Menopause is the time that marks the end of your menstrual cycles. It’s diagnosed after you’ve gone 12 months without a menstrual period. Menopause can happen in your 40s or 50s, but the average age is 51 in the United States.
Menopause is a natural biological process. But the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt your sleep, lower your energy or affect emotional health. There are many effective treatments available, from lifestyle adjustments to hormone therapy.
In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Sleep problems
- Mood changes
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Loss of breast fullness
Signs and symptoms, including changes in menstruation can vary among women. Most likely, you’ll experience some irregularity in your periods before they end.
Skipping periods during perimenopause is common and expected. Often, menstrual periods will skip a month and return, or skip several months and then start monthly cycles again for a few months. Periods also tend to happen on shorter cycles, so they are closer together. Despite irregular periods, pregnancy is possible. If you’ve skipped a period but aren’t sure you’ve started the menopausal transition, consider a pregnancy test.
When to see a doctor
Keep up with regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause.
Preventive health care as you age may include recommended health screening tests, such as colonoscopy, mammography and triglyceride screening. Your doctor might recommend other tests and exams, too, including thyroid testing if suggested by your history, and breast and pelvic exams.
Always seek medical advice if you have bleeding from your vagina after menopause.
Bleeding after menopause :is it normal?
Menopause is the end of menstruation. In clinical terms, you reach menopause when you haven’t had a period for 12 months.
Vaginal bleeding after menopause isn’t normal and should be evaluated by your doctor.
Postmenopausal vaginal bleeding can be caused by:
- Cancer of the uterus, including endometrial cancer and uterine sarcoma
- Cancer of the cervix or vagina
- Thinning of the tissues lining the uterus (endometrial atrophy) or vagina (vaginal atrophy)
- Uterine fibroids
- Uterine polyps
- Infection of the uterine lining (endometritis)
- Medications such as hormone therapy and tamoxifen
- Pelvic trauma
- Bleeding from the urinary tract or rectum
- Excessive overgrowth of the cells that make up the lining of the uterus (endometrial hyperplasia)
The cause of your bleeding may be entirely harmless. However, postmenopausal bleeding could result from something serious, so it’s important to see your doctor promptly.
Menopause can result from:
- Naturally declining reproductive hormones. As you approach your late 30s, your ovaries start making less estrogen and progesterone — the hormones that regulate menstruation — and your fertility declines.In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually — on average, by age 51 — your ovaries stop releasing eggs, and you have no more periods.
- Surgery that removes the ovaries (oophorectomy). Your ovaries produce hormones, including estrogen and progesterone, that regulate the menstrual cycle. Surgery to remove your ovaries causes immediate menopause. Your periods stop, and you’re likely to have hot flashes and experience other menopausal signs and symptoms. Signs and symptoms can be severe, as hormonal changes occur abruptly rather than gradually over several years.Surgery that removes your uterus but not your ovaries (hysterectomy) usually doesn’t cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone.
- Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures may still be desired. Radiation therapy only affects ovarian function if radiation is directed at the ovaries. Radiation therapy to other parts of the body, such as breast tissue or the head and neck, won’t affect menopause.
- Primary ovarian insufficiency. About 1% of women experience menopause before age 40 (premature menopause). Premature menopause may result from the failure of your ovaries to produce normal levels of reproductive hormones (primary ovarian insufficiency), which can stem from genetic factors or autoimmune disease. But often no cause of premature menopause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones.
After menopause, your risk of certain medical conditions increases. Examples include:
- Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. So it’s important to get regular exercise, eat a healthy diet and maintain a normal weight. Ask your doctor for advice on how to protect your heart, such as how to reduce your cholesterol or blood pressure if it’s too high.
- Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists.
- Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). You may have urinary tract infections more often.Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help relieve symptoms of incontinence. Hormone therapy may also be an effective treatment option for menopausal urinary tract and vaginal changes that can result in urinary incontinence.
- Sexual function. Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido).Water-based vaginal moisturizers and lubricants may help. If a vaginal lubricant isn’t enough, many women benefit from the use of local vaginal estrogen treatment, available as a vaginal cream, tablet or ring.
- Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows. You may need to eat less and exercise more, just to maintain your current weight.
caffeine and menopause symptoms : Is There a Link ?
There does appear to be a link between caffeine use and certain menopause symptoms — namely, hot flashes and other symptoms related to the body’s regulation of the diameter of blood vessels (vasomotor symptoms).
Research studies on caffeine and menopause symptoms generally provide conflicting results. But, in a recent study, researchers established a link between caffeine use and bothersome vasomotor symptoms. The researchers found that postmenopausal women who regularly drank caffeinated beverages — such as coffee, tea or soda — experienced more bothersome vasomotor symptoms than did postmenopausal women who didn’t use caffeine. The same association wasn’t seen in premenopausal or perimenopausal women.
If you regularly consume caffeine and you’re troubled by hot flashes, you might consider cutting back on or eliminating caffeine from your diet to see if that eases your symptoms.
Vaginal dryness after menopause: How ti treat it ?
Vaginal dryness can be a problem for many postmenopausal women. Vaginal dryness is a hallmark sign of the genitourinary syndrome of menopause, also known as atrophic vaginitis or vaginal atrophy. With this condition, vaginal tissues become thinner and more easily irritated — resulting from the natural decline in your body’s estrogen levels during menopause.
To remedy vaginal dryness and painful intercourse (dyspareunia) associated with the genitourinary syndrome of menopause, your doctor might recommend:
- Vaginal moisturizers (K-Y Liquibeads, Replens, others), applied every few days to moisturize and keep vaginal tissues healthy.
- Vaginal lubricants (Astroglide, Jo, Sliquid, others), applied at the time of sexual activity to alleviate pain during intercourse.
- A low-dose vaginal estrogen cream, tablet or ring, to reinvigorate vaginal tissues. Even if you’re using systemic hormone therapy pills or patches, your doctor might recommend a low-dose vaginal estrogen treatment if vaginal dryness and related symptoms persist. If you’ve had breast cancer, talk with your doctor about the risks of vaginal estrogen therapy.
- Ospemifene (Osphena), a selective estrogen receptor modulator (SERM) medication taken by mouth is used to treat painful intercourse associated with vaginal atrophy. This medication isn’t recommended for women who have had breast cancer or who are at high risk of breast cancer.
- Dehydroepiandrosterone (DHEA), in the form of a nightly vaginal suppository is a treatment that may ease painful intercourse in menopausal women.
Regular sexual activity or vaginal stimulation — with or without a partner — also helps maintain healthy vaginal tissues in women after menopause.