What is menopause?
Menopause is the stage in a woman’s life when her menstrual periods end, typically in her late 40s to early 50s. Technically, a woman is only “in menopause” for one day, exactly one year from her last period. The time leading up to menopause is perimenopause and after that, a woman is considered postmenopausal.
Menopause signifies that the ovaries are no longer releasing eggs and have dramatically slowed hormone production of estrogen and progesterone. Testosterone also declines during this time.
The natural process of perimenopause is a slow progression leading to menopause. However, a woman of any age who undergoes removal surgery or experiences damage to her ovaries can find herself in menopause much more suddenly. Entering menopause due to surgery typically involves a hysterectomy—surgical removal of all or part of the uterus—which frequently includes removal of the fallopian tubes and ovaries (also known as an oophorectomy).
It is estimated that about 6,000 women in the United States reach menopause every day, which is about 1.3 million women per year. Many women spend three decades or more of their lives postmenopausal.
About Menopause
What are common symptoms of menopause?
Menopause symptoms can range widely, as no two people enter menopause the same way. Some women simply become aware of menstrual irregularity and/or subtle changes in how they think or feel. Others may experience more noticeable symptoms at varying degrees and lengths of time. For example, more than two-thirds of North American women get hot flashes, but some experience them for only a year or two, while others may have them for a decade or more.
Certain symptoms are frequently associated with the hormonal changes that occur as the body transitions from the reproductive years to the non-reproductive phase of life.
Menopause symptoms can include:
- Hot flashes – A brief sensation of heat that comes on suddenly, sometimes with facial flushing and sweating. Triggers may include hot weather, caffeine, nicotine, alcohol, spicy foods, tight clothing, and stress.
- Night sweats – Hot flashes that occur during sleep.
- Trouble sleeping – Hormonal dysregulation, central nervous system imbalances, and circadian rhythm interruptions may all interrupt rest.
- Bladder control problems – Including leakage when coughing or sneezing, urgency, or increasing frequency.
- Vaginal dryness – Vaginal tissue can become dry and damaged when it lacks proper lubrication and elasticity, which can cause discomfort during sex.
- Dry skin – Often connected to loss of estrogen and aging.
- Emotional changes – Mood swings and feelings of depression, anxiety, lack of motivation, irritability, and anger tend to be most common during perimenopause and early postmenopause.
- Facial hair growth– Unwanted hair on the upper lip, chin, and jawline.
- Difficulty concentrating and minor memory problems – Changes in sleep quality and hormonal signaling impact cognition.
- Lower sex drive – Vaginal changes can affect intimacy comfort, and lower testosterone levels may impact desire for sex.
- Bone loss – Increased risk after menopause
- Frozen shoulder – Inflammation and tissue changes that affect the shoulder capsule
- Other symptoms – Some women also experience headaches, rapid heartbeat, joint and muscle aches, weight gain, and hair loss.
What causes menopause?
Menopause is not a disease — it’s a natural process. Women are born with all the eggs they will ever have. A woman may start with 1 to 3 million eggs, but they age and expire over time. At menopause, women may have only 10,000 remaining, and these eggs may not be as healthy as they once were. Meanwhile, as the ovaries age, they produce less estrogen and progesterone—the two key hormones that regulate the female reproductive system.
This natural decline in hormone production and cessation of egg release signals an end to fertility that can affect overall health.
Estrogen affects many parts of the body besides the uterus, including the blood vessels, heart, bone, breasts, urinary system, skin, and brain. Healthy estrogen levels keep the organs and systems functioning at their best, so its decline is often at the root of many menopause symptoms. During menopause, the ovaries also decrease their production of progesterone and testosterone — a hormone involved with sex drive, and the most abundantly active hormone in the female body.
How is menopause diagnosed?
The first step in diagnosing menopause is to have a discussion with a healthcare provider. If other causes have been ruled out, a woman over the age of 45 who has gone a full year without a period is often diagnosed with menopause. For many women experiencing typical menstrual cycle changes and symptoms, additional lab testing isn’t necessary.
Blood tests are available that measure important biomarkers: follicle-stimulating hormone (FSH) — a hormone produced by the pituitary gland and a key player in preparing the body for pregnancy — and anti-mullerian hormone (AMH). FSH and AMH can help provide an indirect or direct measure of ovarian reserve, respectively. However, timing blood draws can be challenging because FSH can vary widely over the menstrual cycle.
AMH levels decline as menopause approaches, making it a useful predictive test, but oral contraceptives can affect these levels, therefore making them less reliable as diagnostic tools. Testing estradiol levels to determine menopause staging can be misleading, especially early in menopause when hormone levels might still be rising and falling irregularly.
Therapies
Many women find that hormone replacement therapy (HRT) for menopause is an ideal way to get relief from life-disrupting symptoms. Additionally, there are potential long-term protective health benefits from HRT that include supporting bone health, cardiovascular health, and cognitive function for many years after menopause (postmenopause).
Commonly prescribed hormone replacement therapies for menopause are different forms of estrogen: estradiol, estriol, or biest, which is a combination of estradiol and estriol. Progesterone, testosterone, pregnenolone, and DHEA may also be recommended based on individual menopausal symptoms.
Belmar Pharmacy compounds bioidentical hormones in a variety of dosage forms, strengths and combinations to help women feel more like themselves again. Bioidentical hormones are chemically and molecularly identical to the hormones the body makes naturally, making them readily available for the body to absorb and use.
Available dosage forms of Belmar’s bioidentical hormone replacement therapy (BHRT) include injectable pellets, oral and sublingual tablets, capsules, injectables, vaginal suppositories, and topical creams. Belmar also compounds medications designed to target specific issues many women face during menopause, including hair loss, dry skin, vaginal dryness, and low sex drive.
Commonly Asked Menopause Questions
Menopause is actually just one day in a woman’s life that marks 12 consecutive months without a period. The time leading up to menopause is perimenopause, and the rest of a woman’s life beyond menopause, is postmenopause.
Some of the most common symptoms of menopause include hot flashes, night sweats, insomnia, joint pain, weight gain (especially around the belly), brain fog, fatigue, and vaginal dryness/painful sex.
Hot flashes can temporarily be relieved by making lifestyle adjustments, such as controlling room temperature at night, dressing in layers, and avoiding triggers like caffeine and alcohol. However, to address hot flashes long term, in perimenopause, menopause, and postmenopause, women may want to consider bioidentical hormone replacement therapy (BHRT). Personalized BHRT may help address the root causes of hot flashes, which during perimenopause is often due to sporadic hormonal changes.
BHRT offers hormonal support when ovarian production of hormones is declining (during perimenopause) or stopped (after menopause). Bioidentical hormone replacement therapy with compounded dosage forms of estradiol, progesterone, or testosterone can help women manage menopausal symptoms. Providing symptom relief by addressing downstream effects of hormonal changes is not the same as delaying or prolonging menopause. Menopause is a biologic event that cannot be changed by the presence of HRT.
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