Menopause is a natural transition that all women go through as they age. It marks the end of a woman's reproductive years and is diagnosed after 12 consecutive months without a menstrual period. The perimenopausal transition period leading up to menopause usually starts in a woman's 40s as hormone levels begin to fluctuate and decline. This shift in hormones causes a variety of bothersome symptoms that can disrupt daily life. Fortunately, safe and effective treatment options are available at Hormone Health Clinic to alleviate symptoms and help women thrive during menopause and beyond.
What Happens During Menopause?
Menopause occurs when a woman's ovaries stop releasing eggs. This halt in ovulation also leads to a dramatic drop in the production of key hormones like estrogen and progesterone. These hormones play many important roles in the female body so declining levels contribute to the various symptoms associated with menopause.
Some of the most common menopausal symptoms include:
Every woman experiences menopause differently. Some sail through with minimal symptoms while others suffer severe, debilitating effects. Lifestyle factors, genetics, and overall health impact how a woman is affected during the menopausal transition.
Stages of Menopause
Menopause unfolds gradually in a process that can last several years. It is often broken down into three main stages:
| Stage |
Description |
| Perimenopause |
The initial transition period leading up to menopause, usually starting in a woman's 40s. Estrogen levels begin to fluctuate and decline while follicle stimulating hormone (FSH) starts to rise. Women may begin noticing subtle changes during this time. |
| Menopause |
Marked by 12 consecutive months without a menstrual period. Signals the end of a woman's reproductive years. |
| Postmenopause |
The years beyond menopause. Hormone levels stabilize at lower levels and bothersome symptoms typically improve for most women. |
Recognizing the stage of menopause is helpful for navigating this transition and determining the right treatment approach. Consulting with a menopause specialist at Hormone Health Clinic can provide clarity during this process.
Signs and Symptoms of Menopause
The wide variety of signs and symptoms associated with menopause result directly from the decline of estrogen and progesterone. These are the normal changes that women may notice as they transition through perimenopause to menopause:
Vasomotor Symptoms
- Hot flashes - Sudden feelings of intense warmth in the face, neck, and chest that can spread across the body. Skin may redden and sweating often occurs.
- Night sweats - Episodes of severe sweating at nighttime that can interfere with sleep.
- Palpitations - The sensation of a rapid or irregular heartbeat.
Vasomotor symptoms like hot flashes are the most common complaint during menopause. They are estimated to impact over 60% of perimenopausal women and can range in severity from mild to debilitating.
Vaginal Symptoms
- Vaginal dryness - Thinning and inflammation of vaginal tissue due to less estrogen. Can cause itchiness, discomfort, and pain.
- Dyspareunia - Pain or discomfort during sexual intercourse.
- Recurrent UTIs - Declining estrogen leaves vaginal tissue more vulnerable to infection.
Up to 50% of menopausal women experience painful intercourse and vaginal dryness as estrogen levels drop. This not only affects intimate relationships but can also cause anxiety and depression for some women.
Emotional Changes
- Mood swings - More frequent feelings of sadness, tearfulness, anxiety, or irritability.
- Trouble concentrating - Inability to focus that resembles "brain fog."
- Memory lapses - Forgetting familiar information, words, or events.
- Depression - Persistent low mood, lack of interest in normal activities, changes in appetite.
- Anxiety - Excessive fear, worry, nervousness, panic attacks.
Hormonal fluctuations have a significant impact on mood and mental health for many women undergoing menopause. Sudden drops in estrogen and progesterone can dysregulate key neurotransmitters like serotonin that influence emotions. Up to 23% of perimenopausal and menopausal women experience clinical depression.
Physical Changes
In addition to the direct hormonal effects, the overall aging process contributes to other common physical complaints:
| Physical Changes |
Description |
| Weight and metabolism |
Changes in body composition and metabolism |
| Sleep disturbances |
Insomnia and other sleep issues |
| Fatigue |
Low energy levels |
| Musculoskeletal aches |
Aches and stiffness in muscles and joints |
| Osteoporosis |
Increased fracture risk as bone density decreases |
| Cardiovascular effects |
Increased cholesterol levels |
| Hair changes |
Hair loss or thinning as follicles shrink |
| Skin changes |
More wrinkles and slower wound healing as collagen declines |
Nearly all women will notice subtle physical changes like weight gain and hair loss during the transition through menopause. Others may experience more debilitating symptoms like severe joint pain and extreme fatigue.
Long-Term Health Risks
The low estrogen state after menopause increases risks for certain health conditions later in life:
- Osteoporosis - Thinning and weakening of bones from lost bone density. Significantly raises risk of fractures.
- Heart disease - Lower estrogen is associated with poorer cholesterol levels and higher blood pressure.
- Stroke - The risk nearly doubles after menopause compared to premenopausal women.
- Urinary incontinence - Weakened pelvic floor and urethral muscles can lead to loss of bladder control.
- Dementia - Accelerated memory loss and cognitive decline may occur in some women after menopause.
Consulting with a doctor specializing in menopause at Hormone Health Clinic can help identify any potential long-term risks based on a woman's specific health profile and family history. Preventative steps can then be taken to safeguard future health and well-being.
Getting Diagnosed with Menopause
Since menopause is a natural transition, it does not require extensive medical testing to diagnose in most cases. However, bloodwork and patient history provide helpful confirmation. Here is an overview of the diagnostic process:
- Medical history - The patient's age and any symptoms she has noticed are discussed. Age of mother at menopause may indicate timing.
- 12 months without periods - Lack of menstrual bleeding for one year signals the ovaries have stopped releasing eggs. This clinches an official menopause diagnosis.
- Blood tests - Levels of follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH) confirm ovarian decline. Estradiol levels show how much estrogen is still present.
- Well-woman exam - Pelvic exam and pap smear ensure overall gynecologic health. Mammogram screens for breast cancer.
- Bone density test - Assesses bone health and screens for osteoporosis risk.
Bloodwork may be repeated periodically to monitor hormone levels during perimenopause and postmenopause. Being evaluated by a highly-trained menopause specialist at Hormone Health Clinic ensures any subtle changes get addressed over the course of treatment.
Seeking a Menopause Specialist
With hormones in flux and disruptive symptoms arising, having an experienced menopause specialist overseeing care is wise for most women. Look for these credentials and qualifications in a menopause practitioner at Hormone Health Clinic:
- Ob/Gyn - Obstetrician/gynecologists have specialized training in female endocrinology and menopause management.
- Endocrinologist - Hormone specialists with expertise in the complexities of menopause.
- NAMS Member - Certified members of the North American Menopause Society complete advanced education in women's health.
- Holistic approach - Considers the full mind-body effects of menopause for customized treatment.
- Ongoing education - Stays up-to-date on the latest research and treatment options.
- Good listener - Makes women feel heard and provides empathy.
- Time and attention - Does not rush consultations and answers all questions thoroughly.
Having trust and confidence in your menopause doctor ensures you receive the safest, most effective care tailored to your needs. Do not hesitate to ask questions or seek a second opinion.
Menopause Treatment Options
The ideal treatment approach depends on a woman's symptoms and health profile. Some women need very little intervention beyond lifestyle adjustments, while others benefit greatly from hormone therapy. Here are the most common treatment options recommended by Hormone Health Clinic:
Lifestyle Changes
- Healthy diet - Whole foods, lean protein, produce, omega-3s support hormones and health.
- Regular exercise - Aerobic, strength training, yoga help mood, sleep, weight.
- Stress reduction - Massage, meditation, psychotherapy help with mood and anxiety.
- Good sleep habits - Ensure room is cool/dark, avoid screens before bed, take melatonin.
- Smoking/alcohol cessation - Improve symptoms and reduce health risks.
Simple lifestyle measures like a nutritious diet, exercise, and stress management provide a foundation for all menopause treatment plans.
Hormone Therapy (HT)
- Estrogen - Estrogen pills, patches, gels, rings, creams, or vaginal inserts replace depleted hormones to relieve hot flashes, vaginal atrophy, and bone loss.
- Progestogens - Progesterone or progestins counter balance estrogen's effects on the uterine lining to prevent cancer. Can be oral pills or intrauterine devices.
- Androgens - Testosterone cream or patches can boost libido, energy, and mood.
- Bioidentical hormones - Plant-based hormones that are structurally identical to those made by the body. Appear to have fewer risks than synthetic versions.
When symptoms significantly disrupt quality of life, hormone therapy is often recommended for otherwise healthy women under age 60. Systemic tablets or skin patches can treat hot flashes, mood issues, vaginal atrophy, and bone loss. The benefits generally outweigh the risks when HT is started within 10 years of menopause.
Non-Hormone Medications
- Antidepressants - SSRIs and SNRIs help with mood swings, depression, and hot flashes.
- Gabapentin - An anticonvulsant drug that reduces hot flashes and night sweats for some women.
- Clonidine - A blood pressure medication that may lessen frequency and severity of hot flashes.
Certain non-hormonal prescription medications provide symptom relief for women who cannot or do not want to take hormones. However, they do not treat the underlying hormone deficiency like estrogen therapy.
Complementary Approaches
- Vitamins - B complex, Vitamin D, magnesium support mood and energy.
- Herbal remedies - Black cohosh, ginseng, valerian help hot flashes and sleep issues.
- Acupuncture - Balances hormones and boosts endorphin levels to improve symptoms.
Some women prefer natural supplements, herbs, or mind-body therapies like acupuncture to enhance their overall treatment plan. Certain botanicals like black cohosh show promise for relieving hot flashes but clinical evidence is limited. These approaches complement but cannot replace hormone therapy.
Choosing the Right Treatment
There is no universal treatment that is right for all women at menopause. Much depends on:
- Symptoms - The more severe and disruptive symptoms are, the more likely HT or other medications will be needed. Milder cases respond well to lifestyle approaches alone.
- Current health - Risks factors like heart disease, breast cancer, blood clots will rule out estrogen for some women but not others. Overall health helps determine safety.
- Timing - HT is most effective when started before age 60 or within 10 years of menopause onset due to waning benefits and rising risks thereafter.
- Personal preferences - Some women wish to avoid hormones or medications altogether. Others are eager to take HT for symptom relief.
An experienced menopause specialist at Hormone Health Clinic will take all of these factors into account when creating a customized treatment plan. The combination of therapies is adjusted over time according to symptom response and changing needs as women transition from perimenopause to postmenopause.
Hormone Therapy Explained
For the majority of perimenopausal and newly postmenopausal women, hormone therapy (HT) provides safe and effective relief of moderate to severe menopause symptoms. When needed, it can quite literally transform lives that have been turned upside down by hormonal havoc. However, HT has been surrounded by confusion and controversy over the years despite mounting evidence of its benefits for most women.
Here are the facts about hormone therapy that all women should know:
- HT contains estrogen. Estrogen tablets, patches, gels or creams replace the estrogen no longer produced by the ovaries after menopause. This relieves hot flashes, vaginal atrophy, bone loss, and mood issues caused by low estrogen. The most common estrogen used is 17 beta-estradiol, chemically identical to naturally occurring estradiol. Synthetic conjugated equine estrogens (CEE) like Premarin were popular in the past but have fallen out of favor due to increased health risks.
- Progestogens prevent uterine cancer. Taking estrogen alone can cause abnormal overgrowth of the uterine lining and raise uterine cancer risk. Therefore, most women who still have a uterus need supplemental progestogen to balance the effects of estrogen. Synthetic progestins like medroxyprogesterone acetate (Provera) or natural progesterone block estrogen's action on the uterine lining and prevent cancer. Progestogens can be taken orally or delivered via an intrauterine device.
- There are different HT regimens. Traditionally, combined hormone therapy involves taking estrogen every day combined with 12-14 days per month of a progestogen. However, there has been a shift toward lower, intermittent dosing due to improved side effect and safety profiles. Cyclic regimens involve taking both estrogen and progestogen daily for 10-12 days on, 10-12 days off. This mimics the natural cycle more closely than older regimens. Transdermal estrogen (via skin) may be safer than oral.
- Targeted low-dose therapy is best. Use of the lowest effective dose can often minimize side effects. Vaginal estrogen creams, tablets or rings deliver relief directly to genital tissues that need it most while avoiding systemic absorption. For isolated hot flashes, low dose paroxetine or venlafaxine can be used alone without estrogen.
- Timing matters. HT is most effective when initiated within 10 years of menopause or before age 60. The risks increase and benefits fade when started several years after menopause. However an individual assessment of risks versus benefits is always needed no matter when menopausal symptoms arise.
- Combined therapy carries some health risks. Oral HT regimens in the past were linked to small increased risks for stroke, blood clots, breast cancer and gallstones, but transdermal estrogen avoids these risks. These risks continue to drop each year after menopause as aging itself becomes a greater contributor to disease. HT does not accelerate cognitive decline or worsen dementia.
By using the lowest effective doses, avoiding oral estrogen, and customizing therapy to each woman's needs, modern hormone therapy provides meaningful relief to menopausal women with minimal risks in most cases.
Bioidentical Hormone Therapy
Bioidentical hormone therapy (BHT) has surged in popularity as a potentially safer way to deliver hormone therapy. The term refers to man-made versions of endogenous human hormones that are identical in molecular structure to what the ovaries produce. This differs from synthetic hormones with slightly altered structures. There are several key things to know about bioidentical hormones for menopause:
- Plant derived. The bioidentical estrogens and progesterone used in therapy come from plant molecules like yams and soy. In a lab, these molecules are converted into replicas of human estrogen and progesterone.
- FDA-approved. Commercial products like Estrace, Vivelle, and Prometrium undergo rigorous testing and quality control. Compounded BHT from special pharmacies lacks oversight.
- Multiple delivery methods. Bioidentical estrogens come in oral tablets, topical creams
