Menopause – Symptoms, Causes, and Complications

Let’s talk about Menopause – Symptoms, Causes, and Complications.

Menopause is the time that indicates the end of your menstrual cycles. It’s diagnosed after you’ve reached 12 months without a menstrual period. Menopause can happen in your 40s or 50s, but the normal age is 51 in the United States.

Menopause is a natural biological method. But the physical symptoms, such as hot flashes and emotional symptoms of menopause, may disrupt your sleep, lower your energy, or affect emotional health. There are many active treatments available, from lifestyle adjustments to hormone therapy.

Symptoms

In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:

  • Irregular periods
  • Vaginal dryness
  • Hot flashes
  • Chills
  • Night sweats
  • Sleep problems
  • Mood changes
  • Weight gain and slowed metabolism
  • Thinning hair and dry skin
  • Loss of breast fullness

Signs and symptoms, including changes in menstruation, can vary among women. Most likely, you’ll undergo some change in your periods before they end.

Skipping periods during perimenopause is common and expected. Often, menstrual periods will skip a month and return, or skip several months and then start monthly cycles again for a few months.

Periods also tend to happen on shorter cycles, so they are closer together. Despite irregular periods, pregnancy is possible. If you’ve skipped a period but aren’t sure, you’ve started the menopausal transition, consider a pregnancy test.

When to see a doctor

Keep up with regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause.

Preventive health care as you age may include suggested health screening tests, such as colonoscopy, mammography, and triglyceride screening. Your doctor might prescribe other tests and exams, too, including thyroid testing if suggested by your history and breast and pelvic exams.

Always seek medical advice if you have bleeding from your vagina after menopause.

Causes

Menopause can result from:

  • Surgery removes the ovaries (oophorectomy): Your ovaries produce hormones, including estrogen and progesterone, that regulate the menstrual cycle. Surgery to remove your ovaries causes immediate menopause. Your periods stop, and you’re likely to have hot flashes and experience other menopausal signs and symptoms. Signs and symptoms can be severe, as hormonal changes occur abruptly rather than gradually over several years. Surgery that removes your uterus but not your ovaries (hysterectomy) usually doesn’t cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone.
  • Naturally declining reproductive hormones: As you approach your late 30s, your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation, and your fertility declines.                                                                                                                                                                                                            In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually, on average, by age 51, your ovaries stop releasing eggs, and you have no more periods.
  • Chemotherapy and radiation therapy: These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures may still be desired. Radiation therapy only affects ovarian function if radiation is directed at the ovaries. Radiation therapy to other parts of the body, such as breast tissue or the head and neck, won’t affect menopause.
  • Primary ovarian insufficiency: About 1% of women experience menopause before age 40 (premature menopause). Premature menopause may result from the failure of your ovaries to produce normal levels of reproductive hormones (primary ovarian insufficiency), which can stem from genetic factors or autoimmune disease. But often, no cause of premature menopause can be found. For these women, hormone therapy is typically recommended until the natural age of menopause to protect the brain, heart, and bones.

Complications

After menopause, your risk of certain medical conditions increases. Examples include:

  • Heart and blood vessel (cardiovascular) disease: When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. So it’s important to get regular exercise, eat a healthy diet, and maintain a normal weight. Ask your doctor for advice on protecting your heart, such as how to reduce your cholesterol or blood pressure if it’s too high.
  • Osteoporosis: This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density rapidly, increasing your risk of osteoporosis. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips, and wrists.
  • Urinary incontinence: As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing, or lifting (stress incontinence). You may have urinary tract infections more often. Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help relieve incontinence symptoms. Hormone therapy may also be an effective treatment option for menopausal urinary tract and vaginal changes resulting in urinary incontinence.
  • Sexual function: Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido). Water-based vaginal moisturizers and lubricants may help. If a vaginal lubricant isn’t enough, many women benefit from local vaginal estrogen treatment, available as a vaginal cream, tablet, or ring.
  • Weight gain.: Many women gain weight during the menopausal transition and after menopause because metabolism slows. You may need to eat less and exercise more to maintain your current weight.

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