Knowing the signs of menopause and at what age they may start can help us recognize this transition and, importantly, help us find ways to control discomfort and health risks.
According to the National Institutes of Health, the term menopause refers to the time when menstruation naturally stops, usually between the ages of 45 and 55. Periods stop when the ovaries stop producing the hormones estrogen and progesterone. A woman is considered to be “in menopause” when she has had no menstrual periods for 12 months and has no other medical reason for menstruation to stop.
The Onset of Menopausal Symptoms
Menopause usually does not occur overnight. The average age at which a woman experiences her final menstrual period is 51; however, women typically begin undergoing physical changes associated with menopause long before that final period. As a woman approaches menopause, estrogen and progesterone (female hormones produced in the ovaries) levels begin to decline—until eventually, the ovaries stop producing eggs and the menstrual cycle ends. This time of transition leading up to menopause is known as perimenopause and can last anywhere from 6 months to 10 years.
There are no conclusive tests to tell you if you’ve entered peri-menopause, so it’s up to you be aware of the signs of this transition, listen to your body, and discuss changes with your healthcare team. Each symptom is related to fluctuating hormone levels. Here’s what to look for:
- Hot flashes and night sweats are very common symptoms of peri-menopause, affecting more than half of all women and are often associated with memory difficulties. Managing hot flashes...
- Irregular periods during peri-menopause can mean more frequent periods, missing periods, heavier or lighter, or longer or shorter periods—any noticeable changes to your regular periods.
- Many women have trouble sleeping as they approach menopause—whether due to night sweats waking you up or other stresses and changes in your body. Activity is a key to avoiding insomnia.
- Skin changes and hair loss are associated with menopause. Tips for improving skin care during menopause.
- Impaired memory - difficulty concentrating?
- If you’ve been prone to premenstrual headaches, you may begin to experience more headaches during peri-menopause.
- Feeling more irritable, fatigued, or down than usual? Mood swings can often accompany peri-menopause.
- Vaginal dryness is caused by a drop in estrogen levels, which occurs with peri-menopause and menopause. Heres what can be done about it....
- Heart problems can be associated with menopause - know your risk.
- Weight gain and thyroid issues.
Though the above symptoms are linked with peri-menopause and menopause, they can also be related to other medical issues. So, even if you’re at an appropriate age for menopause, you’ll want to discuss these changes with your healthcare provider to rule out other health concerns.
Updated Guidelines for Post Menopausal Replacement Hormone Therapy
The North American Menopause Society (NAMS) has been published online guidelines on the use of hormonal therapy (HT).
- The risks of HT differ for different women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is needed. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation for the benefits and risks of HT continuation.
- For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio appears favorable for treatment of bothersome hot flashes and for those at elevated risk of bone loss or fracture. Longer duration may be more favorable for estrogen-alone therapy than for estrogen-progestogen therapy, based on the Women’s Health Initiative randomized, controlled trials.
- For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit-risk ratio appears less favorable than for younger women because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia.
- Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 years for persistent hot flashes, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.
- Vaginal estrogen (and systemic if required) or other non-estrogen therapies may be used at any age for prevention or treatment of the genitourinary syndrome of menopause.
Simple lifestyle changes can make menopause more bearable.
They don’t call it “the change of life” for nothing. Menopause and its notorious symptoms can be frustrating and downright bothersome, but there are some simple lifestyle changes you can make that might ease the transition.
If there is a chance you could be coping with menopausal symptoms for six months to ten years, you’re going to need some strategies. It may sound overly simple, but healthy lifestyle choices can be the key to an easy transition. In fact, it all boils down to one goal—reduce and manage stress. Here’s how:
Relaxation Techniques: Stress exacerbates hot flashes. Minimize stress by engaging in relaxation techniques such as meditation, guided imagery, tai chi, yoga, and deep breathing. Mindfulness meditation has been shown to reduce hot flashes. (1)
Nutrition: Choosing healthy foods is always important, but even more so when facing menopause. Support the body with nutrient dense food and avoid foods that have a warming effect, such as coffee, alcohol, chicken, and spicy foods.
Exercise: Experts agree that maintaining a regular exercise program is one of the cornerstones of a healthy lifestyle. Exercise promotes cardiovascular, mental, and emotional health and helps us to maintain a healthy weight. It can also improve sleep, prevent disease, and boost energy and stamina. Exercise is an effective stress reduction technique. For women coping with menopause, exercise comes with a huge payoff—those who exercise at least three hours per week have 70 percent fewer hot flashes.
Reduce Chemical Exposure: Many chemicals mimic estrogen and/or are carcinogenic. Some household chemicals have even been linked to earlier menopause. (2) Avoid strong cleaning chemicals and perfumes; instead use natural cleaning solutions such as vinegar and baking soda.
Homeopathic and/or Herbal Remedies: Many remedies are effective for reducing hot flashes and other symptoms. Work with a qualified professional to find the remedies that are best for you.
Acupuncture: Acupuncture has proven effective for reducing hot flashes. In fact, one study shows that women who received acupuncture had fewer and less-severe hot flashes. (3)
Aromatherapy: Many women find that aromatherapy is helpful—for example, inhaling essential oil of lavender promotes a sense of relaxation.
What about Fennel?
Fennel, an anise-flavored herb used for cooking, has long been known for its health benefits for a variety of issues, including digestion and premenstrual symptoms. A new study confirms that it is also effective in the management of postmenopause symptoms such as hot flashes, sleeplessness, vaginal dryness, and anxiety, without serious side effects. The study outcomes are published online today in Menopause, the journal of The North American Menopause Society (NAMS).
The use of complementary and alternative medicine for the management of menopause symptoms has surged in recent years as women have attempted to identify alternatives to hormone therapy (HT). Although HT is the most effective treatment for managing most menopause symptoms, some women have turned to herbal medicine because they are either not candidates for HT or are concerned about the negative publicity surrounding potential side effects. Fennel, an herb containing essential oils, has phytoestrogenic properties. Phytoestrogens are estrogen-like chemicals in plants that have been used to effectively treat a wide array of menopause symptoms.
In this small trial of 79 Iranian women aged 45 to 60 years, soft capsules containing 100 mg of fennel were administered twice daily for eight weeks. Improvements were compared between the intervention and placebo groups at four, eight, and 10 weeks, with a significant statistical difference documented. In the end, fennel was concluded to be a safe and effective treatment to reduce menopause symptoms without serious side effects. The study described in the article “Effect of Foeniculum vulgare Mill. (fennel) on menopausal symptoms in postmenopausal women: a randomized, triple-blind, placebo-controlled trial” is one of the first clinical studies to examine the benefits of fennel for managing menopause symptoms, even though it had been previously studied and confirmed to manage premenopause symptoms.
The study was completed in Tehran, Iran, where the average age of women at menopause is younger than in the United States: 48.2 years versus 51 years, respectively. Some of the most common adverse effects of menopause are hot flashes, vaginal dryness, sleep problems, joint and muscular discomfort, exhaustion, irritability, anxiety, and depression.
“This small pilot study found that, on the basis of a menopause-rating scale, twice-daily consumption of fennel as a phytoestrogen improved menopause symptoms compared with an unusual minimal effect of placebo,” says Dr. JoAnn Pinkerton, executive director of NAMS. “A larger, longer, randomized study is still needed to help determine its long-term benefits and side effect profile.” (4)
- Carmody JF, Crawford S, Salmoirago-Blotcher E, et al. Mindfulness training for coping with hot flashes: Results of a randomized trial. Menopause. Published early online: February 26, 2011.
- Knox SS, Jackson T, Javins B, et al. Implications of early menopause in women exposed to perfluorocarbons. Journal of Clinical Endocrinology & Metabolism. Published early online: March 16, 2011. doi:10.1210/jc.2010-2401
- Sunay D, Ozdiken M, Arslan H, et al. The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial. Acupuncture in Medicine. 2011; 29: 27-31.