Menopause is a term used to mark the end of a woman’s menstrual cycles. It’s a completely natural process, but taboo and confusion around the topic can make the experience harder for women. Understanding what happens in menopause, as well as common symptoms and treatments, can help you better support your body in midlife and beyond.
“Many women don’t feel like they have good knowledge of menopause. We often spend so much time focusing on the reproductive years that menopause is pushed under the rug,” said Heather Wahl, MD, FACOG, NCMP, a gynecologist with ProMedica Physicians Pelvic Health. “But every woman, if she lives long enough, is going to go through menopause. We need to change the way we view menopause, especially since most women will be spending a fair amount of time in it.”
As a certified menopause practitioner through The North American Menopause Society (NAMS), Dr. Wahl has a special interest in helping women in menopause. It all starts with helping them understand what it actually is.
What is menopause?
“There is no test to date that can tell with certainty when a woman will go through menopause,” explained Dr. Wahl. “Menopause is defined as going 12 months without a menstrual period.”
The average age for menopause in the United States is 50-52 years old, but it can happen when a woman is in her 40s. The transition into menopause can be harder to spot for women who are actively using birth control. Specialists like Dr. Wahl may recommend stopping birth control use around 50 years of age to see what happens with the woman’s natural menstrual cycle.
For women who have had a hysterectomy, it can be helpful to check the woman’s hormones since they don’t have a regular period. Otherwise, hormone tests aren’t necessary as hormones can fluctuate so much from one month to another.
What are the signs and symptoms of menopause?
Some women may experience signs and symptoms in the months or years leading to menopause. This is called perimenopause. These symptoms may fluctuate and become more pronounced after menopause. Some women may not experience symptoms until menopause occurs.
Here are some of the common signs of perimenopause and menopause:
- Irregular periods: Extended intervals between menstrual cycles or more than one period per month.
- Vasomotor symptoms: Hot flashes and night sweats, which may contribute to sleep problems.
- Vaginal dryness: Loss of vaginal secretions, which may cause vaginal infections or painful sex.
- Hair and nail changes: Thinning hair or hair loss.
- Breast changes: Loss of breast fullness or enlargement of breasts.
- Weight gain: Despite usual activity and diet.
“Women experiencing these symptoms need to be aware that until they go through menopause, they can still get pregnant,” said Dr. Wahl. “Until you are menopausal, it’s still possible.”
What treatments help women cope with menopause symptoms?
Not every woman has significant signs or symptoms during menopause. But there are treatments available when symptoms interfere with daily life. These treatments are individualized, based on a woman’s symptoms.
Hormone Replacement Therapy
“Hormone replacement therapy is designed to treat vasomotor symptoms like hot flashes and night sweats, and only vasomotor symptoms,” explained Dr. Wahl. “Not every patient will be a candidate and it’s meant for a limited time frame.”
Although use in early menopause may have heart protective benefits, extended use and use after age 65 may increase risks for thrombotic events and dementia. Working with a certified menopause provider is key because they can discuss the risks and benefits, and make sure you’re on the lowest possible dose to relieve symptoms. They can also help you find the right type of hormone replacement therapy.
“There are bioidentical FDA-approved hormone therapy options, which have the same hormones your body would naturally create,” explained Dr. Wahl. “Compounded hormone therapy is not recommended by the NAMS because they aren’t regulated, and doses may vary with each refill. They may also contain unnecessary additional hormones.”
Pelvic Floor Physical Therapy and Topical Treatments
For women experiencing vaginal dryness due to the loss of estrogen, lubrication and vaginal moisturizers may be helpful. Lubrication is used during sex, while moisturizers are nonhormonal topicals that are used regularly (not during sex). For those with moderate to severe dryness, prescription options and hormonal options (e.g., vaginal estrogens) may be recommended.
Pelvic pain can sometimes be related to vaginal tissue changes, but sometimes the muscles themselves can be painful after menopause. Pelvic floor physical therapy can help improve the control, support and endurance of pelvic floor muscles to relieve pain and improve coordination.
Where can I find more information about menopause?
Understanding menopause can help make the transition less confusing and scary, so you know what to expect and what treatment options are available if needed.
“We shouldn’t fear aging,” said Dr. Wahl. “You can and should enjoy aging.”