Menopause

• Menopause is defined as the permanent cessation of menstruation, confirmed after 12 consecutive months without a period.
• Menopause can happen as a natural part of aging or due to medical interventions.
• Menopause symptoms can have a severe impact in some cases.
• Menopause treatments exist to relieve symptoms and to decrease the risk of complications.

Menopause happens to all women at some point in their life. For most, it’s a part of natural aging, although it can also happen after certain medical interventions. Menopause usually happens gradually, and the symptoms can differ from person to person. With treatment for menopause, you can reduce the symptoms you’re experiencing. In this guide by Ada’s medical team, you’ll find more information on menopause, its symptoms, diagnosis, and treatment options. 

Menopause is the stage that marks the end of your reproductive years. If you are in menopause, then you haven’t gotten your period for a consecutive period of 12 months. Menopause occurs after the reproductive years due to hormonal changes caused by aging. The transition into menopause usually happens gradually and often begins with changes in the menstrual cycle before other symptoms start showing up. 1 2

Menopause is a process that is different for each woman, so there’s no fixed age at which it starts for everyone. Normally, the transition starts between the ages of 35 and 55. The first phase of menopause, called perimenopause usually starts in your late 40s, after which the average age of menopause itself is about 51 to 52. 3 1

Menopause is a process that usually happens gradually. It can be divided into 3 different stages:

1. Perimenopause: this is the stage before menopause where your hormone levels begin to drop, and you may notice the first signs of menopause. It can last for several months or, in some cases, even up to 10 years. While it's less likely to become pregnant during this time, there's still a possibility. 
2. Menopause: actual menopause is defined as having missed your period for 12 consecutive months. 
3. Postmenopause begins once a year has passed since your last menstrual cycle. In this stage, you can still experience some of the same symptoms you’ve experienced during the other stages. 

Besides these stages, some women can also experience early menopause. This is menopause at an early age, which is usually not the result of aging. 3

Menopause symptoms are caused by the hormonal changes in your body, and can be noticed both physically and mentally. Some common signs of menopause are: 2 1

• Hot flushes: a feeling of sudden heat in the face, neck or chest
• Night sweats
• Palpitations
• Changes in menstruation 
• Vaginal dryness
• Painful intercourse
• Reduced sex drive
• Painful joints and muscles
• Changes to your body composition
• Having dry and itchy skin
• Recurrent urinary tract infections
• Incontinence
• Difficulty sleeping
• Headaches
• Changes in mood
• Memory problems
• Depression 

The symptoms of menopause can vary in nature and intensity, making the transition into menopause something very personal. Some women almost do not experience any menopause signs, while others may experience severe symptoms that affect their quality of life. The symptoms can last for several years in some cases. 

Menopause happens when women grow older, as the ovaries start to lose their function and stop releasing eggs that can be fertilized. This causes changes to your hormones, which can cause irregular menstrual cycles and eventually a complete stop of your menstruation. 

Apart from natural menopause, you can also stop having your period earlier than expected. This is referred to as early menopause, characterized by its onset usually before age 45. Menopause that results from medical or surgical intervention is typically called 'induced menopause.’ Some causes of early or induced menopause include: 4

• A hysterectomy, which means that the uterus is removed
• An oophorectomy, which means that the ovaries are removed
• Primary ovarian insufficiency (POI), which means that the ovaries do not function properly. This can result from genetics, surgery, or cancer treatments like radiotherapy or chemotherapy. Autoimmune disorders and toxins can also contribute to POI. 

The diagnosis of menopause can be made based on your age and the symptoms you’re experiencing. Menopause tests aren’t required to diagnose menopause. However, blood and urine samples can help determine your levels of estradiol, follicle-stimulating hormone, and luteinizing hormone, which typically have different values during menopause. Menopause is medically diagnosed after you have gone 12 consecutive months without a period. 5

Menopause treatment is focused on symptom relief and the prevention of complications. 

Systemic hormonal treatment can help reduce the severity and frequency of the symptoms of menopause. It can also help reduce the risk of complications such as osteoporosis. This therapy can be administered in various forms such as tablets, sprays, gels, patches, or vaginal rings. Which hormones you need depends on your personal situation. Hormonal treatment should only be given for a limited amount of time, so it’s essential to follow the instructions of your healthcare provider. 4

Local estrogen therapy can help with urogenital symptoms such as recurrent urinary tract infections, vaginal dryness, and pain during intercourse. It can be used in addition to systemic hormonal treatment. 4

Nonhormonal treatment exists for the treatment of physical symptoms such as hot flashes. Some examples are: 4

• Paroxetine
• Escitalopram
• Gabapentin
• Neurokinin B

During menopause, vitamin supplements may help relieve your symptoms. Studies show that the best menopause supplements are: 4

• Vitamin E
• Omega-3
• Milk thistle

Menopause self-care can consist of making lifestyle changes such as: 4

• Maintaining a healthy weight
• Cognitive behavioral therapy
• Wearing breathable clothing 
• Doing exercise

After menopause, you can experience some complications due to your decreased estrogen levels. The most common complications are: 3 1

• An increased risk of heart disease
• Osteopenia
• Osteoporosis 
• A risk of prolapse of the bladder, uterus, or rectum due to weakened pelvic muscles

Menopause can cause a variety of symptoms that can look different from woman to woman. It’s a gradual process that marks the end of the reproductive period. There are various treatment options to reduce the severity and frequency of menopause symptoms. The complications of menopause can also be reduced by getting the appropriate treatment. 

Q: When do women go through menopause?
A: The average age of menopause is 51-52 years. However, this is an average. Some women may experience menopause earlier, while others may enter it at a later age.

Q: What is the biggest symptom of menopause? 
A: The main symptom of menopause is a change in your menstruation. Menopause can cause a lot of other symptoms, such as hot flashes, night sweats, vaginal dryness and mood changes. 

Q: What are the effects of menopause? 
A: Due to the changes in your hormones during menopause, you can get osteoporosis, osteopenia, and an increased risk of heart disease and prolapse of the pelvic organs. 

Q: What are the 3 stages of menopause? 
A: The transition into menopause happens gradually and can be divided into 3 stages being: perimenopause, menopause, and postmenopause. 

Q: Is bleeding after menopause always cancer? 
A: There is a possibility that bleeding after menopause can indicate cancer of the inner lining of the uterus. Most bleeding after menopause is, however, an indication of atrophy or polyps. 

Q: Does menopause make you tired? 
A: Yes, fatigue can be a symptom of menopause, but not every woman experiences fatigue during her menopause. There are also various other possible causes for feeling tired.