Menopause, is when a woman stops menstruating. It is a natural event, not a disease or illness. However, for some women the physical and emotional symptoms can be difficult.
Menopause involves hormonal changes that may cause physical symptoms. The ovaries stop producing female sex hormones (estrogen and progesterone), and estrogen levels decline over several years. That decline can cause:
For some women, menopause may bring on feelings of sadness. However, it is important to remember that menopause does not mean an end to your sexuality, or that you are any less feminine. In fact, some women find the years after menopause to be a time of freedom, when they no longer have to think about having a period or becoming pregnant.
Today, an estimated 50 million women in the United States have reached menopause. Most women will spend at least one-third of their lives in or beyond menopause.
Technically, menopause is considered complete when a woman has not had a period for an entire year. On average, menopause occurs at age 51, but it varies from person to person. Because menopause is a process that happens over several years, it is divided into two phases:
Another type of menopause, known as surgical menopause, happens if both ovaries are removed for medical reasons. This may be done if you have a hysterectomy, the removal of the uterus.
After menopause, women lose the protective effects of estrogen and are at increased risk for osteoporosis and heart disease. There are a variety of treatments available, however, to help ease the symptoms and reduce health risks associated with menopause.
Symptoms of menopause vary from woman to woman. Some studies suggest that the signs and symptoms of menopause may vary between cultural groups. For example, up to 80% of American women experience hot flashes while only 10% of Japanese women have that symptom. Some researchers think that may be due to differences in diet, lifestyle, or cultural attitudes toward aging.
The following are general symptoms of menopause:
Post menopausal women are at increased risk for:
Menopause is caused by a gradual reduction in the amount of estrogen and progesterone made by the ovaries. Both hormones regulate your periods and enable you to become pregnant. In the years leading up to menopause, the ovaries start to produce lower amounts of estrogen and progesterone. The timing of menopause can vary greatly from woman to woman. Studies indicate that women who smoke may reach menopause 1 to 2 years earlier than those who do not smoke. Women who have a greater number of children tend to have a later menopause. In the U.S., African American and Hispanic women tend to go through menopause 2 years earlier than Caucasian women. Studies also suggest that the timing of menopause may be hereditary. By age 58, 97% of women have gone through menopause.
Although menopause usually happens naturally, it can happen through surgical removal of the ovaries (surgical menopause). Menopause can also be caused by ovarian failure from cancer treatments, such as chemotherapy or radiation.
Menopause is part of the natural aging process for all women, unless it is caused by surgical removal of both ovaries. Surgical menopause typically causes symptoms to come on more quickly. The following risk factors may also make menopausal symptoms occur faster:
Most women will notice the signs that they are going through menopause. However, if you start to skip periods suddenly, you should see your doctor for a pregnancy test. It is possible to become pregnant when going through perimenopause, as long as you are having periods, even if they are irregular, you can get pregnant. In some cases, your doctor may order blood tests to check hormone levels. Your doctor may also suggest a bone density measurement. If you have moderate or severe symptoms that interfere with your life, talk to your doctor about what treatments might be right for you.
Although you cannot prevent menopause, you can take action to reduce your risk of complications, such as osteoporosis and heart disease:
Menopause itself does not need treatment, but you may want to treat some symptoms and reduce your risk of long-term medical conditions, such as heart disease and osteoporosis, that are more common after menopause. Many treatment options are available, so it is important to discuss them with your doctor.
In the past, a number of women took hormone replacement therapy (HRT), which consists of supplemental estrogen and progesterone. Those without a uterus (womb) sometimes took (ERT), which consists of estrogen alone. Only women who have had a hysterectomy usually take ERT, because taking estrogen without progesterone increases the risk of uterine cancer.
Taking HRT seemed to help reduce symptoms such as hot flashes, and researchers also believe it reduced a woman's risk for heart disease. But an important 2002 study, the Women's Health Initiative (WHI), found that HRT and ERT posed more risks than benefits. That study showed that women who took HRT for several years had an increased risk of:
Women who took ERT for more than 7 years had a greater risk of stroke.
While the WHI did not find a greater risk of breast cancer among women who took ERT for 7 years, other studies have found a slightly increased risk at 10 years. Right now the evidence shows that taking estrogen long term slightly increases the risk for breast cancer, and taking it with progesterone increases the risk more.
Researchers have begun new studies to look at HRT, but the results are not known yet. The WHI looked at women who were already past menopause, the average age was 63, so researchers do not know if the same results would apply to women who took HRT early in menopause, and for a shorter period of time. Currently, the decision about whether to take HRT is an individual one. If your menopause symptoms are so severe that they interfere with your daily life, talk to your doctor about the risks and benefits of using HRT for a short period of time.
The discussion becomes even more complicated when you introduce the subject of Bioidentical Hormone Replacement Therapy (BHRT) versus conventional HRT. Researchers and clinicians disagree on the pros and cons of each approach. People should educate themselves and consult a knowledgable physician to help them make decisions about:
In addition, there are non-hormonal medications and non-drug therapies that can help reduce your symptoms and lower your risk for long-term medical problems that sometimes occur after menopause.
The benefits of exercise include:
Eating a healthy, well-balanced diet can help reduce the risks and discomforts associated with menopause. A diet low in saturated fat and cholesterol, for example, may reduce your risk of heart disease by providing the following benefits:
Some evidence suggests that eating soy-based foods, such as tofu, might help reduce certain symptoms of menopause, including hot flashes. Adding plenty of calcium and vitamin D to your diet should help prevent bone loss. Foods rich in calcium include:
High-fiber foods may also help lower your risk of high cholesterol and heart disease.
Several medications are available to treat the symptoms of menopause, and to help you maintain your health as you grow older. These include:
The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner. Treatments used to relieve menopause symptoms vary in their effectiveness from woman to woman. As with prescription medication taken to relieve menopause symptoms, some women may find relief with complementary therapies while others may not. Such herbs include:
The following herbs are also sometimes suggested to relieve symptoms such as hot flashes, vaginal dryness, and mood swings, although evidence is mixed or lacking. Like soy, they may contain plant-based estrogens (phytoestrogens) that could act like estrogen in the body and possibly raise the risk of breast cancer. Talk to your doctor before taking these herbs:
In the past, wild yam (Dioscorea villosa) has sometimes been mentioned as a treatment for menopausal symptoms, because hormones including progesterone were manufactured from wild yam in the 1960s. However, studies show that the body is not able to convert wild yam into progesterone, so it is not likely to relieve menopausal symptoms.
Several studies show acupuncture may help many women with symptoms of menopause, particularly with hot flashes and mood changes.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of menopause based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Some studies suggest that learning to relax the body (through slow, deep breathing) may reduce the intensity of hot flashes.
As estrogen levels decline during menopause, a woman's risk of developing the following conditions may increase:
Menopause is part of the natural aging process for all women. There are many therapies available, however, to help ease the symptoms and reduce health risks associated with menopause. Selecting the right treatment can minimize discomfort and maximize the opportunities for a vital, healthy, satisfying life during and after menopause.
Al-Azzawi F, Palacios S. Hormonal changes during menopause. Maturitas. 2009;63(2):135-7.
Bai W, Henneicke-von Zepelin HH, Wang S, Zheng S, Liu J, Zhang Z, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: a randomized, double blind, parallel-controlled study versus tibolone. Maturitas. 2007 Sep 20;58(1):31-41.
Bope & Kellerman. Conn's Current Therapy 2013. 1st ed. Philadelphia, PA: Elsevier Saunders; 2012.
Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HH. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment -- results of a large-scale, controlled, observational study. Maturitas. 2007 Aug 20;57(4):405-14.
Buhling KJ, Daniels BV, Studnitz FS, Eulenburg C, Mueck AO. The use of complementary and alternative medicine by women transitioning through menopause in Germany: results of a survey of women aged 45-60 years. Complement Ther Med. 2014;22(1):94-8.
Chandeying V, Sangthawan M. Efficacy comparison of Pueraria mirifica (PM) against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of climacteric symptoms in perimenopausal women: phase III study. J Med Assoc Thai. 2007 Sep;90(9):1720-6.
Ferri. Ferri's Clinical Advisor 2013. 1st ed. Philadelphia, PA: Elsevier Mosby; 2012.
Finch A, Valentini A, Greenblatt E, et al. Frequency of premature menopause in women who carry a BRCA1 or BRCA2 mutation. Fertil Steril. 2013;99(6):1724-8.
Goto V, Frange C, Andersen ML, Junior JM, Tufik S, Hachul H. Chiropractic intervention in the treatment of postmenopausal climacteric symptoms and insomnia: A review. Maturitas. 2014;78(1):3-7.
Green J, Denham A, Ingram J, Hawkey S, Greenwood R. Treatment of menopausal symptoms by qualified herbal practitioners: a prospective, randomized controlled trial. Fam Pract. 2007 Oct;24(5):468-74.
Hammes AE, Wahner-Roedler DL, Bauer BA. Treating the root cause: acupuncture for the treatment of migraine, menopausal vasomotor symptoms, and chronic insomnia. Explore. 2014;10(4):256-9.
Hidalgo LA, Chedraui PA, Morocho N, et al. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: A randomized, double-blind, placebo-controlled study. Gynecol Endocrinol. 2005;21:257-64.
Huang MI, Nir Y, Chen B, et al. A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality. Fertil Steril. 2006;86:700-10.
Kreijkamp-Kaspers S, Kok L, Grobbee DE, et al. Effect of soy protein containing isoflavones on cognitive function, bone mineral density, and plasma lipids in postmenopausal women. JAMA. 2004;292:65-74.
Lentz. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012.
Lin WT, Beattie M, Chen LM, et al. Comparison of age at natural menopause in BRCA1/2 mutation carriers with a non-clinic-based sample of women in northern California. Cancer. 2013;199(9):1652-9.
Low Dog T. Menopause: a review of botanical dietary supplements. The American Journal of Medicine. 2005;118(12) Suppl 2.
Lucas M, Asselin G, Merette C, et al. Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Menopause. 2009;16:357-66.
Lund K. Menopause and the Menopausal Transition. Medical Clinics of North America. 2008;92(5).
Osmers R, Friede M, Liske E, et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. 2005;105:1074-83.
Peng W, Adams J, Sibbritt DW, Frawley JE. Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication. Menopause. 2014;21(5):536-48.
Pirotta M, Ee C, Teede H, et al. Acupuncture for menopausal vasomotor symptoms: study protocol for a randomised controlled trial. Trials. 2014;15:224.
Pockaj BA, Gallagher JG, Loprinzi CL, et al. Phase III Double-Blind, Randomized, Placebo-Controlled Crossover Trial of Black Cohosh in the Management of Hot Flashes: NCCTG Trial N01CC1. J Clin Oncol. 2006;24:2836-41.
Poulsen RC, Moughan PJ, Kruger MC. Long-chain polyunsaturated fatty acids and the regulation of bone metabolism. Exp Biol Med (Maywood). 2007 Nov;232(10):1275-88. Review.
Pruthi S, Thompson SL, Novotny PJ, Barton DL, Kottschade LA, Tan AD, et al. Pilot evaluation of flaxseed for the management of hot flashes. J Soc Integr Oncol. 2007 Summer;5(3):106-12.
Rani S. The psychosexual implications of menopause. Br J Nurs. 2009;18(6):370-3.
Robien K, Cutler GJ, Lazovich D. Vitamin D intake and breast cancer risk in postmenopausal women: the Iowa Women's Health Study. Cancer Causes Control. 2007 Sep;18(7):775-82.
Rosner B, Colditz GA. Age at menopause: imputing age at menopause for women with a hysterectomy with application to risk of postmenopausal breast cancer. Ann Epidemiol. 2011;21(6):450-60.
Sayakhot P, Teede HJ, Gibson-Helm M, Vincent A. Differences in clinician understanding and management of early menopause after breast cancer. Climacteric. 2013;16(4):479-89.
Secreto G, Chiechi LM, Amadori A, et al. Soy isoflavones and melatonin for the relief of climacteric symptoms: a multicenter, double-blind, randomized study. Maturitas. 2004;47:11-20.
Somjen D, Knoll E, Vaya J, et al. Estrogen-like activity of licorice root constituents: glabridin and glabrene, in vascular tissues in vitro and in vivo. J Steroid Biochem Mol Biol. 2004;91:147-55.
Spangler L, Newton KM, Grothaus LC, Reed SD, Ehrlich K, LaCroix AZ. The effects of black cohosh therapies on lipids, fibrinogen, glucose and insulin. Maturitas. 2007 Jun 20;57(2):195-204.
Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol. 2006;107:247-55.
Wuttke W, Jarry H, Seidlová-Wuttke D. Isoflavones -- safe food additives or dangerous drugs? Ageing Res Rev. 2007 Aug;6(2):150-88.
Yang HM, Liao MF, Zhu SY, et al. A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol on the climacteric syndrome in peri-menopausal women. Acta Obstet Gynecol Scand. 2007;86:978-85.
Zaborowska E, Brynhildsen J, Damberg S, et al. Effects of acupuncture, applied relaxation, estrogens, and placebo on hot flushes in postmenopausal women: an analysis of two prospective, parallel, randomized studies. Climacteric. 2007;10:38-45.
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2023 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.