Women's Care of Western Pennsylvania

Menopause is the time in a woman's life when she stops having menstrual periods. The years leading up to this point are called perimenopause, or "around menopause." Menopause marks the end of the reproductive years that began in puberty.

The average age that women go through menopause is 51 years. Most women enjoy a healthy lifestyle for years afterward. This pamphlet explains:

• What to expect around menopause
• How to relieve symptoms of menopause
• How to stay healthy during this time

What Is Menopause?
The ovaries, two glands on either side of the uterus, make estrogen from puberty until menopause. Estrogen is made during the entire menstrual cycle. It causes the lining of the uterus (the endometrium) to thicken each month.

On about day 14 of your menstrual cycle, an egg is released from one of the ovaries. This is called ovulation. After ovulation, progesterone levels increase. If the egg is not fertilized, no pregnancy occurs. This causes the levels of estrogen and progesterone to decrease. This signals the uterus to shed its lining. This shedding is your monthly period.

As menopause nears, the ovaries make less estrogen. One of the earliest and most common signs that menopause may be approaching is a change in your menstrual periods. You may skip one or more periods. The amount of flow may become lighter or heavier. Bleeding may last a shorter or longer time than is usual for you.

Even though periods tend to be irregular around the time of menopause, you should be aware of bleeding that is not normal for you. This could be a sign of a problem. Talk to your doctor if you:

• Have a change in your monthly cycle
• Have very heavy bleeding with clots
• Have bleeding that lasts longer than normal
• Bleed more often than every 3 weeks
• Bleed after sex or between periods

At some point, the ovaries stop making enough estrogen to thicken the lining of the uterus. This is when the menstrual periods stop.

Menopause also can occur when a woman's ovaries are surgically removed. This may trigger severe symptoms because the hormone levels decrease all at once.

Although the removal of the uterus (a hysterectomy) ends menstrual periods, it will not cause menopause unless the ovaries also are removed. If the ovaries remain after surgery, most women will go through menopause around the normal age.

What to Expect
Menopause is a natural part of aging. The lower amounts of estrogen that come with menopause will cause changes in your body. These changes occur over time. Menopause is different for everyone. Some women notice little difference in their bodies. Others may find it difficult to cope with their symptoms.

Hot Flushes
The most common symptom of menopause is hot flushes (hot flashes). As many as 75% of menopausal women in the United States will have them. A hot flush is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush. You also may break out in a sweat. A hot flush may last from a few seconds to several minutes or longer.

Hot flushes can happen at any time—day or night. They can be mild or severe. Hot flushes may come a few times a month or several times a day, depending on the woman. Some women will have hot flushes for a few months, some for a few years, and some not at all. Even though hot flushes are a nuisance, are sometimes embarrassing, and may interfere with daily life, they are not harmful.

Sleep Problems
Hot flushes can cause a lack of sleep by often waking a woman from a deep sleep. A lack of sleep may be one of the biggest problems you face as you approach menopause. Too little sleep can affect your mood, health, and ability to cope with daily activities. Some women have less rapid eye movement—known as REM—sleep. This is the stage of sleep when you dream. REM sleep makes up about 20% of an adult's normal sleep cycle. Without it, you may wake up without feeling rested. Some women approaching menopause also may find it takes longer to get to sleep.

Vaginal and Urinary Tract Changes
Loss of estrogen causes changes in the vagina. Its lining may become thin and dry. These changes can cause pain during sexual intercourse. They also can make the vagina more prone to infection, which can cause burning and itching.

The urinary tract also changes with age. The urethra (the tube that carries urine from the bladder) can become dry, inflamed, or irritated. Some women may need to urinate more often. Women may have an increased risk of bladder infection after menopause.

Bone and Other Body Changes
Bone loss is a normal part of aging. At menopause, the rate of bone loss increases. Osteoporosis, which can result from this bone loss, increases the risk of breaking bones in older women. The bones of the hip, wrist, and spine are affected most often.

The estrogen produced by women's ovaries before menopause protects them from heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. The risk of heart attack and stroke then increases.

Emotional Changes
Menopause does not cause depression. However, the change in hormone levels may make you feel nervous, irritable, or very tired. These feelings may be linked to other symptoms of menopause, such as lack of sleep.

If you are under a lot of stress, the changes of menopause may be harder to manage. Many women in midlife are going through major life changes anyway. There may stress related to money or your job. Some women may be watching children leave home and are learning to deal with the "empty nest." Some are saddened that they can no longer have children. More often, women find themselves part of the "sandwich generation," becoming caregivers for their children, grandchildren, and their aging parents. If you find it hard to cope, talk about your feelings with your partner, a close friend, a counselor, or your doctor.

Sexuality
Menopause does not have to affect your ability to enjoy sex. Although the lack of estrogen may make the vagina dry, vaginal lubricants can help moisten the vagina and make sex more comfortable. There are a number of over-the-counter lubricants available. If you do not like one product, try another.

Regular sex may help the vagina keep its natural elasticity. If you have been having sex on a regular basis, you may not notice any major changes during menopause. If you have not been sexually active for a while, you may want to talk with your partner and perhaps your doctor, too, about ways to make sex more comfortable.

Some women find that they have less interest in sex around and after menopause. Lower hormone levels may decrease the sex drive. It may affect your ability to have an orgasm, or it may take longer for you to reach orgasm.

You are not completely free of the risk of pregnancy until 1 year after your last period. Until this time, if you do not wish to become pregnant, it is important to use a method of birth control. Keep in mind you still need to prevent sexually transmitted diseases. If you are at risk for sexually transmitted diseases, use a latex condom.

Men, too, may find that their sex drives decrease as they age. It may take an older man longer to achieve an erection and ejaculate, or he may have problems with impotence. Impotence usually is caused by physical or medical problems, or it may be caused by medications. In many cases, impotence can be treated with success.

The Gynecologic Visit
Routine health care, even if you are not sick, can help detect problems early. You should visit your doctor once a year to have regular exams and tests. Certain tests should be done regularly for all women in your age group.