Menopause

Perimenopause, or the menopausal transition, is the time leading up to your last period. Perimenopause means “around menopause.” Perimenopause is a long transition to menopause, or the time when your periods stop permanently and you can no longer get pregnant. As your body transitions to menopause, your hormone levels may change randomly, causing menopause symptoms unexpectedly. During this transition, your ovaries make different amounts of the hormones estrogen and progesterone than usual.

Irregular periods happen during this time because you may not ovulate every month. Your periods may be longer or shorter than usual. You might skip a few months or have unusually long or short menstrual cycles. Your period may be heavier or lighter than before. Many women also have hot flashes and other menopause symptoms during this transition.

Perimenopause, the transition to menopause, usually starts in a woman's mid- to late 40s. On average, women are in perimenopause for four years before their periods stop.

Symptoms of menopause may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time once they begin, or they may happen only once in a while. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome (PMS). Others may be new to you. For example:

• Your menstrual periods may not come as regularly as before. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.

• Your periods might be heavier or lighter than before.

• You might have hot flashes and problems sleeping.

• You might experience mood swings or be irritable.

• You might experience vaginal dryness. Sex may be uncomfortable or painful.

• You may have less interest in sex. It may take longer for you to get aroused.

Other possible changes are not as noticeable. For example, you might begin to lose bone density because you have less estrogen. This can lead to osteoporosis, a condition that causes bones to become weak and break easily. Changing estrogen levels can also raise cholesterol levels and increase your risk for heart disease and stroke.

Perimenopause, the transition to menopause, can last between two and eight years before your periods stop permanently. For most women, this transition to menopause lasts about four years. You will know you have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.

After menopause you will no longer be able to get pregnant and you will no longer get a period. If you have any type of vaginal bleeding after menopause, you should see a doctor as soon as possible. Vaginal bleeding after menopause is not normal and can mean that you have a serious health problem.

You may experience any of the following after menopause:

• Low hormone levels. With menopause, your ovaries make very little of the hormones estrogen and progesterone. Because of changing hormone levels, you may develop certain health risks, including osteoporosis, heart disease, and stroke.

• Menopause symptoms instead of period problems. After menopause, most women get relief from period problems or menopause symptoms. However, you may still experience symptoms such as hot flashes because of changing estrogen levels. One recent study found that hot flashes can continue for up to 14 years after menopause.

Vaginal dryness. Vaginal dryness may be more common post-menopause.

After menopause, your ovaries make very little estrogen. Women who have gone through menopause have very low estrogen levels. Low levels of estrogen and progesterone raise your risk for certain health problems after menopause. Other health problems may happen naturally as you age.

Examples of common health problems in the years after menopause include:

• Heart disease. Before age 55, women have a lower risk of heart disease than men. Estrogen helps keep blood vessels relaxed and open and helps the body maintain a healthy balance of good and bad cholesterol. Without estrogen, cholesterol may start building up on artery walls leading to the heart. By age 70, women have about the same risk for heart disease as men of the same age.

• Stroke. Your risk for stroke doubles every decade after age 55. The lower levels of estrogen in your body may play a role in cholesterol build-up on artery walls leading to the brain.

• Osteoporosis. Having less estrogen after menopause causes you to lose bone mass much more quickly than you did before, which puts you at risk for osteoporosis. Osteoporosis is a condition that causes your bones to become brittle and weak and break easily. A recent large study found that women who have severe hot flashes and night sweats during the years around menopause usually have more bone loss and are at higher risk for hip fractures than women who do not have severe symptoms.

• Urinary incontinence. About half of postmenopausal women have trouble holding in their urine. Lower estrogen levels may weaken the urethra.

Maybe. Many women gain an average of 5 pounds after menopause. Lower estrogen levels may play a role in weight gain after menopause. But weight gain may be caused by your metabolism slowing down as you age. You may also not eat as healthy or be as active as when you were younger. You also lose muscle mass as you age (muscle burns more calories at rest than other types of tissue in the body). Weight gain can raise your risk for high blood pressure, cholesterol, diabetes, heart attack, and stroke. The risk is greater if you are already overweight or are not active or eating healthy.

The best way to lose weight, if you are overweight or obese, is to eat fewer calories each day. Exercise or physical activity is also important for good health, but works better to keep weight off than it does to help you lose weight. Researchers think this might be because people who are physically active are usually hungrier. Eating healthy and getting at least 30 minutes of exercise on most days is the best way to keep a healthy weight.

Menopausal hormone therapy is prescription medicine to help relieve your menopause symptoms, such as hot flashes and vaginal dryness, if they are severe enough to disrupt your daily life. Menopausal hormone therapy is sometimes called hormone therapy or hormone replacement therapy. During menopause, your ovaries make very low levels of the hormones estrogen and progesterone. Menopausal hormone therapy replaces some of the hormones no longer made by your ovaries with artificial estrogen and progesterone. Menopausal hormone therapy can help with hot flashes and other menopause symptoms. Like all medicines, menopausal hormone therapy has risks. If you decide to take it, use the lowest dose for the shortest time needed.

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