Menopause

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Menopause is a natural biological process and a normal part of life. It occurs when a woman’s periods eventually stop and the body goes through changes that no longer allow her to get pregnant. Although it ends fertility, you can stay healthy and sexually active through this process. Learning more about menopause can help you better navigate this life transition.

This section contains information to help you understand menopause, as well as the many symptoms associated with it. Menopause itself requires no medical treatment however different forms of therapy are available to relieve bothersome symptoms. Our Tips to Manage Menopause page lists some simple lifestyle changes that can help reduce symptoms and provide relief. Alternatively, there are medical treatments available, such as hormone therapy, which can also help if lifestyle adjustments are not enough.

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Each woman’s experience of menopause is unique. While some women report no physical changes in the months or years leading up to menopause (known as perimenopause) except irregular periods that stop when menopause is reached, others might also experience the following symptoms:

  • Hot flashes: These are sudden feelings of heat all over or in the upper part of your body. According to the North American Menopause Society , hot flashes are the most common menopause-related discomfort.
  • Vaginal dryness: Changing estrogen levels can lead to drier and thinner vaginal tissue, which can make sex uncomfortable.
  • Sleep problems: Trouble sleeping through the night is another common symptom of menopause. This may possibly be caused by night sweats.
  • Urinary problems: During menopause, you may have urinary tract infections or experience urinary incontinence.
  • Mood changes: Menopause can sometimes be accompanied by mood changes. You may have mood swings, feel irritable or cry more often.
  • Weight gain and slowed metabolism: Menopause can result in you losing muscle, gaining fat, and having a larger waist.
  • Other body changes: This may include thinning hair, dry skin, or achy joints and muscles.
  • Memory problems: Menopause may also cause forgetfulness or trouble focusing.

Starting at perimenopause, schedule regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause.

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Tests typically aren't needed to diagnose menopause. Signs and symptoms of menopause are usually enough to let most women know that they've started the menopausal transition. But in some cases, your doctor may recommend blood tests to check your level of:

  • Follicle-stimulating hormone (FSH) and estrogen (estradiol), because your FSH levels increase and estradiol levels decrease as menopause occurs
  • Thyroid-stimulating hormone (TSH), as hypothyroidism can cause symptoms similar to those of menopause
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Menopause is a natural biological process and a normal part of life. It occurs when a woman’s periods (menstruation) eventually stop and the body goes through changes that no longer allow her to get pregnant. Usually, menopause occurs between the ages of 45 and 55, but in a few exceptional cases women may become menopausal in their 30s or even younger.

During menopause, a woman's ovaries gradually stop producing eggs for fertilisation. At this time, lower levels of reproductive hormones (known as estrogen) are produced and released, causing the body to behave differently. However the process can take several years during which symptoms, such as irregular periods and hot flashes, may arise. This gradual change is called perimenopause and ends one year after a woman’s final menstrual period. After a full year without a period, menopause is complete.

Certain factors can influence the timing of natural menopause. Smoking, for example, has been shown to lead to early menopause. Some medical treatments can also end a woman’s menstrual periods, particularly surgical removal of both ovaries or cancer treatments such as chemotherapy and pelvic radiation.

Health complications associated with menopause

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

  • Osteoporosis: Every day, your body is busy breaking down old bone and replacing it with new healthy bone. Estrogen helps control bone loss, and the reduction of estrogen after menopause causes women to lose more bone than is replaced. This increases the risk of osteoporosis, a condition that causes bones to become brittle and weak, leading to an increased likelihood of fractures. Postmenopausal women with osteoporosis are especially susceptible to fractures of their hips, wrists and spine.
  • Heart disease: When your estrogen levels decline, your risk of cardiovascular disease increases. As you age, you may also gain weight and develop other problems linked with heart disease, like high blood pressure. It’s important to ask your doctor for advice on how to protect your heart, such as safe ways to get regular exercise, as well as tips on eating healthily and maintaining a normal weight.
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Fortunately, many bothersome symptoms associated with menopause are temporary. Making simple lifestyle changes can help reduce symptoms and provide relief. Some tips to try include:

  • Keep a hot flash diary: Using a diary to keep track of when hot flashes occur allows you to pinpoint what triggers your hot flashes so you can then avoid these triggers. For many women, triggers may include hot beverages, caffeine, spicy foods, alcohol, stress, hot weather and even a warm room.
  • Dress in layers: To cool hot flashes, dress in layers that you can take off if you get too warm and choose clothing that let your skin "breathe".
  • Sleep in a cool room: If night sweats wake you, sleep in a cool room or with a fan on.
  • Get enough sleep: Avoid caffeine and drinking too much alcohol, as these are both stimulants and can interrupt sleep. Create a routine where you go to bed and wake up at the same time every day. Physical activity can also promote good sleep, although make sure to exercise during the day and not right before bedtime.
  • Use products to decrease vaginal discomfort: Over-the-counter, water-based vaginal lubricants or moisturisers can help keep moisture in your vagina and make sex more comfortable.
  • Strengthen your pelvic floor: Pelvic floor muscle exercises, known as Kegel exercises, can improve some forms of urinary incontinence.
  • Review your diet: The drop in hormone levels that accompanies menopause can increase the risk of heart disease and osteoporosis. A healthy diet can lower your risk of developing these diseases. Make sure your diet is low in saturated fat and salt to reduce blood pressure, and rich in calcium and vitamin D to strengthen bones. Ask your doctor if you need calcium or Vitamin D supplements to help meet daily requirements.
  • Quit smoking: Smoking has been shown to lead to earlier menopause and trigger hot flashes. If you smoke you also run a higher risk of developing osteoporosis, heart disease, and a range of other health problems.
  • Exercise regularly: Be physically active on most days to help protect against heart disease, diabetes, osteoporosis and other conditions associated with aging.
  • Learn relaxation techniques: Discover new ways to deal with stress so you are better able to manage mood swings. Techniques such as deep breathing, guided imagery and progressive muscle relaxation can help relieve menopausal symptoms.

You could also talk to your doctor about whether there are medications and other forms of treatment to help you manage symptoms of menopause. 

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Menopause itself requires no medical treatment however different forms of therapy are available to relieve symptoms. Treatment may also be used to manage chronic conditions that can occur alongside menopause. These include:

  • Hormone therapy: If you are bothered by symptoms like hot flashes, night sweats or vaginal dryness, your doctor might suggest taking estrogen and progesterone to provide symptom relief for you. Taking these hormones may also slow bone loss that can happen at menopause. Hormone therapy has risks and for some women it can increase their likelihood of getting blood clots, heart attack, stroke, breast cancer and gall bladder disease. The National Institute on Aging suggests that women should use the lowest dose of hormone therapy that works, for the shortest time it's needed.
  • Vaginal estrogen: Estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring. This treatment releases a low dose of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.   
  • Low-dose antidepressants: Certain antidepressants are used to treat hot flashes affecting menopausal women. They can also be prescribed to help with irritability, depression and moodiness. A low-dose antidepressant may be useful as a symptom treatment alternative for women who can't take estrogen for health reasons.
  • Medications for osteoporosis: Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures.

Before deciding on any form of treatment, it is important to discuss your options with your doctor, as well as the risks and benefits involved with each. 

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