma Personal trauma may have an impact.

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  Race, ethnicity, and family history may be other factors.
• Education Women who have achieved higher levels of education have been shown to start menopause later.

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• Weight Extremes Obesity or being underweight can have an impact, too.

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How Is Menopause Diagnosed?

Menopause diagnoses happen in hindsight; women are able to confirm they’ve reached the milestone after they’ve surpassed it. Put simply, you’ve reached menopause after not having a menstrual cycle for more than a year (12 consecutive months).

Most women do not require a formal test or diagnosis to confirm menopause. However, for those naturally entering this phase at midlife, PicoAMH Elisa — a diagnostic tool that can reveal menopause status — may be helpful for demystifying fertility concerns or risk of early ovarian failure.

Treatment and Medication Options for Menopause Symptoms

Many menopause symptoms are treatable, or at least manageable, through medications, complementary and alternative medicine, or lifestyle changes. Your doctor can tailor treatments specifically for you.

If you want to try any supplements or vitamins, check with your physician first. Certain supplements may interfere with your current medications.

Medication Options

• antidepressants
• clonidine (Catapres)
• elinzanetant

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• fezolinetant

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• gamma aminobutyric acid (gabapentin)
• hormone therapy, including bioidentical hormones and low-dose estradiol vaginal inserts
• ospemifene (Osphena)

Complementary and Integrative Health Therapies

• Acupuncture
• Hypnotherapy
• Yoga
• Mindful meditation
• Lifestyle changes, such as layering clothing, using vaginal moisturizers and lubricants, quitting smoking, exercising more intensely and regularly, and eating a bone health–promoting diet of foods with calcium and vitamin C

Hormone Therapy

There has been a complicated relationship between breast cancer and hormone treatments for menopause.

Early results from the Women’s Health Initiative’s Hormone Therapy Trials suggested that women who took estrogen plus progestin had a slightly higher risk of developing breast cancer. But women who did not have a uterus had a slightly lower risk.

Everyone’s risk profile is unique; discuss the best option for you with your healthcare practitioner.

Disparities and Inequities in Menopause

Every woman’s experience with menopause may look different. One may breeze through it with minimal discomfort; another may experience extreme hot flashes and mood disorders.

The reasons for the disparities are not fully understood, but current hypotheses hold that chronic stress, lifestyle factors, socioeconomic status, and more — which all may relate to systemic racism — can contribute significantly.

Lifestyle Changes for Weight Management During Menopause

That stubborn belly fat you may experience with the onset of menopause may be due to the drop in hormones, which in turn slows your metabolism. You can work to manage your weight with these tips:

• Exercise regularly. Focus on aerobics for at least 150 minutes a week, and strength train two or more times a week.

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   Mix moderate and intense activities. If you get in an exercise rut or start feeling bored, try different workouts to target different muscle groups, or exercise with friends to keep you on track. Check out our cheat sheet on age-related exercise recommendations for perimenopause and menopause.
• Stand more if doing so is accessible to you. Try using a standing desk when working on the computer.
• When eating, practice portion control, and eat three meals a day.
• Choose healthy unsaturated fats. Cut back on restaurant and takeout food, which is often high in unhealthy fats, salt, and sugar. Especially watch your carb intake; your body converts it into sugar.
• Eat according to your circadian rhythm, during an 8- to 12-hour window, such as from 7 a.m. to 7 p.m. only. Avoid or limit eating late at night.
• Follow good sleep hygiene to get better z’s at night. (Not enough sleep wakes up your hunger hormones.) Research has linked weight gain during menopause to disrupted sleep cycles.
• Work to reduce your stress levels, as doing so can help you more successfully avoid unhealthy eating.
• Talk with your doctor or nutritionist.

Menopause Prognosis

In the months and years leading up to menopause (called perimenopause), women are likely to begin experiencing certain symptoms of the transition.

Complications of Menopause

The main feature of perimenopause and menopause is the drop in levels of hormones such as estrogen, and with that, a coinciding drop in estrogen’s many protective effects. As your estrogen levels decline, you may experience other complications:

• Mood Disorders As mentioned earlier, the risk of depression is higher in menopausal women, even those who have never experienced this mood disorder.
• Weight Gain Fat distribution can change during menopause, with more of it developing around your belly. This can increase your risk of type 2 diabetes, hypertension, heart disease, and some cancers.
• Metabolic Syndrome Your chances of developing metabolic syndrome, a group of conditions that includes high blood pressure, belly fat, and high cholesterol and blood sugar, rises as much as 38 percent after menopause.

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• Sleep Disorders Menopausal women may have problems with falling asleep and not staying asleep once they do. They are also at risk of obstructive sleep apnea.

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• Sexual Dysfunction Some postmenopausal women experience vaginal dryness or pain during sexual intercourse.

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The Takeaway

• Menopause happens when a woman hasn’t had a menstrual cycle for 12 consecutive months. It typically occurs between 45 and 55 years old. All women experience menopause.
• Perimenopause describes the transitional period leading up to menopause, when hormone levels start to shift and a woman may experience certain symptoms of menopause. Perimenopause can last for up to 10 years.
• Menopause can come with many symptoms, including weight gain, hot flashes, sexual dysfunction, and more. Lifestyle shifts along with certain interventions can help manage many if not all of these issues. Work with your doctor to develop a tailored plan of care to fit your needs.