11676 Health Library | Health and Wellness | Wellmont Health System
  • Menopause


    Menopause is the time when a woman's menstrual period ends. Menopause is considered complete when a woman has been without her period for one year. Menopause can occur any time between ages 40 and 58. On average, it occurs at age 51.


    Menopause is a natural process. It is caused by a gradual decrease in a hormone called estrogen. This period of time when hormones have begun to decrease but menopause has not started is called perimenopause.
    When menopause occurs before the age of 40, it is called premature menopause. Factors that may cause premature menopause include:
    • Family history of premature menopause
    • Autoimmune diseases
    • X-chromosome abnormalities
    • Medical treatments, such as pelvic surgery, surgical removal of ovaries, chemotherapy, or pelvic radiation therapy
    • Medications that lower estrogen levels
    • Smoking

    Risk Factors

    Menopause is a natural process associated with aging. You may have a higher risk of premature menopause if you have a family history of it.


    As menopause approaches, women may have a number of physical and emotional symptoms, such as:
    • Irregular menstrual periods
    • Hot flashes and night sweats
    • Disturbed sleep patterns, for example, insomnia
    • Anxiety
    • Mood changes
    • Depression
    • Dry skin
    • Irritability
    • Vaginal dryness and pain with sexual intercourse
    • Difficulty concentrating
    • Trouble remembering things
    • Decreased interest in sex
    • Frequent urination or leaking of urine
    • Headaches
    • Achy joints
    • Fatigue
    • Early-morning waking


    Your symptoms and medical history will be taken. A physical exam will be done. Your doctor may do blood tests, a pelvic exam, and a Pap smear. Natural menopause is usually diagnosed when a woman has not had a menstrual period for 12 consecutive months.
    Menopause may need to be confirmed if it was caused by a surgical procedure. A blood test may be done to look for follicle-stimulating hormone (FSH). High levels of FSH (greater than 40) may indicate menopause.


    Menopause is a natural part of life. It does not necessarily require treatment. However, symptoms and health risks associated with low estrogen can be treated. These include hot flashes, vaginal dryness, and osteoporosis (loss of bone mass).
    Osteoporosis in Hip
    Copyright © Nucleus Medical Media, Inc.

    Hormone Replacement Therapy (HRT)

    Types of hormone replacement therapies include:
    • Natural, synthetic, and plant-derived estrogens
    • Progesterone
    • Combinations of estrogen and progesterone
    • Low amounts of male hormones
    HRT is available as tablets, gels, skin patches, vaginal rings, vaginal tablets, injections, and pellets inserted into the skin.
    There are a number of possible risks associated with HRT, such as:

    Healthful Diet

    A healthful diet during menopause can improve your sense of well-being. It may also reduce the risk of heart disease, osteoporosis, and certain cancers associated with estrogen. The diet should be low in fat. It should include plenty of fruits, vegetables, and whole grains. Your diet should also include enough calcium and vitamin D.

    Limit Caffeine and Alcohol

    Caffeine and alcohol may increase your symptoms of anxiety and insomnia. They can also increase your loss of calcium.

    Quit Smoking

    Smoking can increase the risk of early menopause, heart disease, and osteoporosis.

    Regular Exercise

    Regular exercise may reduce hot flashes.
    Weight-bearing exercises like walking and climbing stairs, and strength exercises may also decrease your risk of osteoporosis.

    Stress Management

    Stress management may help ease tension, anxiety, and other menopausal symptoms. Deep breathing, massage, warm baths, and quiet music are examples of relaxation techniques.

    Over-the-Counter Products

    Moisturizers and lubricants are used to help vaginal dryness.

    Nonhormonal Medications for Hot Flashes

      Certain blood pressure medicines (taken in lower doses)
      • Examples include: clonidine (Catapres), methyldopa (Aldomet)
      Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
      • Examples include: fluoxetine (Prozac), paroxetine (Paxil), venlafaxine (Effexor), desvenlafaxine (Pristiq)
      • Note: SSRIs and SNRIs should not be used if you are taking tamoxifen (Nolvadex), a medication to reduce the risk of breast cancer recurrence.


    Menopause is a natural biologic event that does not need to be prevented. Quitting smoking could slightly delay menopause.


    Healthy Women.org http://www.healthywomen.org

    The North American Menopause Society http://www.menopause.org


    Health Canada http://www.hc-sc.gc.ca

    Women's Health Matters http://www.womenshealthmatters.ca


    Menopause. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com. Updated June 11, 2012. Accessed October 3, 2012.

    Menopause. Planned Parenthood Federation of America website. Available at: http://www.plannedparenthood.org/health-topics/womens-health/menopause-4807.htm. Accessed October 3, 2012.

    Menopause 101. North American Menopause Society website. Available at: http://www.menopause.org/for-women/menopauseflashes/menopause-101-a-primer-for-the-perimenopausal. Accessed October 3, 2012.

    9/30/2008 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Jacobson BC, Moy B, et al. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168:1798-1804.

    1/30/2009 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. Am J Obstet Gynecol. 2008;199:455-466.

    1/30/2009 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Kaszkin-Bettag M, Ventskovskiy BM, et al. Confirmation of the efficacy of ERr 731 in perimenopausal women with menopausal symptoms. Altern Ther Health Med. 2009;15:24-34.

    4/14/2009 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Archer DF, Dupont CM, et al; Study 319 Investigators. Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: a double-blind, randomized, placebo-controlled trial of efficacy and safety. Am J Obstet Gynecol. 2009;200:238.e1-238.e10. Epub 2009 Jan 24.

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