Menopause

Natural menopause is when menses permanently cease because the ovaries stop producing estrogen and progesterone. It generally occurs in women after 45 years of age with no pathological or physiological cause, but early menopause can result from surgery, chemotherapy, radiotherapy, or primary ovarian insufficiency. Perimenopause is the transitional phase into menopause and may last between 4 to 8 years.^[1]

Hot flashes, night sweats, vaginal dryness, insomnia, trouble focusing, and mood swings are the primary symptoms women experience during the transition into and sometimes throughout menopause. Women can also experience changes in body composition. The main sign of menopause is a lack of menstruation.

Menopause is clinically diagnosed after 12 months of amenorrhea (lack of mentruation) without other causes, such as surgical removal of the ovaries, chemotherapy or radiotherapy, or primary ovarian insufficiency. It usually occurs after 45 years of age and is considered abnormal if it occurs prior to 40 years of age. Blood and urine tests can be conducted to detect changes in hormone levels.^[2]

For some women experiencing severe hot flashes, night sweats, and vaginal dryness, hormone replacement therapy (HRT) may be prescribed to relieve these symptoms. HRT comes in the form of pills, skin patches, vaginal creams, gels, and rings. HRT is not appropriate for everyone and should be taken in the lowest dose that is effective and for the shortest amount of time needed.^[3] While HRT was previously considered a standard therapy, it is increasingly cautioned against due to the known risk of blood clots and cancer with long-term use.

A number of botanical and other nutritional supplements have been investigated for the treatment of menopausal symptoms. Black cohosh, red clover, omega-3 fatty acids, dehydroepiandrosterone, evening primrose oil, Vitex agnus-castus, soy isoflavones and St. John's wort are among the variety of supplements purported to reduce menopausal symptoms.

Hormone changes during menopause can negatively affect lipid and glucose metabolism. The American Heart Association recommends women consume a diet rich in fruits, vegetables, high-fiber whole grains, and oily fish, and that they limit saturated fat, cholesterol, alcohol, sodium, and sugar and avoid trans-fatty acids.

Exercise like yoga may be particularly helpful for vasomotor and psychological symptoms.^[4] Strength and resistance training are especially important for maintaining muscle mass and bone mineral density, especially when combined with high-impact exercises like jumping, skipping, and jogging.^[5]

Menopause is a natural condition that occurs as women age. Over time, a woman’s ovarian follicles and granulosa cells diminish. Given these cells are the main producers of estradiol and inhibin^[6] (a hormone that tells the pituitary gland to make less follicle-stimulating hormone), the body’s hormonal balance shifts toward lower estrogen and progesterone levels and increased follicle-stimulating hormone and luteinizing hormone levels. This hormonal profile results in irregular menstrual cycles, which ultimately stop altogether.