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Diagnosing Menopause

Thursday, December 12th, 2013

Thousands of women enter menopause each day. With average life expectancy increasing, the average woman will live out a third of her life after menopause. Menopause begins anywhere between 48 and 55 years old, but the average is 52. What does it mean to enter menopause, though, and what changes lead up to the official beginning of menopause?

Estimating when menopause will begin is more important than simply predicting the final menstrual period (FMP). In the year leading up to this, bone loss accelerates and cardiovascular risk factors increase. Until fairly recently, there was no reliable way to predict when the FMP would occur. Now, we are beginning to learn ways to estimate whether a woman is within a year or two of her FMP. These models are not used in clinical settings yet, but work in this area is promising.

Perimenopause begins several years (four, on average) before menopause. This is a transitional stage that includes several physiologic changes, including:

1. Irregular menstrual periods. A woman’s menstrual cycle undergoes marked changes in the years leading up to menopause. Typically this is a gradual lightening and spacing out of periods, but it can include heavier, more frequent periods, or sporadic combination of both.  

2. Hot flashes. Hot flashes are an extremely common symptoms of menopause, occurring in up to 80 percent of women.  These generally last several minutes and are characterized by a sudden sensation of heat that spreads out from the chest and face. Sweating and heart palpitations can accompany hot flashes, which are sometimes followed by feeling cold and shivering. Hot flashes may occur less often than daily, or they may occur several times in one day. They happen particularly often at night.

3. Sleep disturbances. Sometimes, hot flashes cause sleep problems, but often, sleep problems occur even without hot flashes. Feelings of anxiety or depression may contribute to sleep disturbances.

4. Vaginal dryness. As estrogen decreases, the vaginal lining thins, resulting in atrophic vaginitis, which can cause vaginal dryness, itching, and dyspareunia (painful intercourse) due to insufficient natural lubrication. A water-based lubricant can easily solve this problem.

5. Depression. Perimenopausal women are more likely to experience depression than premenopausal women, and sometimes this is new-onset depression. Then, in early postmenopause, the risk decreases.

Other symptoms can be present during the menopausal transition, including problems with sexual function, cognitive changes such as memory loss or difficulty concentrating, joint aches and pains, breast tenderness, headaches, and long-term issues such as bone loss and the increased risk of cardiovascular disease. A woman may experience only one or two menopausal symptoms or she may get every symptom in the book.

After several years of menstrual irregularity, menses eventually ceases altogether. Clinical menopause is defined as the absence of menstrual periods for at least six months. All of the symptoms of menopause can be treated and quality of life improved. Talk to your doctor about treatments for individual symptoms, or the possibility of hormone replacement therapy. You can also find more information on this topic in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.