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8 Must-Know Truths About Menopause

It’s not only about hot flashes and mood swings. This part of aging is different for everyone.

Medically reviewed in September 2021

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Menopause occurs when your period stops permanently because your ovaries cease producing estrogen and progesterone. You’re technically in menopause when you haven’t had menstrual bleeding for 12 consecutive months. Some women fear menopause because of symptoms like hot flashes, vaginal dryness, sleep problems, and decreased sex drive. The good news is that there are effective ways to relieve symptoms.

Here are eight things women should know about this important part of aging.

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Women will have different experiences

As with pregnancy and menstruation, women can experience menopause at different times and have different symptoms. Treatments may not work the same way for each woman, either. As therapies have improved, you may not have the same experience that women in previous generations did.

“Just in the last few years, things have changed drastically when it comes to available treatments,” says Christine Hunter, MD, an OBGYN at Summerville Medical Center in Charleston, South Carolina.

While it can be helpful to talk through the ins and outs of the menopause experience with friends and family, just remember that it’s unlikely your experiences will be identical.

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The cause of menopause onset varies

Menopause is most often a natural process, and the average age of onset is 52. That said, it’s also common for women to experience the changes prematurely after a surgery that removes the ovaries, such as a total hysterectomy with salpingo-oophorectomy. Chemotherapy or radiation to treat certain cancers may damage the ovaries and decrease the production of ovarian hormones, also bringing about early menopause. Other causes of early onset menopause include:

  • Smoking
  • Certain health conditions like autoimmune diseases (such as rheumatoid arthritis), thyroid disease, HIV/AIDS, or chronic fatigue syndrome
  • Chromosomal abnormalities

Although it’s common for early onset menopause to occur with these procedures or health conditions, menopause can also arrive early for no apparent reason.

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Perimenopause can bring major symptoms, too

Menopause is a consecutive year without a period, but you may experience changes in your period several years before that. This stage is called perimenopause, or menopausal transition.

“Some people may skip a few periods here and there, then have a period, then have three in a row, then skip three months,” Dr. Hunter explains. “During the time they’re not having regular periods, they can have symptoms of menopause.”

Estrogen levels rise and fall irregularly during perimenopause and that’s why your periods may be shorter or longer. You may notice symptoms associated with menopause during this time, such as hot flashes, sleep issues, or vaginal dryness. Heavy or prolonged bleeding may be a sign you’re going through perimenopause, too. Perimenopause occurs at different ages but can start as early as your mid-thirties. On average, it lasts up to four years until you enter menopause.

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You can relieve menopause symptoms

Menopause can bring a slew of not-so-enjoyable symptoms like night sweats, sleeping problems, vaginal dryness, mood swings, hair loss, and trouble concentrating. The most common symptom by far is hot flashes, experienced by up to 80 percent of women.

Treatment options aren’t going to stop menopause, but they can help relieve some of the symptoms. For women who are still having periods or going through perimenopause, low-dose hormonal birth control may help. Hunter notes that the most common treatment for menopausal symptoms is hormone therapy.

“With hormone therapy,” she explains, “you’ll get prescriptions for two or three hormones that are usually produced by the ovaries—estrogen, progesterone, and testosterone.” Different types of hormone therapy are recommended depending on your health profile. For example, women without a uterus are typically prescribed estrogen only, while those with a uterus usually take estrogen and progestin.

Although major health organizations like the American College of Obstetricians and Gynecologists (ACOG) and the North American Menopause Society say that hormone therapy is safe for most women, there are some risks. Talk with your OBGYN about the pros and cons. Some methods, for example, slightly increase the risk of uterine cancer, breast cancer, heart attack, stroke, or gallbladder disease.

Some healthcare providers (HCPs) may also recommend herbal remedies such as red clover, dong quai, vitamin E, and black cohosh. “ACOG studies show they’re not necessarily effective, but I think they are worth a shot for some women who don’t want to use typical hormone replacement therapy,” says Hunter. Talk to your gynecologist before taking any supplements, since some of them may have negative interactions with medications or present safety concerns for certain people.

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It may affect your bone and heart health

Postmenopausal women may have an increased risk for certain health conditions like osteoporosis and heart disease. Why?

Estrogen, the hormone that your ovaries normally produce, helps build strong bones. When your ovaries stop producing that hormone, you may have some bone loss.

“Women who are already at risk for bone loss, like those who smoke, have thyroid disease, or are on the thinner side don’t have as much bone density to start out with, so their risk is higher,” says Hunter. If you’ve gone through menopause, aim to take in 1,200 milligrams of calcium per day. Foods like tofu, low-fat yogurt, milk, leafy green vegetables, and fortified cereals are great sources of calcium.

Postmenopausal women are also at increased risk for heart disease. “As your estrogen levels drop, your risk for heart disease is going to go up,” says Hunter. Estrogen helps keep blood vessels flexible and encourages proper blood flow. During menopause, it’s also possible that rising blood pressure and LDL (“bad” cholesterol) levels play a role in heart disease risk.

Researchers are working to learn more about the connection between menopause and heart disease, but in the meantime, a healthy diet and regular exercise will help keep your ticker strong. The American Heart Association recommends eating a diet rich in fruits, vegetables, whole grains, low-fat dairy products, fish, lean meat and nuts, and limiting your intake of red meat and sugary foods and drinks.

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Irregular bleeding is a red flag

Whether or not you’re around the age of menopause onset, irregular bleeding warrants an HCP visit. “Any type of increased bleeding is something that needs to be checked out,” says Hunter.

Monitoring heavy bleeding is especially important if you think you’re going through menopause. “As our hormone levels decrease, our bleeding should decrease,” Hunter says. If your periods are very heavy—they last more than seven days, you soak through one or more tampons or pads per hour, or your menstrual flow’s blood clots are bigger than a quarter—see your HCP.

You should also visit your HCP if your period is occurring more than every three weeks. Heavy periods or too-frequent periods may signal a larger health issue like fibroids (non-cancerous growths that develop from uterine tissue), polyps (non-cancerous growths that appear on the uterine wall, or endometrial surface), endometriosis (endometrial tissue that grows somewhere outside of the uterus), or uterine cancers.

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It can be a time to appreciate the positives

While there are certainly some not-so-pleasant side effects of “the big M,” there are some potential positives. You can use this time of change as an opportunity to appreciate the life experience you’ve earned and to set new goals for the next chapters of your life.

First, it may help to set aside any negativity you’ve heard about the transition. It may also help to keep a gratitude journal. Each night, try writing a short list of things for which you feel grateful.

Next, it’s important to take care of yourself. While you may not feel your best every day, make sure to squeeze in time for things that make you feel happy and relaxed. That could mean meeting a friend for a yoga class, winding down at night with a warm bath, or treating yourself to a blowout, just because.

Lastly, remember to communicate with loved ones. Although your friends or family members may not be experiencing the same changes you are, try to connect with someone who is. Talking with those who’ve gone through or are going through menopause can help put your mind at ease. And having a strong social network overall may help you live longer.

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It’s okay (and safe) to seek help

“I don’t want women to suffer from menopause symptoms because they are afraid of something,” says Hunter. Many women shy away from seeing their HCP for fear that hormone therapies will cause breast cancer or other issues.

“Breast cancer is so prevalent in our society that the risk alone from hormone replacement therapy is small compared to the baseline risk of breast cancer,” Hunter says.

Quality of life is very important now, as it always is. Hunter urges women to talk with their OBGYNs during perimenopause and menopause.

Sources:

North American Menopause Society. “Natural Remedies for Hot Flashes.” 2021. Accessed April 20, 2021.
North American Menopause Society. “How Do I Know When I’m in Menopause.” 2021. Accessed April 20, 2021.
National Center for Complementary and Integrative Health. “Menopausal Symptoms: In Depth.” May 2017. Accessed April 20, 2021.
Mayo Clinic. “Perimenopause.” May 7, 2019. Accessed April 20, 2021.
American Heart Association. “Menopause and Heart Disease.” July 31, 2015. Accessed April 20, 2021.
The American College of Obstetricians and Gynecologists. “Heavy Menstrual Bleeding.” April 2019. Accessed April 20, 2021.
HealthyWomen.org. “Heavy Periods.” September 2009. Accessed April 20, 2021.
Office on Women’s Health. “Menopause basics.” March 18, 2019. Accessed April 20, 2021.
UpToDate.com. “Clinical manifestations and diagnosis of menopause.” March 2021. Accessed April 20, 2021.
Office on Women’s Health. “Early or Premature Menopause.” May 22, 2019. Accessed April 20, 2021.
The American College of Obstetricians and Gynecologists. “The Menopause Years.” July 2020. Accessed April 20, 2021.
North American Menopause Society. “Hormone Therapy: Benefits & Risks.” 2021. Accessed April 20, 2021.
UpToDate.com. “Patient education: Calcium and vitamin D for bone health (Beyond the Basics).” March 2021. Accessed April 20, 2021.
The American College of Obstetricians and Gynecologists. “Perimenopausal Bleeding and Bleeding After Menopause.” October 2020. Accessed April 20, 2021.
North American Menopause Society. “Make Your Menopause a Positive Experience.” 2021. Accessed April 20, 2021.
Dan Buettner. “Power 9: Reverse Engineering Longevity.” Blue Zones. 2021. Accessed April 20, 2021.
Mayo Clinic. “Bleeding after menopause: Is it normal?” September 16, 2020. Accessed April 20, 2021.

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