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Age at Menopause | Stages of Menopause | Menopause Symptoms | Surgical Menopause | Premature Menopause | Healthy Lifestyle for Menopause | Natural Menopause Treatments | Hormone Replacement Therapy | Non-HRT medications | Weight Gain | Sex and Menopause | Disease risk and Menopause | Second Spring
Menopause happens to every female who has been through puberty. There is so much you need to know about menopause to help your menopausal transition be as smooth as it can be. Remember how traversing puberty felt like you were flying by the seat of your pants because nobody bothered to fill you in on all the details. This guide distills the essentials down to 13 things every woman needs to know about menopause. Hopefully can get experience perimenopause empowered, with better managed symptoms and more confidence than you got through puberty.
Just to be clear, the menopause is a point in time 12 months after your final period. So you will only know you have experienced menopause in retrospect. Once you have experienced menopause you will no longer have a monthly menstrual cycle or menstrual periods.
1. What is the average age for menopause?
Approximately a third of women start experiencing perimenopause symptoms between 30 and 40 years, another third between 41-45 years and another third between 46 and 50 years. The age that your perimenopause starts is due interactions between factors such as lifestyle, environment, hormones and genetics.
The average age for menopause (or reaching that 12 month point after your final period) is age 51 years. Perimenopause symptoms can occur over a 4-10 year period. On average body composition changes begin around 8 years prior to menopause.
2. What are the 3 stages of menopause?
There are 3 stages of menopause.
Perimenopause: This is the transition period leading up to menopause. It typically begins when your periods become less regular, as you start to produce lower levels of estrogen. You may also experience hot flushes, night sweats and vaginal dryness.
Menopause: This is the point in time 12 months after your final period. Your ovaries stop releasing eggs due to reduction in estrogen. You no longer experience monthly hormonal cycles.
Post-Menopause: This is the stage after menopause where your body adjusts to lower hormonal levels.
3. Menopause symptoms
Menopause symptoms vary from person to person, but due to the fact that the female hormones; estrogen, progesterone and testosterone have effects in all the systems in the body, symptoms can be diverse.
Some women experience very few and only mild symptoms, but other women have extreme hormonal fluctuations and severe symptoms.
The most common symptoms of menopause include:
hot flushes
night sweats
fatigue
insomnia
changes in menstrual bleeding such as longer, heavier or shorter periods,
mental health effects such as depression, anxiety, and mood swings
decreased libido
urinary tract infections or urinary incontinence.
Managing menopausal symptoms can be achieved with menopausal hormone therapy, lifestyle health habits and natural hormone treatments such as herbs and supplements.
4. What is surgical menopause?
Surgical menopause is when the ovaries are removed by a surgeon or are damaged as part surgery such as when removing endometriosis. Surgical menopause can also occur after a hysterectomy, even if the ovaries remain in the body due to a disrupted blood supply to the ovaries.
Surgical menopause can cause an immediate drop in estrogen levels and can cause more severe menopausal symptoms such as hot flushes, fatigue, insomnia and joint pain without treatment.
All women undergoing pelvic surgery for oophorectomy (removal of ovaries), hysterectomy or surgery affecting the ovaries should be counselled about surgical menopause.
If women are younger than menopausal age, women should be provided with HRT to reduce negative risks to health.
5. What is premature menopause or primary ovarian insufficiency?
Primary ovarian insufficiency is when the ovaries stop working before the age of 40, resulting in a lower estrogen levels, irregular and subsequently absent periods. It is also called premature ovarian insufficiency or premature ovarian ageing.
It occurs in 1 percent of women under the age of 40 years. Symptoms are similar to those experienced during a natural menopause, only they are experienced earlier. Most women notice an irregular period.
It is diagnosed by measuring follicle stimulating hormone (FSH) and estradiol levels.
Women with primary ovarian insufficiency have higher risks of bone loss, heart disease, Alzheimer's and mood disorders so it is recommend that HRT is used as a minimum until age of expected menopause unless they have a medical reason they cannot use it.
6. Healthy lifestyle for menopause
Making some lifestyle changes during menopause can help alleviate many of the physical and emotional symptoms associated with this stage in life.
Menopause Exercise
Regular exercise can reduce hot flushes and night sweats as well as improve mood, sleep quality, muscle strength, joint flexibility and overall health. Weight bearing exercise is important for building strong bones such as dancing, walking, and running.
Resistance training, even if only with body weight such as squats, press-ups and triceps dips are important to stimulate maintenance of muscle tissue.
Some good mind-body exercise for menopause include yoga, Pilates and Tai Chi. These not only help strengthen the body but also support stress management.
Eating a balanced anti-inflammatory diet including plenty of fresh fruit and vegetables can help to alleviate the symptoms of menopause by improving your overall health.
Eating diverse fruit, vegetables, beans, chickpeas, seeds and nuts provides fiber to support gut health and also phytoestrogens to support your hormones. Eating a whole food diet reduces inflammation in the body which increases as the protective effects of hormones reduce.
Make sure you eat enough protein to try to limit muscle loss. Complex carbohydrates, are a good choice to minimize hormonal-driven weight gain.
Healthy fats such as olive oil and omega-3 fatty acids have anti-inflammatory effects on the body and brain.
Avoid processed foods and high-sugar foods as these can make the symptoms of menopause worse.
Menopause and Stress
Fluctuating hormone levels can mean you feel less resilient to coping with everyday stressors. Having healthy ways to manage stress is important to support both your mental health and to reduce your physical symptoms.
Unmanaged stress during menopause as it can make many of the symptoms worse. Take time for yourself, practice relaxation techniques such as yoga or meditation and try to get enough sleep. A healthy lifestyle including regular exercise and a balanced diet can also help reduce stress levels.
Menopause and Sleep
Insomnia is a common complaint during menopause due to the way estrogen affects the circadian rhythm. To help improve your sleep, make sure you get early morning sunshine, enough exercise during the day and try to avoid caffeine late in the evening.
You can also create a comfortable sleeping environment by keeping your bedroom dark and cool, avoiding screens before bedtime and ensuring that your mattress is supportive. Regular exercise during the day can help improve your sleep quality.
Caffeine and Alcohol with Menopause
Caffeine and alcohol can make many of the symptoms of menopause worse. Caffeine can worsen hot flushes and cause insomnia, while alcohol can contribute to anxiety, mood swings and insomnia. It is best to limit or avoid both caffeine and alcohol during menopause.
By making some simple lifestyle changes you can improve your menopause symptoms, such as hot flushes, fatigue, insomnia and joint pain.
Read more about the lifestyle medicine pillars for perimenopause and menopause here.
7. What are natural menopause treatments?
Natural treatments are an option for women who don’t want to use medical treatment or HRT for their menopause symptoms. Some natural therapies that can help include:
Herbal remedies typically involve phytoestrogen supplements from red clover, black cohosh, Siberian rhubarb and soy
Nutritional phytoestrogens found in foods such as soy products, nuts and seeds
Vitamin supplements such as Vitamin E and B6
Acupuncture to help reduce hot flushes, mood swings and insomnia
Lifestyle changes including eating a balanced diet, getting plenty of exercise and managing stress.
These natural treatments may not be suitable for all women, but for many women lifestyle and herbal or supplement support is all they need to feel great through menopause.
Hormone Replacement Therapy (HRT) is standard medical treatment for menopausal symptoms. It uses hormones to supplement the balance the fluctuations experienced during perimenopause. It is also known as menopause hormone therapy or MHT. It can be used alongside natural treatments and lifestyle changes to more effectively support women reduce their menopause symptoms.
According the North American Menopause Society 2022 Position statement:
Menopause hormone therapy is the most effective treatment for vasomotor symptoms (VMS) such as hot flashes, night sweats and heat intolerance and the genitourinary syndrome of menopause (GSM) and prevents bone loss and fracture.
The benefits of hormone replacement therapy outweigh the risks for most healthy women who are aged younger than 60 years and within 10 years of menopause (the year after their final period).
It is important to discuss the risks, benefits and costs of HRT with a medical professional before starting any form of treatment.
HRT can be continued beyond age 65 for persistent vasomotor symptoms, quality-of-life issues, or for the prevention of osteoporosis after conversations and counseling with your health provider regarding the benefits and risks.
Hormone therapy can come in a variety of forms including:
Combined estrogen/progestogen tablets
Estrogen patches, gels or creams
Utrogestan or natural progesterone
Mirena (form of progestogen)
Tibolone - steroid hormone that has estrogen, progesterone and testosterone effects.
Contraceptive pills
Women who have a uterus need to use both and estrogen and progesterone/progestogen.
Women who have had a hysterectomy only need estrogen but may use progesterone for sleep or treatment of anxiety symptoms.
It is recommended that women with a history of endometriosis continue to use progesterone after hysterectomy to minimise risk of stimulation of endometrial lesions by estrogen.
9. Non-HRT medications for menopause
Non-hormone based medications are also available for managing menopausal symptoms.
These include:
antidepressants,
antiseizure medicines and
other medications that can help with hot flushes and night sweats.
These medications are not as effective as hormonal therapy but can be important for women who cannot use HRT. They may be also prescribed in addition to HRT where additional symptom support is needed.
10. Menopause weight gain & metabolic changes
Menopause causes changes in metabolism This can lead to weight gain, particularly around the abdomen, and often known as menopause belly.
The reduced levels of estrogen during menopause affects your insulin levels, causing insulin resistance. This causes an increase in fat storage and a decrease in muscle mass and bone mass
To counteract the hormonal-driven menopause belly it is important to eat a whole food anti-inflammatory diet and do muscle resistance exercise regularly. It is also important to manage stress as high cortisol levels also contribute to increased energy storage.
Prioritizing protein, complex carbohydrates, fiber and healthy fats is a great way to eat to minimise body composition changes.
11. Sex and menopause
Menopause may affect your sex life. It is important to talk to your partner about any changes and look for ways to keep intimacy alive during menopause.
The changes in hormone levels can affect your mood, your tolerance levels and ability to cope with stressors. This can have a negative effect on your relationships. It's important to let your partner know how you are feeling and what they can do to support you.
The decline in estrogen levels can cause vaginal dryness, which can make sex uncomfortable. Using lubricants, moisturizers and topical hormone estrogen therapy can help make sex more pleasurable.
Changes in estrogen and testosterone can contribute to changes in female sexual desire (or libido). Both estrogen and testosterone hormonal therapy can support libido.
Often there are also relational and emotional factors that need addressing at the same time. You can get support from a doctor who works in psychosexual medicine or a sex therapist.
Learn more about Sexual Health Clinics in Dunedin.
12. Increased disease risk after menopause
After menopause, due to the reduction in the ovarian hormones estrogen, progesterone and testosterone, women are at an increased risk of some diseases. These include diseases such as:
osteopenia, osteoporosis and fractures,
sarcopenia
osteoarthritis
heart disease, and
insulin resistance which increases risk of type 2 diabetes.
To reduce your risk it is important to eat an abundance of phytonutrients via an anti-inflammatory diet, including adequate calcium intake. Get enough sunshine to support vitamin D production and exercise regularly.
It is also important to have regular health check ups, to maintain good metabolic health and participate in screening programs such as cervical screening and mammograms to detect cancer early.
If you notice new symptoms see your health provider to discuss your concerns.
13. Your second spring: a time for growth & development
Menopause can be a time of great change and newfound freedom, you no longer need to be concerned about preventing pregnancy, or being surprised by your period. In China, menopause is celebrated as a woman's second spring and in Northern Thailand it is celebrated with a menopause ceremony.
Western cultures places value on young women, so many women experiencing menopause feel like they are losing their youth and dislike their aging self.
Menopause is a time of rebirth into your new self. It is offers a window into our own mortality and is an opportunity to take stock of where you are in life, and to re-evaluate your values, meaning, goals and ambitions.
Embrace the change by looking after yourself both physically and mentally, staying active, creating meaningful relationships with your family and friends, and engaging in new adventures.
FAQ About Menopause
Can a woman have an orgasm after menopause?
Hell yes!, What kind of a question is that?
If you are having difficulties with sex during menopause, discuss it with your health professional.
Is bleeding after menopause a concern?
Your should see your health provider if you have bleeding after menopause.
The most common cause of bleeding is inflammation and thinning of the vaginal lining (atrophic vaginitis) or uterus (womb) lining (endometrial atrophy) – which is caused by low estrogen levels.
Cervical or womb polyps – growths, can also be a cause of bleeding. More serious conditions include endometrial hyperplasia and cancer so you should definitely get any post-menopausal bleeding checked out.
Look for signs such as:
less frequent periods
fewer and less severe mood swings
worsening vasomotor symptoms
more insomnia and difficulty with sleep.
Where can I get Menopause Support?
Tracking your perimenopause symptom patterns is a great place to start. Contact your health provider or menopause specialist/clinic to get personal advise and support.
As a menopause doctor, Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you through the perimenopause and menopausal stages of life, supporting all aspects of your health and wellbeing.
Dr Deb Brunt is a menopause specialist in New Zealand and Menopause health coaches internationally. She has a passion for supporting women adapt to their changing female physiology for optimum health so they are able to live their best life
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