Menopause: Symptoms, Coping, and Duration

Menopause is the natural process that marks the end of menstrual periods and your reproductive years. In most cases, this happens roughly between the ages of 45 and 55. It is also possible to have premature menopause or induced menopause due to surgery or an injury to the ovaries.

Menopause occurs when you have not had a period for 12 consecutive months. The transitional period—starting premenopause and continuing with perimenopause—usually lasts about seven years but can be as long as 14 years.

Symptoms of menopause transition can vary from person to person, but it's common to experience lighter and less frequent periods, hot flashes, and weight gain. Treatments may be prescribed to ease specific symptoms.

This article looks at the symptoms, causes, and treatment of menopause. It also offers tips on how to cope with the physical and emotional changes you might experience.

Symptoms of Menopause

Menopause happens when your ovaries stop producing the hormones (estrogen and progesterone) that regulate your menstrual cycle. The hormonal fluctuations that happen prior to and during this time can cause various symptoms.

People experience the transition into menopause differently. Some may have very severe perimenopausal symptoms, while others will barely have any complaints.

The most common symptoms include:

• Irregular periods: Before periods altogether stop (referred to as amenorrhea), periods may become lighter and/or less frequent. They can also occasionally get heavier.
• Hot flashes: Also known as vasomotor symptoms, this is the sudden feeling of heat in the upper part or all of the body caused by changes in estrogen levels. They last anywhere from one to five minutes, in most cases occurring at least once per day.
• Vaginal dryness: This is also due to declines in estrogen levels, causing the vagina to lose volume and moisture and become thinner and easily irritated. Vaginal dryness can lead to painful sex, an increased risk of vaginal infections, and chronic vaginal discomfort.
• Emotional symptoms: Because hormones influence emotions, rapidly shifting levels can cause mood swings, anxiety, or depression.
• Sleep disturbances: Declines in estrogen are linked with poorer sleep quality. Hot flashes can cause abrupt sleep disruptions and insomnia.
• Weight gain: The loss of estrogen shifts fat distribution to the waistline. This type of weight gain is associated with an increased risk of heart disease.

Causes

Menopause occurs when menstruation ceases and the ovaries no longer release an egg every month (known as ovulation). This can occur naturally or be accelerated by other conditions.

There are three different ways your body can enter menopause:

• Naturally menopause: This is the most common route. It is caused by the natural depletion and aging of eggs (oocytes), of which there is a finite amount.
• Premature menopause: This is menopause before age 40. It is most often associated with autoimmune disorders that disrupt the menstrual cycle and induce amenorrhea years before what is commonly experienced.
• Induced menopause: This is caused by an injury to the ovaries, usually related to medical procedures like surgery, chemotherapy, or radiation. Unlike the other forms of menopause, induced menopause usually happens abruptly with sudden, intense symptoms.

Duration of Menopause

The transition to menopause can start at different ages and differ in how long it takes for menstrual periods to stop a full 12 months.

At What Age Does Menopause Start?

Menopause usually happens around age 52 but is perfectly normal between the ages of 40 and 58.

There are many factors that can influence when menopause starts, including:

• Genetics: Genes and heredity are thought to influence the timing of menopause in 50% of cases.
• Age of first period: Females who experience their first period (menarche) at an early age also tend to enter menopause earlier.
• Oral contraceptives: The use of birth control pills is associated with late menopause.
• Pregnancy history: Having a first pregnancy at an older age is associated with later menopause.
• Body mass index (BMI): Being underweight (defined as a BMI less than 18.5) is linked to early menopause, while having obesity (BMI 30 or higher) is linked to late menopause.
• History of smoking: Smoking 14 or more cigarettes a day can lead to early menopause (almost three years earlier than those who do not smoke).

How Long Does Menopause Last?

As with the onset of menopause, the duration of the perimenopause can vary, lasting anywhere from seven years to 14 years.

While many of the factors that influence the age of onset also influence the duration of perimenopause, the one factor that appears the most influential is the age of menarche.

A 2017 study from the University of Michigan School of Public Health reported that having your first period at a very young age increases the duration of perimenopause by as much as four years compared to having it at an older age.

Treatment

Despite the symptoms it can cause, menopause is a normal process and doesn't need to be treated unless the symptoms are disrupting your quality of life and well-being.

Medical options include:

• Estrogen replacement therapy (ERT): This is effective for treating hot flashes and can also help prevent bone loss. Even so, ERT needs to be managed as long-term estrogen use is linked to an increased risk of heart disease and breast cancer, 
• Vaginal estrogen: Vaginal dryness along with painful sex can be eased by applying estrogen to the vagina using a vaginal cream, suppository, or ring.
• Prescription oral drugs: Other medications for hot flashes include Neurontin (gabapentin), Kapvay (clonidine), Veozah (fezolinetant), and a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). 

Home Remedies

Menopause symptoms can also be managed with simple lifestyle changes and home remedies, including:

• Well-balanced diet: A low-fat diet combined with a higher intake of protein and calcium is beneficial in postmenopausal females. Some experts endorse a Mediterranean diet to reduce the risk of heart disease.
  
• Regular physical activity: This not only includes aerobic activities that reduce your risk of heart disease but resistance training to prevent muscle thinning that commonly occurs when hormone levels are decreased.
• Vitamin D or calcium supplements: Both may help prevent osteoporosis, especially if you don't obtain enough through diet.
• Herbal remedies: Some experts endorse the use of black cohosh, red clover, Dong Quai, ginseng, kava, and evening primrose oil to treat hot flashes, although the safety and effectiveness of these remedies have not been proven.

Coping With Menopause

The age at which you approach menopause is an age that often coincides with many personal changes and stresses. You may be seeing your kids off to college, dealing with the death of a parent, taking on a leadership role at work, or worrying about your finances.

The added stress of menopause, including sleep deprivation and anxiety or depression, can add to the overall demands on your life.

To better cope with menopause:

• Discuss sex: Letting your partner know about any pain or changes you may be experiencing (including a loss of libido) can help reduce stresses that can interfere with relationships and your personal well-being.
• Explore mind-body therapies: Practices like meditation, tai chi, and yoga can help ease stress and anxiety that contributes to sleep problems and a higher perception of pain.
• Get plenty of rest: One of the best ways to deal with the challenges of menopause is to improve your sleep hygiene. This includes keeping regular sleep hours, avoiding stimulation before bedtime, and creating a conducive sleep environment.
• Get support: If you are unable to cope, do not hesitate to ask your healthcare provider for a referral to a therapist or psychiatrist who can teach coping skills and prescribe medications if needed.

Summary

Menopause marks the end of menstruation and your reproductive years. Symptoms include hot flashes, vaginal dryness, and mood swings.

Menopause normally occurs around age 50 but can happen earlier due to autoimmune diseases, medical treatments, and other causes. The transition to menopause tends to last for around seven years but may be as long as 14 years.

Estrogen replacement therapy, vaginal estrogen, improved nutrition, routine exercise, and mind-body therapies can help you better cope with the physical and emotional challenges of menopause.