Menopause and Hormone Replacement Therapy

Menopause is the permanent cessation of menstruation. Menopause is a normal part of a woman’s life cycle. Sometimes referred to as “the change of life,” we’ll discuss everything about menopause in this section, from definitions to the transition to menopause, the physical and mental effects of menopause on your health, in short, everything about menopause.

What is Menopause?

Menopause is the period when menstruation permanently ceases, and pregnancy is no longer possible. For it to be called menopause, at least one year must have passed since your last period. After menopause, your ovaries produce estrogen and progesterone hormones at very low levels. These low hormone levels can increase your risk for certain health issues.

What is Perimenopause or Transition to Menopause?

Perimenopause, or menopause transition, is the time leading up to your last period. The transition period before and after menopause is referred to as “perimenopause.” As your body transitions to menopause, your hormone levels fluctuate randomly, leading to unexpected menopause symptoms. During this transition, your ovaries produce more estrogen and progesterone hormones than usual. You may experience irregular periods because you may not ovulate every month. Your periods may be longer or shorter than normal, or you may experience unusually heavy or light menstrual bleeding.

Many women experience hot flashes and other menopause symptoms during this transition.

When Does Menopause Transition Typically Begin?

Perimenopause, the transition to menopause, typically begins in a woman’s late 40s.

How Do I Know if I’m Transitioning to Menopause?

Sometimes, it can be difficult for you and your doctor to determine if you are in perimenopause. You need to provide information about the symptoms you experience during this process.

Symptoms: Hot flashes, sleep disturbances

Irregular periods: Keep track of your periods. Irregular periods may be the first sign of menopause.

Hormone levels: If your periods stop before the age of 40, your doctor may test your hormone levels. Doctors usually do not recommend this test unless there is no medical reason. This is because hormone levels fluctuate unpredictably up and down during the transition to menopause. Therefore, it is difficult to decide whether you are going through menopause based on this blood test alone.

How Does Menopause Affect Me?

Menopause symptoms can start suddenly and may initially be very mild. Some women notice many changes in various aspects. Some menopausal symptoms, such as mood swings, are similar to premenstrual syndrome (PMS) symptoms. Others may be new to you. For example:

• Your periods may not be as regular as before, and they may last longer or be shorter. Your periods may stop for a few months and then start again.
• Your periods may be more or less intense than before.
• You may experience hot flashes and sleep problems.
• Your mood may change, or you may feel irritable.
• You may experience vaginal dryness. Sexual intercourse may be uncomfortable or painful.
• You may be less interested in sex.

Other possible changes may not be noticeable. For example, you may begin to lose bone density because you have less estrogen. This can lead to osteoporosis, a condition that weakens bones and makes them more likely to break. Changes in estrogen levels can also increase cholesterol levels and your risk of heart disease and stroke.

How Long Does the Menopause Transition Last?

Perimenopause, the transition to menopause, can last from two to eight years without permanent cessation of your periods. For most women, the transition to menopause lasts about four years. You will know you have reached menopause only after you have gone a year without any bleeding after your last period. This means that there has been no bleeding, including spotting, for 12 consecutive months.

Should I Continue to Use Birth Control During the Transition to Menopause?

Yes. During perimenopause, even if you don’t have a period for one or several months, you can still get pregnant during the transition to menopause. During perimenopause, you may still ovulate some months, but it is impossible to know exactly when you will ovulate. If you do not want to get pregnant, you should continue to use birth control for one more year after your last period. You can learn more about different birth control methods from your doctor.

After menopause, you cannot get pregnant, but anyone with an active sex life can contract sexually transmitted infections (STIs). After menopause, if you do not use condoms, you may be more likely to contract STIs. Vaginal dryness or irritation is more common after menopause and can cause small cuts or tears during sexual intercourse, exposing you to STIs.

When Does Menopause Occur?

Menopause occurs when there have been 12 consecutive months without menstruation. The average age for menopause in women is generally between 45 and 55. One way to understand when you might enter menopause is to consider the age at which your mother experienced it. Menopause may occur earlier due to:

Never having children: Pregnancy, especially multiple pregnancies, can delay menopause.

Smoking: Studies suggest that smoking can lead to entering menopause about two years earlier than non-smokers.

Some health issues may also lead to early menopause.

Menopause usually happens on its own. However, if you undergo chemotherapy or surgery to remove both ovaries, you may enter menopause.

What Happens After Menopause?

After menopause, you will no longer be able to become pregnant, and you will no longer have periods. If you experience any vaginal bleeding after menopause, you should see a doctor as soon as possible. Post-menopausal vaginal bleeding is not normal and may indicate a serious health issue.

After menopause, you may experience:

• Low hormone levels: With menopause, your ovaries produce very little estrogen and progesterone hormones. Due to changing hormone levels, you may develop health risks such as osteoporosis, heart disease, and stroke.
• Menopause symptoms: After menopause, you may experience symptoms such as hot flashes due to changes in estrogen levels.
• Vaginal dryness: Vaginal dryness can occur after menopause.

Menopause Symptoms

During the transition to menopause, fluctuating hormone levels can affect menstrual patterns and lead to symptoms such as hot flashes and sleep problems. As you approach menopause, you may also experience other symptoms such as pain during intercourse, urinary problems, and irregular periods. Medications and other treatments can help alleviate your symptoms.

Hot Flashes

Hot flashes are the most common menopausal symptom. Three out of four women experience hot flashes.

A hot flash is a sudden sensation of heat in the upper part of your body. Your face and neck may become flushed. Red blotches may appear on your chest, back, and arms. You may even experience cold chills after hot flashes or sweats.

Recent studies suggest that hot flashes can last up to 14 years after menopause. Doctors and researchers do not fully understand why hot flashes are so common during menopause. The good news is that there are medications available that can prevent hot flashes.

What Can You Do?

You can consider hormone therapy. If you are still menstruating, talk to your doctor about low-dose hormone therapy. Hormone therapy helps relieve hot flashes and night sweats in menopausal women. There are some risks associated with hormone therapy. If you decide to undergo hormone therapy, take the lowest effective dose that helps with your symptoms and for the shortest duration possible.

Consider other medications. If hormone therapies are not an option for you, consult your doctor about prescription drugs used for other health problems. Even if you don’t have specific health issues, some antidepressants, epilepsy drugs, and blood pressure medications can help with hot flashes.

Monitor your hot flashes. Write down what triggers your hot flashes and try to avoid them. Possible triggers include spicy foods, alcohol, caffeine, stress, or being in a hot environment.

Drink cold water. When you feel a hot flash coming on, try drinking ice-cold water.

Dress in layers and remove a layer as needed.

Take deep breaths. When a hot flash starts, try taking slow, deep breaths. Slow, deep breaths signal to your body that it’s time to relax and calm down. This may help shorten the duration of the hot flash.

Lose weight. Hot flashes may be worse in women who are overweight. A recent study found that losing weight may help alleviate hot flashes.

Vaginal Problems and Infections

Vaginal problems such as vaginal dryness may begin or worsen during the menopausal period. Low estrogen levels can cause the vaginal tissue to become drier and weaker. This can lead to itching, burning, pain, or discomfort. It can also cause pain during sexual intercourse and may result in small cuts or tears in the vagina during intercourse, putting you at a higher risk for sexually transmitted infections.

What Can You Do?

Vaginal moisturizer. A vaginal moisturizer can help lubricate your vagina.

Vaginal lubricant. A water-based vaginal lubricant can make sexual intercourse more comfortable.

Prescription medication. You can also discuss other ways to treat vaginal dryness with your doctor, such as hormone therapy, estrogen cream, gel, or a vaginal ring.

Irregular Periods or Bleeding

Your periods will become either more frequent or less frequent. Regular periods will cease. There will be days when you ask yourself, “Where did this bleeding come from?” or “Why haven’t I had my period yet?”

What Can You Do?

Always see your doctor first to ensure that there is no other reason for your lack of menstruation, such as pregnancy or a health problem.

If you haven’t had a period for a year and then begin bleeding or spotting, be sure to see your doctor. In menopausal women, spotting or light bleeding may indicate cancer or another serious health issue, which may require taking a sample from the uterine lining.

Sleep Problems

Many women going through menopause find it difficult to sleep at night. Low progesterone hormone levels can make it difficult to fall asleep and stay asleep. Low estrogen levels can also cause hot flashes, which lead to night sweats. This is sometimes referred to as nocturnal sweating. As a result, you may feel more tired than usual during the day.

What Can You Do?

One of the best ways to get a good night’s sleep is to engage in regular physical activity. Doing too much activity close to bedtime can make you more awake. Even if you haven’t exercised regularly in the past, starting to exercise during menopause can help you feel better. Studies have shown that certain exercises, such as yoga and stretching, can help reduce hot flashes.

• Avoid eating, smoking, and drinking alcohol before bedtime. Avoid caffeine in the afternoon.
• Drink hot beverages. Try drinking something warm before bedtime, such as decaffeinated tea or warm milk.
• Limit the use of TV, phone, or computer screens in your bedroom according to bedtime. The bright light from screens tells your brain to wake up instead of sleep.
• Develop good sleep habits. Keep your bedroom dark, quiet, and cool.
• Try to go to bed and wake up at the same times every day.

Memory Problems

You may be forgetful or have difficulty concentrating. Two-thirds of women going through perimenopause report experiencing memory or concentration problems.

What Can You Do?

Adequate sleep and physical activity are important, as well as eating healthily and quitting smoking. This can improve memory.

Stay socially active. Social interaction can delay memory loss and help prevent diseases such as dementia and Alzheimer’s.

Stay mentally active. You can strengthen your memory and focus by engaging in mental activities such as crossword puzzles.

If forgetfulness or other mental issues are affecting your daily life, talk to your doctor.

Urinary Problems

Many women develop bladder or urinary problems during menopause. Lower estrogen levels than before can weaken your urinary tract. You may experience urine leakage when sneezing, coughing, or laughing. Post-menopausal urinary problems are not a normal part of aging and can be treated.

What Can You Do?

The treatment for urinary leakage depends on the cause and may include limiting or preventing caffeine, medication use, using special medical devices, physical therapy, or surgery.

Talk to your doctor about what you can do at home to treat urinary leakage. These include special exercises for pelvic floor muscles called Kegel exercises. Your doctor may also recommend losing weight, as extra weight puts more pressure on your bladder and nearby muscles.

Mood Swings

You may feel tense. If you experienced postpartum depression or sadness, you are more likely to experience mood swings.

What Can You Do?

• Try to get seven to eight hours of sleep.
• Find ways to be active to help you feel your best. Find ways to be active.
• Look for ways to relieve your stress.

Talk to your doctor about menopausal hormone therapy, which may help with mild mood swings. All medications have risks, including menopausal hormone therapy. Mood changes during menopause are usually not the same as depression, which is a different, serious condition that often requires treatment.

Depression and Anxiety

Your risk of depression and anxiety is higher during menopause. You may experience sadness or depression due to fertility loss or changes in your body. If you have symptoms of depression or anxiety, talk to your doctor. Your doctor may recommend therapy or medication or both for depression or anxiety treatment.

What Can You Do?

• Try to get enough sleep. Most adults need seven to eight hours of sleep each night. Lack of sleep is associated with depression.
• Be physically active for at least 30 minutes most days of the week.
• Limit alcohol consumption.
• Lower your stress levels. Try relaxation techniques, such as reading, spending quiet time outdoors, or trying other healthy ways to relax.

Changes in Sexual Feelings

Some women feel more comfortable with their sexuality after menopause. Some may have difficulty becoming aroused. If it’s uncomfortable or painful, you may be less interested in sexual intercourse.

What Can You Do?

If you’re bothered by vaginal dryness, there are treatments available to improve vaginal lubrication. Learn more about menopause and your sexuality.

Some women are less interested in sex during menopause due to other menopausal symptoms such as depression, anxiety, or lack of sleep. If your menopausal symptoms bother you, talk to your doctor about possible treatments.

Menopause Treatment

Many women may not need treatment for menopausal symptoms. You may find that your symptoms improve on their own. If you’re bothered by your symptoms, talk to your doctor about ways to find relief. You can work together to find a treatment that’s right for you. Some women may find that changing their eating habits and engaging in more physical activity can help reduce menopausal symptoms, while others may need medication to alleviate their symptoms.

Which Medications Treat Menopausal Symptoms?

If your menopausal symptoms are bothering you, talk to your doctor. Your doctor may recommend medications to help with your symptoms. All medications have risks, and your doctor can help you find out which ones are best for you.

Low-dose hormone therapy can help reduce these symptoms. They help stop or reduce hot flashes, vaginal dryness, and mood swings. They also treat heavy or irregular periods. If you smoke, you should not use hormone therapy. Hormone therapy, especially methods containing combined hormones like birth control pills and vaginal ring or patch, can increase your risk of blood clots and high blood pressure, and the risk is higher in women who smoke.

Water-based vaginal lubricants can make sexual intercourse more comfortable. A vaginal moisturizer can help retain the moisture needed in vaginal tissues.

Some prescription medications can help with vaginal discomfort, dryness, or pain if lubricants don’t work. These include estrogen creams, tablets, or rings applied to the vagina (see information about topical hormone therapy).

If you have severe vaginal dryness, hormone replacement therapies may be effective.

What is Hormone Replacement Therapy?

Hormone replacement therapy is prescription medication that helps relieve menopausal symptoms such as hot flashes and vaginal dryness that affect your quality of life.

During menopause, your ovaries produce very little estrogen and progesterone hormones. Hormone replacement therapy aims to replace the hormones that are no longer produced by your ovaries with artificial estrogen and progesterone.

These treatments are usually taken as a pill every day. You can also use estrogen or estrogen plus progesterone hormone therapy as skin patches. Like all medications, hormone replacement therapy has risks. It is recommended that if you decide to use medications, you use the lowest dose for the shortest time needed. Other menopausal hormone therapies called topical hormone therapy do not treat hot flashes but can help with vaginal dryness.

What is Topical Hormone Therapy?

Topical hormone therapy is creams containing low doses of estrogen applied directly to the vagina. It helps relieve vaginal dryness but does not help with menopausal symptoms like hot flashes. There are also vaginal ring and gel forms. The risks of topical cream are different from the risks of menopausal hormone replacement therapy.

Is Hormone Therapy Safe During Menopause?

Menopausal hormone therapy (sometimes called hormone replacement therapy) may be safe for some women, but it also carries some risks.

Research shows:

• Menopausal hormone therapy may be an option for women up to age 59, but it’s usually recommended only within the first 10 years of menopause. Younger women and those closer to their last menstrual period are less likely to experience harmful side effects of menopausal hormone therapy.
• Menopausal hormone therapy reduces symptoms such as hot flashes, sleep problems, mood changes, and vaginal dryness.
• Hot flashes usually require higher doses of estrogen therapy that affect the entire body.
• Women experiencing vaginal dryness or discomfort during intercourse may find relief with low-dose vaginal estrogen creams.
• Estrogen alone and estrogen combined with progesterone medications increase the risk of stroke and blood clotting in the legs and lungs. The risks are rare in women under 50.

Who Should Not Take Menopausal Hormone Therapy?

• Menopausal hormone therapy may not be safe for some women.
• You should talk to your doctor if you have the following risks:
• A history of risk factors such as heart disease or high cholesterol
• A family or personal history of breast cancer
• High blood cholesterol levels
• A family history of gallbladder disease
• Liver disease
• A history of stroke or blood clotting disorder

How Long Does Menopausal Hormone Therapy Last?

This process varies from person to person and depends on the symptoms experienced, but it is not recommended to last more than 10 years.

Talk to your doctor to learn about the risks and benefits of menopausal hormone therapy based on your symptoms, age, and risk factors.

Menopause and Sexuality

You may experience changes in your sex life during menopause. Some women say they have more sexual intercourse due to the relief of not having children during this period and social circumstances, while others express less frequent thoughts of sexual intercourse or less enjoyment.

What Effects Will Menopause Have on My Sex Life?

Menopause can cause changes in your sex life.

• Some possible changes include:
• Due to low hormone levels, vaginal tissues become drier and thinner. This condition, called vaginal atrophy, can cause discomfort or pain during sexual intercourse.
• Low hormone levels can reduce your sexual desire.
• Night sweats can make you more tired by disrupting your sleep quality.

If changes in your sexual condition bother you, talk to your doctor.

What Can I Do to Improve My Sexual Health Before and After Menopause?

You can take some steps to improve your sexual health during the transition to menopause and after menopause:

• Be active: Physical activity can increase your energy levels, elevate your mood, and make you feel better about yourself. All of these can help increase your interest in sex.
• Don’t smoke: Smoking can decrease blood flow to the vagina and reduce the effects of estrogen.
• Avoid alcohol: It can slow down your body’s response to sexuality.
• Have sex more often: If you choose to have sex, you can increase blood flow to your vagina and keep tissues healthy.
• Give yourself time during sex: Prolonged foreplay increases blood flow to the vagina and vulva, leading to moistening. Moisture preserves tissues, allowing for more comfortable sex.
• Do pelvic floor exercises: These exercises can increase blood flow to the vagina and strengthen the muscles involved in orgasm. Learn more about pelvic floor exercises.
• Avoid products that irritate the vagina: Foam baths and some soaps can cause irritation. If you have vaginal itching or irritation, consult your doctor as it may be a sign of infection.

Treatment for Postmenopausal Vaginal Dryness

For mild discomfort during sex caused by vaginal dryness, you can use over-the-counter, water-based vaginal lubricants. For more severe vaginal dryness, your doctor may prescribe certain medications that you can insert into the vagina.

These medications include:

• Vaginal estrogen creams
• Estrogen tablets or rings for insertion into the vagina
• Ospemifene (a non-hormonal medication)

Discuss your symptoms and personal health concerns with your doctor to determine if one or more treatment options are right for you.

How Can I Talk to My Partner About Menopause and Sexuality?

Talking to your partner about your concerns can strengthen your relationship. You can ask them the following questions:

• What makes you feel good about yourself?
• When do you feel more comfortable?
• In which positions do you feel more comfortable and happy?
• What do you think about changes in my appearance?

If changes in your sexual life bother you, consider seeing a therapist for individual or couples therapy.

Do I Still Need Protection During Sex After Menopause?

Yes, if you are not in a monogamous relationship, you still need to use condoms after menopause to prevent sexually transmitted diseases. In a monogamous relationship, you and your partner should only have intercourse with each other and no one else.

Condoms are the best way to prevent STDs when you have sexual intercourse.

Menopause and Your Health

Changes in your body during menopause can increase your risk of certain health problems. Low estrogen levels and other age-related changes (such as weight gain) can increase your risk of heart disease, stroke, and osteoporosis.

How Does Menopause Affect My Health?

After menopause, your ovaries produce very little estrogen. Women going through menopause have very low estrogen levels. Low levels of estrogen and progesterone after menopause increase your risk of certain health problems. Other health problems may naturally occur as you age.

Common health problems that occur 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 open and maintains a healthy balance of cholesterol in the body. Without estrogen, cholesterol can build up in the walls of blood vessels leading to blockages.
• Stroke: Your risk of stroke doubles every ten years after age 55. Low estrogen levels in your body can contribute to cholesterol buildup in blood vessel walls leading to stroke.
• Osteoporosis: Due to decreased estrogen after menopause, there is a faster loss of bone mass. Osteoporosis is a condition where your bones become fragile and weak, making them more likely to break. A large study in recent years showed that women who experienced severe hot flashes and night sweats during menopause generally had more osteoporosis.
• Urinary incontinence: About half of women after menopause have difficulty holding urine. Lower estrogen levels can weaken the urethra, a tube that extends from the bladder. If the urethra weakens, you may have difficulty holding urine. Learn about treatment options for urinary incontinence.
• Oral health: Dry mouth and the risk of cavities increase with menopause.

Does Hormone Therapy During Menopause Prevent These Health Problems?

No. Menopausal hormone therapy helps alleviate menopausal symptoms such as hot flashes and vaginal dryness. Menopausal hormone therapy can increase your risk of blood clots, stroke, and some cancers and does not prevent heart disease or dementia (memory loss).

What Routine Screenings Do I Need After Menopause?

All women need regular check-ups and screening tests throughout their lives. Some routine tests to be done:

• Regular mammograms from age 50 to 75 (X-ray imaging of breast tissue)
• Regular Pap smear tests after menopause, every five years, both Pap test and HPV test
• Bone density measurement, measurements to detect bone loss
• Other tests to screen for diabetes and heart disease
• Blood pressure, cholesterol, and other tests recommended by your doctor
• Consult your doctor about flu shots and other vaccines. In addition to the flu vaccine, vaccines are available for pneumonia, shingles, and other diseases.

Your doctor may recommend other tests based on your health condition. For example, you may need to see a specialist for certain specific problems such as urinary incontinence.

How to Stay Healthy During and After Menopause

There are several important steps you can take to improve your health during menopause.

• Quit smoking: Quitting smoking is one of the most important steps you can take to become healthier. Smoking harms your bones, increases the risk of heart disease, and contributes to 12 different types of cancer, among other health risks.
• Stay active: Engaging in at least 30 minutes of physical activity on most days of the week is one of the best ways to stay healthy. Physical activity can benefit your bones, heart, and mood. Your exercise routine doesn’t have to be complicated. Brisk walking and regular household chores are good for your health. Ask your doctor which activities are suitable for you.
• Goal: Aim for at least 2 hours and 30 minutes of moderate-intensity physical activity (such as brisk walking) or 1 hour and 15 minutes of high-intensity activity (such as running or playing tennis) per week.
• Eat well: Consuming vitamins, minerals, fiber, and other essential nutrients is crucial. Learn how many calories you need each day based on your age, height, weight, and activity level. Consult your doctor about dietary supplements.

After menopause, calcium is needed to maintain bone health. Doctors recommend that women aged 51 and older consume 1,200 milligrams of calcium per day. Vitamin D is also important for bone health. If you need calcium supplementation or more vitamin D, ask your doctor.

Practice safe sex: You cannot become pregnant after menopause. However, you can still contract a sexually transmitted infection. Condoms are the best way to prevent STIs during sexual intercourse. After menopause, the vagina may become drier and thinner, leading to small cuts or tears during sexual intercourse. Vaginal cuts or tears put you at a higher risk for STIs. Learn ways to prevent STIs.

Will I Gain Weight After Menopause?

Yes, it’s possible. Many women gain an average of 5 kilograms after menopause. The decrease in estrogen levels may play a role in weight gain after menopause.

Weight gain can increase your risk of high blood pressure, high cholesterol, diabetes, heart attack, and stroke. If you are overweight, inactive, or have an unhealthy diet, the risk is even higher. Learn about the effects of excess weight and obesity on heart health.

The best way to lose weight (if you are overweight or obese) is to consume fewer calories each day. Eating healthily and engaging in at least 30 minutes of exercise per day are the best ways to maintain a healthy weight.