What is menopause?
Menopause is a natural, biological stage in a woman's life. It occurs when a woman stops having her monthly period, and it marks the end of her reproductive years. Menopause typically occurs when a woman is in her late 40s to early 50s; however, women who have their ovaries surgically removed undergo "sudden" menopause.
The changes associated with menopause occur when the ovaries begin to stop functioning. The ovaries are the reproductive glands that store eggs and release them into the fallopian tubes. They also produce the female hormones estrogen and progesterone. Together, these hormones control menstruation. Estrogen also influences how the body uses calcium and maintains cholesterol levels in the blood.
As menopause nears, the ovaries begin to deplete their store of eggs. Eventually, the ovaries no longer release eggs into the fallopian tubes and the woman has her last menstrual cycle. The ovaries also stop most of their production of estrogen and progesterone. Low estrogen levels lead to unpleasant, short-term effects, as well as an increased risk to a woman's long-term health.
What are the short-term effects of menopause?
Each woman's experience with menopause is unique. Some women experience few symptomatic effects, while others suffer significant discomfort. Although the short-term effects related to menopause can be traced directly to the decrease in hormones, stress can add to the problem by increasing the severity of the symptoms. Common short-term effects of menopause include:
- Hot flashes: A hot flash is a sudden sensation of heat that spreads from the chest to the head, often followed by sweating and cold shivering.
- Night sweats: Essentially, night sweats are hot flashes that occur during sleep. In some cases, the sweating is intense enough to soak the woman's clothing and bed sheets.
- Difficulty sleeping: Some of this can be the result of night sweats, which can disturb sleep.
- Vaginal changes: With decreased estrogen, the vagina becomes thinner, drier, and less elastic. It may take longer to become lubricated during sexual arousal, and the vagina becomes more vulnerable to infection.
- Changes in sex drive: It is not clear if menopause affects sex drive directly, or if sex becomes uncomfortable and less desirable due to changes in the vagina.
- Mood changes: These may include irritability, anxiety, and mood swings.
- Urinary changes/stress incontinence: A loss of muscle tone in the bladder can lead to the involuntary leaking of urine, especially when laughing and coughing. The urinary tract is also more susceptible to infection.
- Skin changes: The skin may become drier, thinner, and less elastic.
- Other changes: Other effects include headaches, heart palpitations (rapid or pounding heartbeat), increased facial hair, and poor concentration or memory.
What long-term health risks are associated with menopause?
The decrease in estrogen that occurs with menopause can have an effect on nearly every body system. The long-term risks—most notably an increased risk for osteoporosis and heart disease—can have a major impact on a woman's overall health and quality of life.
- Osteoporosis: Osteoporosis—also called "brittle bone" disease—occurs when the bones become less dense, making them more fragile and more likely to fracture. Estrogen plays an important role in preserving bone mass. Estrogen signals cells in the bones to stop breaking down. Women lose an average of 25 percent of their bone mass from the time of menopause to age 60, due in part to the loss of estrogen. Over time, this loss of bone can lead to bone fractures (breaks).
- Coronary artery disease: Coronary artery disease (CAD) is the narrowing or blockage of arteries that surround the heart muscle. It results when fatty plaque builds up in the artery walls (known as atherosclerosis). This buildup is associated with high levels of cholesterol in the blood. After menopause, a woman's risk for coronary artery disease increases. This increase may be linked to the loss of estrogen. Estrogen helps maintain healthy levels of cholesterol in the blood. It also may improve blood flow to the heart muscle and reduce blood-clotting factors, if started in women with normal arteries.
The loss of estrogen after menopause has been linked to a number of other health problems that become more common as women age. After menopause, women are more likely to suffer from:
- Poor bladder function
- Poor brain function (increased risk of Alzheimer's disease)
- Poor skin elasticity (increased wrinkling)
- Poor muscle power and tone
- Some deterioration in vision, such as from cataracts (clouding of the lens of the eye) and macular degeneration (scarring of the tiny spot in the center of the retina that is the center of vision)
- Some weight gain
What can I do to manage the changes and risks associated with menopause?
Hormone replacement therapy (HRT) is a treatment program in which a woman takes estrogen and progestin (a synthetic form of progesterone) to relieve menopause symptoms. It also reduces the risk of osteoporosis and other conditions that become more common after menopause. However, HRT can have serious side effects and has been shown to increase a post-menopausal woman's risk of developing breast cancer. It is very important to weigh the benefits and risks when considering HRT.
There are other steps a woman can take to treat her menopause symptoms and help ensure her long-term health:
- Eat a nutritious, well-balanced diet. Restrict your calories to maintain a healthy weight. Restrict fat intake to no more than 30 percent of your total calories, especially for cholesterol and saturated fat. Eat a diet rich in fiber and lots of green vegetables.
- Consume at least 1,000 to 1,500 milligrams of calcium a day (one glass of milk contains about 300 mg of calcium) and 1,000 IU of vitamin D3 daily.
- Limit your consumption of caffeine, sugar, salt, and alcohol.
- Quit smoking.
- Exercise regularly. Choose exercises that require your muscles to work against gravity (weight-bearing exercises), such as walking or jogging.
- Treat vaginal dryness with water-soluble lubricants such as Astroglide® or K-Y Jelly®. Do not use non-water soluble lubricants such as Vaseline ® because they can weaken latex (the material used to make condoms).
- Dress in layers that you can remove during a hot flash. Use cotton clothing, lingerie, and bed sheets to allow your skin to breathe.
- If you cannot or will not take hormone therapy, talk to your doctor about alternative treatments.
For more information, see Dr. Holly L. Thacker’s book, "The Cleveland Clinic Guide to Menopause," available from Kaplan Publishing. Dr. Thacker is director of the Women's Health Center at Cleveland Clinic.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic 216.444.3771 or toll-free 800.223.2273 extension 4-3771 or visit www.clevelandclinic.org/health. This document was last reviewed on: 2/21/2008
