Could you please explain the changes a woman experiences when she experiences the onset of menopause to its completion?

— Approaching

Dear Approaching,

To answer a question fully, it’s usually good to start at the beginning: The onset of menopause, referred to as perimenopause, typically starts for most women in their 40’s. Perimenopause is characterized by a gradual change in the menstrual cycle, which can include more frequent periods, skipped periods, or those that are more spaced widely apart. Once the ovaries stop producing eggs and ovulation ceases, there isn't a need for the menstrual lining to build up each month. As such, you'll stop getting your menstrual period. Health care providers classify menopause as beginning twelve months following the last menstrual period. In the United States, the average age menopause begins is at 51 years old. While there are a number of symptoms associated with menopause, there are also several ways, both medical and non-medical, to address them.

During menopause, both physical and psychological changes occur due to the reduction in estrogen production by the ovaries. The physical changes that accompany menopause include: 

  • Hot flashes
  • Night sweats
  • Changes in sexual desire
  • Frequent urination
  • Thinning hair
  • Irritability
  • Sleep difficulties
  • Skin dryness
  • Vaginal dryness
  • Reduction in vaginal elasticity
  • Metabolism slows down

In addition to these physical changes, menopause can increase the risk for certain health conditions as well. Bones lose calcium more rapidly during menopause, which can lead to an increase in bone brittleness, and as estrogen normally functions to maintain bone mass, reduced estrogen can lead to a decrease in bone density. As such, osteoporosis is of concern for those experiencing menopause. Cardiovascular disease risk also increases as estrogen production decreases. Due to the loss of vaginal and urethral elasticity, some may experience urinary incontinence and more frequent urinary tract infections.

Approximately 70 percent of menopausal women experience hot flashes and night sweats that can intermittently occur over a two to five year period of time. Some of the most common psychological symptoms of menopause are anxiety, loss of concentration, and depression. These symptoms are probably due to a combination of reduced estrogen and a reaction to the physical symptoms. For example, night sweats impede sleep, which can result in fatigue, headaches, and irritability. Also, these symptoms can be made more intense by life changes that may be occurring around the same time, such as shifts in family, lifestyle, or retirement status.

Medical approaches to menopause typically involve medications to increase estrogen (i.e., hormone replacement therapy), to decrease the experience of hot flashes (e.g., low-dose anti-depressants), and to reduce and prevent osteoporosis. Above and beyond medications, many common healthy lifestyle behaviors are recommended as a means of at-home menopause management (i.e., eating a healthy diet, getting regular exercise, not smoking, and getting plenty of rest). Dressing for comfort to accommodate any hot flashes and determining any possible hot flash triggers is also recommended. Over-the-counter vaginal lubricants or moisturizers may help treat discomfort associated with vaginal dryness and Kegel exercises may strengthen the pelvic floor and stave off urinary incontinence.  

While menopause is a natural part of aging, it’s also good to note that if a woman has undergone a total hysterectomy (removal of uterus and ovaries), chemotherapy or radiation therapy, or has a genetic or autoimmune condition that causes what is called primary ovarian insufficiency, she would experience menopause symptoms as well. For more information regarding menopause, check out the National Women's Health Network website or Our Bodies, Ourselves.


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