Menopause is a normal stage in a woman’s life where the amount of hormones produced by the ovaries has declined and menstrual periods no longer occur. This change does not occur overnight, but instead is a gradual transition over several years which is called perimenopause. Perimenopause may occur in women between the ages of 40 and 50. One of the first signs of perimenopause may be a decrease in how often a woman has a menstrual period. Typically, a woman has a menstrual period every 25 to 30 days, but during perimenopause menstruation may only occur once every 40 to 50 days. As perimenopause continues, this may be followed by missing or irregular periods. The perimenopause transition may last anywhere from 3 to 5 years and also mark the appearance of additional symptoms such as:

• Hot flashes
  
• Night sweats
  
• Vaginal dryness
  
• Joint pain
  
• Mood changes
  
• Sleep disturbances 
  

The transition to complete menopause is marked by the lack of a menstrual period for at least 12 months which cannot be explained by any other medical issue such as illness, medication, pregnancy or breastfeeding. Additionally, the various symptoms of perimenopause listed above may continue into the post-menopause period.

Hormone therapy is used to treat some of the unpleasant symptoms of menopause such as hot flashes, night sweats, and vaginal dryness. Doctors may prescribe pills, creams, or skin patches containing the hormones estrogen or progesterone in order to “replace” the amount of hormones that were naturally produced by the ovaries prior to menopause. 

While the use of hormone therapy is still regarded as one of the most effective ways to control menopause symptoms, it may not be appropriate for everyone. This is because it may increase the risk of blood clots, heart attack, stroke and uterine or breast cancer in some individuals. Clinical guidelines established by the Endocrine Society suggest that you and your doctor should discuss the pros and cons of hormone replacement therapy and determine any risk factors you may have prior to establishing treatment of any kind.

Research Connection: Recently, scientists at the University of Illinois developed a chemically-modified version of estrogen which may be used to treat menopause symptoms but without the risk of uterine or breast cancer [1]. This new compound is thought to work by acting only within specific organs or tissues. While promising, much more research is needed before this compound may be tested in humans.  

As mentioned earlier, hormone therapy may not be appropriate for everyone. The good news is that there are a variety of alternative approaches to managing the symptoms of menopause. The North American Menopause Society recently reviewed the efficacy of over 20 different therapies including lifestyle changes, dietary supplements, mind-body techniques, and non-hormonal medications. They recommend the following for the treatment of night sweats and hot flashes:  

Cognitive-behavioral therapy – Studies have found that cognitive- behavioral therapy helps women cope and manage the symptoms of menopause. While the frequency of the symptoms did not decrease, the women reported a decrease in the severity of their symptoms.

Selective Serotonin Reuptake Inhibitors (SSRI) -  There is evidence that suggests treatment with SSRIs, drugs typically used to treat depression and anxiety, are effective in reducing the frequency and severity of hot flashes.
In addition, the Office on Women’s Health encourages women to maintain a healthy lifestyle by staying active, eating a balanced diet, and reducing stress to ease the discomfort of menopause symptoms. 

If you are interested in learning more about how to manage menopause, the Women’s Health Research Institute has an on-line guide with detailed explanations of the stages, symptoms, and management of menopause. In addition, we offer a menopause self-assessment tool which you can share with your healthcare provider!

Sources:

1. Madak-Erdogan et al., Sci Signal. 2016; 9(429); ra53.
   
2. Bailey et al., Menopause. 2016; Epub.
   

Author: Nicole C. Woitowich, PhD, Director of Science Outreach and Education, Women’s Health Research Institute.