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, which 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 Transitions

You can enter menopause a few ways, though it’s difficult to predict when this transition will start and how long it may last.

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 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 your 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.

• Hot flashes
• Night sweats
• Weight gain
• Mood changes, including symptoms of depression and anxiety
• Sleep problems
• Hair loss, brittle nails, dry eyes and mouth, and skin issues
• Vaginal dryness or irritation
• Incontinence and bladder problems
• Loss of libido
• Memory issues or brain fog

Causes and Risk Factors That Can Affect the Timing of Menopause

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

• Family History and Genetics Research has suggested that genetics play a large role when it comes to the timing of natural menopause.

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• Race and Ethnicity Research has also identified differences in natural menopause timing by race and ethnicity, though more studies are needed to better understand this connection.

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• 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, and Genetics The removal of the ovaries (surgical menopause), ovarian failure due to chemotherapy, and some genetic and endocrine issues will bring on menopause.
• Medical Conditions Women who smoke or have certain medical conditions, such as autoimmune diseases, thyroid disease, and 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 Research suggests that personal trauma and post-traumatic stress disorder may have an impact.

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

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How Is Menopause Diagnosed?

Menopause diagnoses happen in hindsight: Women are able to confirm they’ve reached menopause after not having a period for more than a year (12 consecutive months).

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, and some may have serious side effects.

Medication Options

• antidepressants
• clonidine (Catapres)
• elinzanetant (Lynkuet)

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• fezolinetant (Veozah)

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• gabapentin (Gralise, Neurontin)
• hormone therapy, including bioidentical hormones and low-dose estradiol vaginal inserts
• ospemifene (Osphena)

Complementary and Integrative Health Therapies

• Acupuncture
• Hypnotherapy
• Yoga
• Meditation
• Vaginal moisturizers and lubricants
• Lifestyle changes, such as layering clothing, quitting smoking, exercising more intensely and regularly, and eating a diet of foods with calcium, vitamin C, and vitamin D to support bone health

Hormone Therapy

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

Everyone’s risk profile is unique, so it’s best to discuss the right 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:

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 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 During the menopause transition, you have a higher risk of developing metabolic syndrome, a group of conditions that includes high blood pressure, belly fat, high cholesterol, and high blood sugar. This risk is 27 percent higher for those who naturally undergo menopause earlier (around age 47).

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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 a higher risk of obstructive sleep apnea than premenopausal women.

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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 58 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 symptoms of menopause. Perimenopause can last 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 of these issues. Work with your doctor to develop a tailored plan of care to fit your needs.