Menopause

What is menopause?

Menopause is marked by the ending of a woman's menstrual cycle. A woman is considered menopausal after she has had 12 consecutive months without a period.

Menopause marks the end of a woman's reproductive period as the ovaries are no longer producing eggs(ova).

The average age of menopause in the US is 51.


What is premature menopause?

Menopause that occurs before the age of 40.


What is perimenopause or the menopause transition?

This refers to the time period leading up to menopause. A woman may experience changes in her menstrual cycle such as irregular periods, a change in the amount of bleeding she has each cycle, missed or absent periods. This transition may start as early as age 45 and last until about age 55.

Because the ovaries are still producing eggs (ovulation), it is possible for a woman to get pregnant during this period.


What factors may influence the menopausal transition?

  • Cigarette smoking and alcohol use.
  • History of chemotherapy or radiation.
  • Obesity - obese women may encounter menopause later. However, research shows that they tend to have more severe symptoms.
  • Mother`s age of menopause.
  • Race.
  • Menstrual cycle duration / frequency.
  • Exercise.
  • Diet.
  • Socioeconomic status.

What is surgical menopause?

Women who have their ovaries removed prior to the natural onset of menopause experience surgical menopause.


What are signs and or symptoms of menopause?

  • Hot flushes/ night sweats.
  • Sleep disturbances and fatigue which may cause mood changes.
  • Vaginal dryness which may contribute to pain during sex.
  • Hair growth .
  • Skin changes.
  • Changes in the genital area (Vulva and vagina – see picture).
  • Decreased sex drive (libido).



What happens during the transition?

There is a gradual decrease in the levels of estrogen and progesterone in the body which in turn impacts the menstrual cycle and the female urogenital system.. These hormonal disturbances in turn cause the symptoms associated with menopause.


What are hot flashes or night sweats?

These are spontaneous episodes of feeling very hot. They generally are not triggered by any specific activity and occur at any time. Some women tend to have more flushes at night. These episodes generally last a few seconds to minutes at a time.

They may leave the woman feeling flushed, sweaty and hot.

Hot flushes are also referred to as vasomotor symptoms (VMS).


Are hot flushes/night sweats dangerous?

Hot flushes are the most common complaint that women experience. They are not dangerous, however, they may interfere with a woman`s quality of life including sleep interruption. Poor sleep may lead to fatigue and mood changes.

Not every perimenopausal or postmenopausal woman will experience hot flashes or night sweats.


How long do these last?

A woman may have hot flashes anywhere from a few years up to approximately 10 years.


What other changes are associated with menopause?

  • The woman may notice a change in skin texture including dryness.
  • She may also notice she is growing hair on her chin and above her upper lip.
  • Her pubic hair will also thin out and the pubic fat will decrease.
  • Thinning labia and increased skin laxity.
  • Fatigue, decreased focus and memory as a result of inadequate sleep.
  • Women may experience an increase in urinary tract infections.

What is the impact of menopause?

  • A postmenopausal woman is no longer able to conceive or have children i.e. loss of fertility
  • Decreased bone strength increases risk of bone fractures.
  • Increase risk of heart disease.



    • Image Courtesy of Menopause Update: cdm.mdedge/obgm0320630_upate

  • Structural changes to the vagina and vulvar area such as:
    • Shortening of vagina.
    • Thinning or loss of pubic hair.
    • Loss of pubic fat and thinning of labia.
    • Decrease in size of vaginal opening.
    • Vaginal walls smoothen.
  • After menopause, a woman should not have any vaginal bleeding. Any bleeding no matter how slight or short, should prompt evaluation by a clinician.

What is GSM?

Genitourinary syndrome of menopause refers to changes in the female genitalia and urinary tract system secondary to menopause. Signs and symptoms include vaginal dryness, dry skin, irritation, pain with sex, urinary symptoms like increased urination, burning, infection and leaking urine.


References:

  1. Management of Menopausal Symptoms, Practice Bulletin 141. January 2014. "https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2014/01/management-of-menopausal-symptoms
  2. .“The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023 Jun 1;30(6):573-590. doi: 10.1097/GME.0000000000002200. PMID: 37252752.
  3. The Menopause Years. Patient Education. FAQs. ACOG. "https://www.acog.org/womens-health/faqs/the-menopause-years
  4. Vikram Talaulikar, Menopause transition: Physiology and symptoms, Best Practice & Research Clinical Obstetrics & Gynaecology. Volume 81, 2022. Pages 3-7.
  5. 2020 GSM position Statement."www.menopause.org