During midlife, a woman’s menstrual periods occur further and further apart and eventually stop, marking the end of a woman’s reproductive years. This time is called menopause, and many know this end to monthly periods as “the change of life.” A woman reaches menopause when she has not had a menstrual period for one year, and many women experience a variety of symptoms as they go through this change.
Menopause is a normal part of aging caused by a decrease in the ovaries’ production of estrogen and progesterone, the reproductive hormones that regulate menstrual cycles.
“As a woman you’re born with the amount of eggs that you will have for a lifetime,” said Amanda Ricker, FNP-C, CNM, a specialist Glen Meade Center for Women’s Health - NHRMC Physician Group. “As you go through your life span and those eggs decrease, your hormones decrease as well.”
Ricker said the average age of menopause is about 52. Aside from naturally occurring with age, menopause can also have other causes such as surgical procedures that remove a woman’s ovaries; cancer therapies like chemotherapy and radiation, or failure of one’s ovaries to produce normal levels of reproductive hormones.
Hot Flashes and Other Symptoms
Perimenopause, the time during which a woman’s body makes the natural transition to menopause, can begin several years before menopause. During perimenopause women may see changes or irregularities in their periods. They can become shorter or longer, lighter or heavier, and have more time or less time in between their occurrences.
Ricker said the age of onset for perimenopause varies but is typically 10 years before menopause. Many women may start to experience perimenopause in their 40s.
“With perimenopause you can have an early and late phase,” said Ricker. “The early phase typically consists of irregularities in your periods, such as change in your menstrual cycle length of more than seven days or in the later phase you may have intervals of 60 days or more between your periods. You are more likely to have symptoms such as hot flashes and night sweats when you get to that late perimenopausal phase."
Ricker said as hormone levels fluctuate and change, women can experience a variety of symptoms during perimenopause and menopause.
“Hot flashes tend to be one of the most bothersome symptoms that women seek care for,” said Ricker. “They occur most likely during that late perimenopausal period and into the early years of menopause, and then they can get better. However, there is a certain number of women for whom those hot flashes will just continue.”
For women experiencing ongoing hot flashes, according to the National Institutes of Health some tips for managing this symptom include: wear light clothing, keep your room cool, use a fan, drink cold water, avoid smoking, caffeine, spicy foods, and alcohol, maintain a healthy weight, take several slow and deep breaths when you feel a hot flash coming on and ask your doctor about medicines that can help.
Some other symptoms women can experience include:
- Vaginal dryness
- Brain fog
- Trouble sleeping
- Night sweats
- Mood swings
- Trouble focusing
- Pain during sexual intercourse
- Hair loss
“Symptoms of vaginal dryness and changes in the vaginal tissues tend to happen later in menopause,” said Ricker. “Those are things we start to see seven to 10 years after menopause.”
For some women, symptoms are mild and go away on their own, but others may need to seek treatment for symptom relief.
Women with concerns about their symptoms should speak with their providers.
“There’s a range of treatment options available for each symptom,” said Ricker. “We consider each patient’s symptoms, goals and personal risks. I think some women are sometimes hesitant to consider certain things because they have heard different risks or concerns, but treatments are very individualized. If you are having symptoms, it’s worth considering all of the different options based on your specific risk factors and goals for therapy.”
For some women experiencing perimenopause, treatment may focus on addressing menstrual bleeding.
“That perimenopausal stage is where we have a lot of fluctuations in bleeding patterns, and a lot of times women will have very unpredictable or irregular bleeding,” said Ricker. “Therefore, we consider ways to control the bleeding, such as potentially using low dose birth control pills, IUDs, and other ways to help control menstrual bleeding.”
Hormone therapy, which involves replacing estrogen and progesterone, is one treatment option for hot flashes and some other symptoms. Ricker said while this type of therapy is effective it comes with risks and is not appropriate for everyone.
“We use the lowest dose amount that’s effective for symptom relief,” said Ricker, adding the treatment can be administered various ways, including orally, through a patch or a vaginal ring.
Dr. H. Kyle Rhodes, MD, FACOG, of Glen Meade Center for Women’s Health - NHRMC Physician Group offers some patients the treatment option of estrogen and testosterone pellets, another form of hormone replacement therapy that consists of administering hormones via small pellets implanted under the skin.
Other treatment options used for hot flashes include prescriptions typically used as antidepressants and other medications.
“For vaginal dryness—there are vaginal moisturizers, lubricants, and estrogen therapy that we can put directly into the vagina that doesn’t have the same risk concerns like a systemic hormone therapy,” said Ricker.
Ricker said vaginal estrogen is also an effective treatment for painful intercourse.
“We can typically help women who have painful intercourse associated with menopause, and I think many women are hesitant to ask about that type of help,” said Ricker. “Vaginal estrogen is very low risk, and it works fabulously,” she said.
Not all women experience menopause the same way. Seek guidance from your provider if you need help navigating changes that occur with perimenopause and menopause.
For more information or to schedule an appointment, call 910.763.9833 or visit www.nhrmcphysiciangroup.org.