- What is menopause?
- What is perimenopause?
- What is induced menopause?
- I had a hysterectomy with removal of my ovaries, so I've had a surgical menopause. How can I control the intense menopause symptoms I’m experiencing?
- What is early or premature menopause?
- I’m only 36 years old and I’ve prematurely reached menopause. What specific information do I need?
- What is postmenopause?
- How can I find a menopause specialist?
- How will my body change as menopause approaches?
- What are hot flashes?
- How long will I have hot flashes?
- What are the treatments for hot flashes?
- Is it safe to take dietary supplements to help my menopause symptoms?
- I’m having trouble sleeping and I’m tired all the time. Is this due to menopause?
- I’ve been having headaches lately. Can this be due to menopause?
- My memory is not as good as it used to be. Is this aging or is it menopause?
- Does menopause cause moodiness and depression?
- I need information about feminine dryness due to menopause.
- Since my periods have stopped, my desire for sex has decreased. Is this normal?
- Does menopause cause urine leakage?
- I’m finding it harder to lose weight now that I’m older. Is menopause to blame?
- Is there anything I can do to relieve the aching in my knees?
- Why has my skin started to sag?
- Is there anything I can do to stop my hair from thinning?
- My eyes itch and sometimes tear. How can this be treated?
- My gums are starting to recede and it hurts my teeth to eat anything cold. Is this normal?
- Heart disease
- Diabetes
- Osteoporosis
- Cancer
- What is hormone therapy?
- What are custom-compounded hormones?
- What are bioidentical hormones?
- No one in my family ever talked about menopause. Now that I’m having hot flashes, should I be afraid of what lies ahead?
- As I mature past menopause, how can I achieve the best possible health?
- Menopause Guidebook
- Early Menopause Guidebook
- Menopause Flashes® E-Newsletter
1. What is menopause? Menopause is a normal, natural event—defined as the final menstrual period and usually confirmed when a woman has missed her periods for 12 consecutive months (in the absence of other obvious causes). Menopause is associated with reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other hormones. It marks the permanent end of fertility. Menopause occurs, on average, at age 51. The years between puberty (when periods start) and menopause
are called premenopause. Learn more on page 2 2. What is perimenopause? Physical signs of menopause begin many years before the final menstrual period. This menopause transition phase is called perimenopause (literally meaning “around menopause”). It can last 6 years or more, and ends
1 year after the final menstrual period. Learn more on page 3 3. What is induced menopause? Induced menopause, which can occur at any age between the first and last periods, is when menstrual periods stop due to a medical intervention, surgical removal of both ovaries, or sometimes cancer treatments. Learn more on page 4 4. I had a hysterectomy with removal of my ovaries, so I've had a surgical menopause. How can I control the intense menopause symptoms I’m experiencing? Symptoms related to medically induced menopause can be similar to those from natural menopause, including hot flashes, sleep disturbances, and vaginal dryness. But premenopausal women who experience induced menopause are faced with menopause and its effects without the gradual adjustment time of perimenopause. The abrupt loss of estrogen may result in more sudden and intense symptoms. Women who experience induced menopause usually have a greater need for treatment to control their menopause-associated symptoms than women who undergo natural menopause. And because these women are often younger, they need ongoing monitoring and sometimes treatment to lower the risk of menopause associated diseases such as osteoporosis later in life. As such, you have special healthcare needs, and NAMS has developed the Early Menopause Guidebook just for you. Learn more in the Early Menopause Guidebook 5. What is early or premature menopause? Menopause, whether natural or induced, is called premature when women reach it at age 40 or younger. Premature menopause can be genetic, the result of one or more poorly understood autoimmune processes, or it can be induced with a medical intervention. Learn more on page 5 6. I’m only 36 years old and I’ve prematurely reached menopause. What specific information do I need? Women experiencing premature menopause (age 40 or younger) that is not medically induced go through perimenopause and may have the same symptoms as women with natural menopause, including hot flashes, sleep disturbances, and vaginal dryness. However, compared to women who reach menopause at the typical age, women who experience premature menopause—whether natural or induced— spend more years without the benefits of estrogen and are at greater risk for some health problems later in life, such as osteoporosis and heart disease. As such, you have special healthcare needs, and NAMS has developed the Early Menopause Guidebook just for you. Learn more in the Early Menopause Guidebook 7. What is postmenopause? Postmenopause is all the years beyond menopause. Learn more on page 32 8. How can I find a menopause specialist? The North American Menopause Society maintains referral lists on this Web site for those women in the United States or Canada who are searching for physicians and other healthcare providers interested in helping them manage their health through menopause and beyond. Similar lists are maintained for those women who wish to join a menopause discussion (support) group. Those who have passed a competency examination leading to the prestigious credential of NAMS Menopause Practitioner are highlighted on the referral lists. View the NAMS Referral Lists 1. How will my body change as menopause approaches? Each woman’s menopause experience is different. The greatest differences observed are between women who have natural menopause and those whose menopause is early or induced, which typically requires specialized care. Many women who have natural menopause report no physical changes at all during the perimenopausal years except irregular menstrual periods that eventually stop when menopause is reached. In addition to irregular menstrual periods, some women experience symptoms of hot flashes, difficulty sleeping, and/or vaginal dryness. The severity of these changes varies from woman to woman, but for the most part, they are perfectly natural and normal. In fact, some experts and women prefer not to call perimenopausal changes “symptoms,” a term usually reserved to describe diseases. Learn more on page 7 2. What are hot flashes? The most common menopause-related discomfort is the hot flash (sometimes called a hot flush). Although their exact cause is still a matter of speculation, hot flashes are thought to be the result of changes in the hypothalamus, the part of the brain that regulates the body’s temperature. If the hypothalamus mistakenly senses that a woman is too warm, it starts a chain of events to cool her down. Blood vessels near the surface of the skin begin to dilate (enlarge), increasing blood flow to the surface in an attempt to dissipate body heat. This produces a red, flushed look to the face and neck in light-skinned women. It may also make a woman perspire to cool the body down. An increased pulse rate and a sensation of rapid heart beating may also occur. Hot flashes are often followed by a cold chill. A few women experience only the chill. Learn more on page 11 3. How long will I have hot flashes? Good news! Hot flashes typically stop on their own over time, and may not require any treatment. If treatment is needed, hot flashes can usually be reduced or eliminated completely. Learn more on page 12 4. What are the treatments for hot flashes? The best treatment depends on how severe the hot flashes are, how much they interfere with a woman’s quality of life, her personal philosophy and preferences, and her health profile. If treatment is needed, hot flashes can usually be reduced or eliminated completely with lifestyle changes, nonprescription remedies, and prescription therapies. Systemic estrogen therapy is the only
therapy approved by the U.S. Food and Drug Administration (FDA)—and Health Canada—for treating hot flashes. Learn more on page 12 5. Is it safe to take dietary supplements to help my menopause symptoms? Supplements and prescription drugs have a lot in common. Both are used in an attempt to improve health. But “natural” remedies marketed as “dietary” supplements (including even topical progesterone cream and other nonprescription hormone treatments) are missing something their prescription counterparts come with—a Patient Package Insert. This document, required by the U.S. Food and Drug Administration (FDA) for all marketed prescription medications, provides vital information on how to take a drug safely, identify its negative side effects, and avoid potentially dangerous interactions with other drugs. In Canada, all natural health products require an eight-digit product license number before they can be sold. Homeopathic medicine that is approved will have a license number beginning with NPN-HM, indicating to consumers that the product has been reviewed and approved by Health Canada for safety and efficacy. When purchasing supplements, it is preferable to choose specific brands that have been tested in clinical trials. Last but not least, proceed with caution. Consulting a healthcare provider is advisable prior to using any supplement. Learn more on page 13 6. I’m having trouble sleeping and I’m tired all the time. Is this due to menopause? Some women experience sleep disturbances (insomnia) around menopause, especially if hormone changes provoke hot flashes during the night. Sleep is adequate when one can function in an alert state during desired waking hours. Most adults require 6 to 9 hours of sleep each night. Treatment of sleep disturbances should first focus on improving sleep routine with good sleep hygiene. When lifestyle changes fail to alleviate sleep disturbances, a clinician should be consulted to discuss other options and to rule out sleep disorders, such as thyroid abnormalities, allergies, anemia, restless leg, depression, or sleep apnea (breathing problems). Learn more on page 15 7. I’ve been having headaches lately. Can this be due to menopause? Studies suggest that hormones may play a role in headaches. Women at increased risk for hormonal headaches during perimenopause are those who have already had headaches influenced by hormones, such as those with a history of headaches around menstrual periods or when taking oral contraceptives. Hormonal headaches typically stop when menopause is reached and hormone levels are consistently low. Most headaches do not require treatment or can be treated with nonprescription pain medications. Some headaches, however, can be serious. More serious headaches, including migraines, may require prescription drugs. Learn more on page 15 8. My memory is not as good as it used to be. Is this aging or is it menopause? There is no firm evidence that memory or other cognitive skills actually decline because of natural menopause. However, difficulty remembering and concentrating are common complaints during perimenopause and the years right after menopause. More research is needed to determine the cause of these complaints. Although studies are lacking to prove the association, sleep disturbances and hot flashes may contribute to these symptoms, as well as dealing with various midlife stressors. Remaining physically, socially, and mentally active may help prevent memory loss. Women who are concerned about declining cognitive performance are advised to consult with their healthcare provider. Learn more on page 16 9. Does menopause cause moodiness and depression? Few scientific studies support the belief that menopause contributes to true clinical depression, severe anxiety, or erratic behavior. However, some perimenopausal women report symptoms of tearfulness, mood swings, and feeling blue or discouraged. It is unclear whether these mood symptoms are related to the gradual decline in ovarian hormone levels, but sleep deprivation associated with night sweats often results in fatigue, irritability, and moodiness. Abrupt hormonal fluctuations during perimenopause may have an impact on these symptoms as well. During their reproductive years, most women become accustomed to their own hormonal rhythm. During perimenopause, this rhythm changes, and the erratic hormonal ups and downs—although normal—can create a sense of loss of control that can be upsetting. Sometimes, coping skills and lifestyle changes are not sufficient to relieve symptoms of stress. These symptoms may be a side effect of medication, a symptom of a medical condition, or the result of clinical depression or anxiety. A healthcare provider can help determine the cause of mental health stressors, assess options, and prescribe appropriate treatment. Learn more on page 17 10. I need information about feminine dryness due to menopause. During their life, at least one-third of all women will experience some troubling symptoms in the vulvovaginal area (external female genitals and vagina). These symptoms range in severity from mildly annoying to debilitating—and include vaginal discharge, irritation, burning, dryness, itchiness, and pain (both with and outside of sexual activity). There are many possible causes of vulvovaginal symptoms. Women around the time of menopause should not assume that vulvovaginal problems are due to reduced estrogen levels. Symptoms should be investigated by a clinician to identify the cause and possible treatment. A thorough, regular evaluation of vulvovaginal health is recommended to all women at menopause and beyond, regardless of whether or not they have symptoms or are sexually active. Learn more on page 19 11. Since my periods have stopped, my desire for sex has decreased. Is this normal? Sexual feelings and activities are a natural part of living. Many women remain sexually active throughout their postmenopausal years. In general, sexual desire (sex drive) decreases with age in both sexes, but each individual is different. Although some experience a significant decline in desire, a few have increased interest, and others notice no change at all. Research shows, however, that sexual problems are common for both women and men of all ages, with women being two to three times more likely than men to be affected by low desire. Low sexual desire is especially common in relationships of long duration. A clinical evaluation can help to identify any underlying medical or psychological causes of low sexual desire, which can then be treated as appropriate for each individual woman. Learn more on page 21 12. Does menopause cause urine leakage? Urinary symptoms, including incontinence (persistent, involuntary leaking of urine), become more common with aging. Women are much more prone to the occasional episode of urine leakage than men. These symptoms may be partially affected by menopause. As menopause approaches and during the years that follow, lack of estrogen can cause thinning of the lining of the urethra, the outlet for the bladder. With aging, the surrounding pelvic muscles may weaken. As a result, women are at increased risk for urinary incontinence. Learn more on page 25 13. I’m finding it harder to lose weight now that I’m older. Is menopause to blame? In their 40s and 50s, women often gain weight, and they sometimes attribute this gain to menopause. Midlife weight gain appears to be mostly related to aging and lifestyle, but menopause also contributes to the problem. In general, fewer calories are needed after midlife because less energy is expended. Whether weight gain is linked to menopause itself and/or age, the important thing is that studies shows that weight gain around menopause years can be prevented by exercise and diet—by minimizing fat gain and maintaining muscle, thereby reducing body size and burning more calories. Learn more on page 28 14. Is there anything I can do to relieve the aching in my knees? Sometimes the joints are just achy or stiff from overuse, but a woman’s healthcare provider should be consulted to rule out arthritis, a more serious joint disease. Maintaining a healthy weight will help with achy knees. Mild pain can often be managed with acetaminophen (Tylenol), while more severe pain may require an anti-inflammatory drug such as ibuprofen (Advil, Motrin), although long-term use of anti-inflammatory drugs may lead to ulcers. In addition, long-term use of the supplement glucosamine has been shown to relieve joint pain in some studies with no serious side effects (although women with seafood allergy should avoid it). A wide variety of prescription therapies are also available. Learn more on page 29 15. Why has my skin started to sag? Aging skin undergoes normal loss of collagen and elasticity, which creates slight sags and wrinkles. It also becomes more dry and flaky. Hormones play an important role in skin health. Diminished levels of estrogen at menopause contribute to a decline in skin collagen and thickness, which is more rapid in the years right after menopause than in later ones. Estrogen therapy may have beneficial effects on skin, but it cannot reverse genetic aging or sun damage, or change any risk of skin cancer. Due to potential risks, estrogen therapy should never be used solely for its beneficial effect on skin. Learn more on page 29 16. Is there anything I can do to stop my hair from thinning? Aging increases the likelihood that hair will become gray and more brittle. In addition, excessive hair growth (hirsutism) may occur in areas of the body where hair follicles are especially androgen-sensitive, such as the chin, upper lip, and cheeks. The menopause-related shift in the balance between androgen and estrogen can also result in the opposite effect—hair loss. Eating a healthy diet, adding a daily multivitamin, and avoiding harsh chemicals and sunlight that dry the hair will help keep hair healthy. For mild hirsutism, treatments include plucking, waxing, shaving, bleaching, electrolysis, and laser treatment. Treating severe hirsutism or hair loss can be more of a challenge because the cause is often difficult to determine. Consulting a dermatologist is advised. Learn more on page 30 17. My eyes itch and sometimes tear. How can this be treated? After menopause, some women report chronically dry and scratchy eyes, often along with light sensitivity, blurred vision, increased tearing, or swollen or reddened eyelids—a condition called chronic dry eye. This condition can occur in climates with dry air, as well as from certain diseases (such as Sjögren’s syndrome) and with the use of some drugs (such as allergy medications and antidepressants). Consult your healthcare provider about the therapies available to help provide relief. Learn more on page 31 18. My gums are starting to recede and it hurts my teeth to eat anything cold. Is this normal? With aging come increased dental problems, including tooth loss, need for dentures, gum recession, higher risk of gum tissue injury, “burning” mouth and tongue, general hot and cold tooth sensitivity, and decreased bone mineral density (BMD) in the jawbone. While some of these problems are related to estrogen decline at menopause, other causes include advancing age, inadequate intake of calcium and vitamins, medication side effects, and medical conditions such as anemia or diabetes. Practicing good oral hygiene is extremely important. Brushing and flossing daily, regular dental checkups, and professional dental cleaning twice yearly are all recommended. A woman’s primary healthcare provider should be advised of any changes observed by her dental professional, as some of these changes can be indicators of serious health problems elsewhere in the body. Learn more on page 31 1. Heart disease Many women think of heart disease as a man’s disease. In reality, diseases of the heart and circulatory system (cardiovascular diseases) are the number one killer of women in North America. After age 55, more than half of all deaths in women are caused by cardiovascular disease. Risk for this disease increases after menopause. Learn more on page 32 2. Diabetes With diabetes, either the body doesn’t produce enough insulin or the cells aren’t able to use the insulin, or a person is so overweight that normal insulin production is inadequate. Insulin transports the glucose from circulating blood into the cells. This is necessary for the body to utilize glucose (sugar), the basic fuel for the cells. When glucose doesn’t go into the cells, it builds up in the blood. If a fasting blood glucose level is above 126 mg/dL (7.0 mmol/L), diabetes is diagnosed. Learn more on page 35 3. Osteoporosis Postmenopausal osteoporosis is a skeletal disorder in which bone strength has weakened to a point where the bone is fragile and at higher risk for fractures. Bone strength and thus fracture risk are dependent on both bone quality and bone mineral density. Risk for this disorder increases after menopause. Learn more on page 36 4. Cancer Menopause is not associated with increased cancer risk. However, some cancer rates typically increase with age, so postmenopausal women should be informed about the most common cancers that may affect them. Also, some of the therapies used to treat menopause symptoms are associated with an increased or a decreased risk for certain types of cancer. Learn more on page 41 1. What is hormone therapy? Several prescription drugs are available to help relieve menopause-related symptoms and decrease long-term health risks across the menopause transition and beyond. Hormone therapies are the prescription drugs used most often when treating menopause symptoms. - Estrogen therapy (ET) has been widely studied and used for more than 50 years by millions of women. Many kinds of estrogen therapy are available in the United States and Canada to treat menopause-related symptoms. A variety of estrogen types, delivery systems, and dosage strengths give each woman a better chance to find which option is best for her.
- Progestogen, another hormone, has sometimes been used alone during perimenopause to treat symptoms such as hot flashes, to manage abnormal uterine bleeding, or to counter “estrogen dominance” that can occur in some women as estrogen levels fluctuate to high levels during this transition. There are various progestogen options, and they allow tailoring to a woman’s unique needs.
- Combined estrogen-progestogen therapy (EPT) with various dosing schedules (often called “regimens”) can also be used for menopause-related symptoms. These regimens include taking estrogen and progestogen separately or through convenient combination EPT products. Each woman should feel comfortable exploring different options with her clinician to determine which is best for her.
Learn more on page 47 2. What are custom-compounded hormones? Recently, there has been increased interest in custom-mixed (“custom-compounded”) hormone products—recipes containing one or more of various hormones in differing amounts, depending on the individual prescriber’s order. The recipe contains not only the active hormone (or hormones), but also other ingredients that either hold everything together (in the case of a rectal suppository, an under-the-tongue tablet, or an under-the-skin pellet) or provide a vehicle for applying the product onto the skin (such as a cream or gel) or into the body (such as a liquid for a nasal spray). These custom products have the benefit of individualized doses and mixtures of products that are not available commercially. However, risks have also been identified. Although the “active ingredients” (the raw estrogen and/or progestogen components) are government approved, the mixtures are not, because they have not been studied to confirm that they are absorbed appropriately or provide predictable levels in blood and tissue. Thus, there is little or no scientific evidence about the effects of these hormones on the body, either good or bad. Learn more on page 52 3. What are bioidentical hormones? Sometimes custom-compounded hormones are referred to as “bioidentical hormones” or “natural hormones.” These terms mean different things to different people. To scientists and healthcare providers, bioidentical hormones are those that are chemically identical to the hormones produced by women (primarily in the ovaries) during their reproductive years. A woman’s body can make various estrogens (such as 17beta-estradiol, estrone, and estriol) as well as progesterone, testosterone, and other hormones. Thus, bioidentical hormone therapy can mean a medication that provides one or more of these hormones as the active ingredient. Learn more on page 47 1. No one in my family ever talked about menopause. Now that I’m having hot flashes, should I be afraid of what lies ahead? Menopause is a fact of life that affects every woman around the world. However, the physical and mental impact of this physiologic inevitability varies both within and across all cultures. There is no universal menopause experience. But, for all women, menopause can mark the beginning of an exciting new time of life. Learn more on page 62 2. As I mature past menopause, how can I achieve the best possible health? Regular clinical checkups will help a woman achieve optimal health. The checkups can identify any health conditions that need to be addressed. For example, regular mammograms are important for women over 40. Pap tests are also recommended, even after menopause. Height measurements detect loss of height, possibly an indicator of osteoporosis. Blood, urine, and other tests can help to screen for existing or increasing risk of various diseases, such as diabetes, heart disease, and thyroid disease. Learn more on page 57 If you’d like to know even more about menopause, consult these educational resources developed by NAMS.
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