Menopause: Q&A

When does menopause typically begin? 

The average age of menopause in the US is about 51, with ranges of several years on either side.  There is a familial component to age of onset of menopause. 

In fact, I often ask patients when their mother and/or sisters went through “the change.”

The period of life between premenopausal (when women get regular periods and can get pregnant) and post-menopause (we define as no period for one year without a period) is called PERI menopause.  I see many women struggle with symptoms during this transition, which can last 2-8 years.  

Common symptoms include irregular/heavy periods, mood swings, weight changes (weight gain and differing distribution of weight. Women who never had “belly fat” may now carry more weight in their mid-section). 

Hot flashes, vaginal dryness and difficulty sleeping also occur.  It is important to see a physician with expertise in menopause to ensure any symptoms you are experiencing are not due to any other medical conditions. 

Thyroid disease/imbalance is common in women and can cause menstrual irregularities.

A full evaluation typically includes a comprehensive history/physical, lab work, Pap smear, possible biopsy of the lining of the uterus and an ultrasound.  It is important to identify any medical conditions that can mimic menopause and/or co-exist and treat them appropriately.

What are common symptoms of menopause?

Symptoms include menstrual irregularities, hot flashes, weight gain/changes in how women carry weight, difficulty sleeping, decrease in libido, vaginal dryness, sometimes painful intercourse.

Menopause Generic (Credit Getty Images)

Are there other health issues you have to think about as you go through menopause? 

Cardiac disease is more common in post-menopausal women.  “Typical” symptoms of heart disease can include chest pain, shortness of breath, arm/jaw pain, sweaty feeling.  It is important to note that women often present with atypical symptoms – a vague sense of “feeling unwell”, nausea, and anxiety. Women need to advocate for themselves when seeking medical care given they may not experience the same symptoms that men do when suffering from cardiac disease.

 Many women regularly see their OB/GYN throughout their reproductive years as they are having their babies, annual GYN exam/pap smears, and contraceptive visits.  We often perform annual screening for other medical conditions (thyroid, cholesterol, depression, etc…) but it is extremely important women get plugged into a primary care MD at this time.  I can’t tell you how many times patients ask me “can’t you be my PCP?” OB/GYNs are considered specialists and it is important for women to have an internal medicine/family practice physician to manage existing and/or developing medical conditions, ensure you are up to date with immunizations and any other screening tests i.e.: screening colonoscopies are recommended at age 50 in those at low risk.

How can the symptoms of menopause be treated?

Irregular/heavy menstrual bleeding can be treated in several ways.  Years ago, the only treatment was hysterectomy. Now, treatment options for heavy/irregular bleeding include hormonal medication (a low dose birth control pill or cyclic progestin), a hormone containing intra-uterine device (the most common one used is the Mirena IUD – it manages bleeding very effectively).  Compliance is excellent as patients don’t need to remember to take a pill every day. It is placed during an office visit and it lasts for 5 years.  If women have not completed the menopausal transition at 5 years, another Mirena IUD can be placed and this typically carries the patient through menopause.

Endometrial Ablation is also an option – commonly performed as an outpatient procedure, we cauterize the entire lining of the uterus. Many women never get a menstrual period after an ablation.

I reserve hysterectomy as treatment of last resort, and typically only when a patient has failed the above methods.

Vaginal dryness and pain with intercourse can be treated with over the counter lubricants or prescription vaginal estrogen creams/tablets/rings.

Hot Flashes can be more difficult to treat.  OTC remedies include anything containing Soy and Black Cohosh.  Dietary increase in soy/yams/Tofu and other estrogen containing foods can alleviate mild symptoms.  Hormone Replacement therapy remains the mainstay for treatment of hot flashes.  We recommend using the lowest dose for the shortest amount of time (typically 2-5 years) to ease the menopausal transition.  Some women may not be candidates for HRT so it is important to discuss risks/benefits with your doctor.

There are also non hormonal ways to treat hot flashes – the most common is with SSRI medications.  These medications help to stabilize the vascular system to prevent the flushing/sweating many women experience.  SSRIs are antidepressant medications; however, we often use them in much lower doses to alleviate these symptoms.

What are your top recommended lifestyle changes? For example, top recommended physical activities?

It’s important to maintain a healthy lifestyle as you approach menopause - eating a well- balanced diet and regular exercise at least 3 times per week. I recommend limiting alcohol intake (red wine often causes flushing in women) and no smoking. Smoking has been shown to have a deleterious effect on bones and increases the risk of fracture in menopausal women. Yoga and meditation can also help with trouble sleeping. These are all things your healthcare provider should discuss with you

When will it end?

The menopausal transition can last 2-8 years.  I do have patients who continue to experience hot flashes well beyond 8 years.  After careful consideration of pros/cons, many choose to continue with hormone replacement therapy.  There are risks of prolonged use (slight increase in breast cancer and heart disease) so it is important to follow these patients closely and reevaluate on an annual basis.

Posted February 2018. The above content is provided for educational purposes by Tufts Medical Center. It is free for educational use.  For information about your own health, contact your physician.

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