.png)
Menopause
What is Menopause?
In simple terms, menopause is when a woman stops having periods. It is a bit of a misnomer as it is not a pause – it’s an end; the end of a woman’s reproductive life cycle.
Women are born with every egg they will ever release already stored in their ovaries. Throughout their lives, once they begin menstruating, they release one (or sometimes more than one) of these eggs every time they have a period. When there are no more eggs left, there is no need for a period, so it stops.
Sounds great, right? Many of us would love to “pause” our periods! Unfortunately, menopause is often not that simple, and can cause women all kinds of complications, ranging from heart disease to mental health crises. Combine this with the fact that it is one of the least researched areas of women’s health, and the result is a large majority of menopausal women being underdiagnosed, misdiagnosed, and left untreated.
Menopause happens in three stages: perimenopause, menopause, and postmenopause. “Menopause” itself is defined as beginning one year from a woman's last menstrual cycle. Before that, a woman can be “perimenopausal” – meaning she is in the transition phase. This phase usually begins between the ages of 45 and 55, and usually lasts about seven years (but can be as long as 14 years).
Surgery that removes your uterus but not your ovaries (hysterectomy) usually doesn't cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone.
Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures may still be desired. Radiation therapy only affects ovarian function if radiation is directed at the ovaries. Radiation therapy to other parts of the body, such as breast tissue or the head and neck, won't affect menopause.
Perimenopause can also happen to women who have had hysterectomies; surgery to remove the uterus and/or ovaries will cause a sudden stop in the production of estrogen and progesterone. If these hormones are not replaced, women in this situation will experience symptoms of menopause immediately.
What are the symptoms?
-
The most obvious symptom of perimenopause is an absence of or irregularity of menstruation. This correlates with a drop in the production of the hormones estrogen and progesterone, which can have all kinds of side effects. The transitional phase causes many women to also experience heavy periods, painful periods, hot flashes, chills, insomnia, incontinence, weight gain, headaches, heart palpitations, hair loss, memory lapse, depression and anxiety, and more.​
-
​There are also women who experience few to no symptoms beyond irregular periods. It’s very hard to predict how any individual’s body will react to hormonal changes.
How is it diagnosed?
Doctors can generally diagnose perimenopause and menopause by a patient’s age and symptoms. They can also conduct blood tests to measure estrogen and progesterone levels.
How is it treated?
Most treatments focus on managing symptoms with medications like painkillers, sleeping pills, and antidepressants. Lifestyle changes can help; exercising regularly, avoiding hot flash triggers, and eating a healthy diet are just a few examples.
Hormone Therapy (HT) is also an option. Estrogen can be taken alone as a pill or in several topical forms. However, Estrogen Therapy (ET) increases a woman’s risk of endometrial cancer, so this treatment is usually only prescribed to women who no longer have uteruses.
Estrogen Progesterone/Progestin Hormone Therapy (EPT), also called combination therapy, can be taken via pill, patch, or vaginal insert.
However, HT comes with health risks, including an increased risk of blood clots, deep vein thrombosis, and pulmonary embolism, increased risk of stroke. Increased risk of gallbladder/gallstone problems, increased risk of breast cancer with long term use, and an increased risk of dementia if started later in life (interestingly, HT started in middle age is associated with a reduced risk of Alzheimer’s disease and dementia). These risks are lower if you start HT within 10 years of menopause.
Hot flashes and night sweats have also been connected to an increased risk of cardiovascular disease. For all these reasons, starting HT should be a well thought-through decision made with your doctor.
Data, statistics, and research
According to Let’s Talk Menopause, there are currently 50 million women in the U.S. between the ages of 42 and 58, the typical age group that experiences menopause. Overall, 75 million women are in perimenopause, menopause and postmenopausal. Of this group, 85% report experiencing menopause-related symptoms, and yet, 75 percent who seek care are left untreated by their doctors.
Menopause symptoms vary across racial and ethnic populations and by socioeconomic background. For example, the SWAN study found that hot flashes are more intense and more frequent for some races. It saw major differences in cardiovascular health among racial and ethnic groups. Black women are also more likely than White women to undergo hysterectomies, which sometimes include oophorectomies (surgery to remove the ovaries). Oophorectomies can bring on menopause symptoms earlier.
