By Kelly Evans Hullinger
MD
Menopause is one of those things that, let’s face it, will ultimately affect everyone with previously functional ovaries. Unfortunately we don’t talk about it enough, which makes it a topic riddled with misinformation. So… what is menopause?
Menopause is defined by the permanent cessation of menstrual bleeding for 12 months. This occurs naturally when the ovaries stop reproductive activity and a marked decrease in ovarian hormones (estrogen and progesterone) occurs. Symptoms of menopause are a result of these hormonal changes.
Most women enter menopause “naturally,” or just due to aging. The average age of menopause in North America is 51 years, but that can vary by up to 8-10 years on either side. However, menopause can also occur when the ovaries are surgically removed or if a patient needs to take a medication that affects ovarian hormone secretion, for example certain therapies for breast cancer.
Perimenopause refers to the phase, often lasting 1-2 years, before complete cessation of menses in which a person is likely to experience irregularities in menstrual periods (shorter or longer intervals, lighter or heavier bleeding) and sometimes the start of menopausal symptoms like hot flushes. Some patients will experience problematic or heavy perimenopausal bleeding that warrants medical or surgical treatment.
It is worth noting that laboratory testing is not recommended to diagnose menopause in a patient of typical age range with expected menopausal symptoms. In some cases, especially if a patient is younger than expected, limited testing is warranted to rule out other conditions including pregnancy and thyroid disorders.
Some fortunate women experience no significant symptoms of menopause, but the majority will. The most common symptoms of menopause are the infamous vasomotor symptoms (hot flashes and night sweats) and urogenital symptoms (vaginal dryness and sexual dysfunction). The average duration of vasomotor symptoms after menopause is about 7 years, but approximately 10% of women have symptoms lasting more than 10 years.
Decisions around various options for treatment for these symptoms is highly individualized and depends on how symptoms are affecting a given patient’s quality of life. Treatment, if warranted, can involve hormonal therapy (replacing estrogen is the most effective way to reduce hot flashes) or various non-hormonal options. This choice necessitates a conversation about an individual’s symptom severity and that patient’s risk of hormonal therapy, including breast cancer, blood clots, and cardiovascular events.
In summary, menopause is indeed a part of life. However, if you are really suffering with symptoms of menopause, it is worthwhile to talk to your healthcare provider about potential treatment for your symptoms.