Menopause is a natural part of aging for all women. It begins when you go a full year with no menstrual period. For 2 to 8 years leading up to menopause, your period may have more irregular timing. On average, menopause happens around 51 years old, but this varies. Genetics play a major role in determining age at menopause, but it may be influenced by things like smoking, alcohol consumption, exercise, medical conditions, and where you live in the world.
What causes menopause?
Signalling hormones from the brain control hormone production by the ovaries. The ovaries produce estrogen and progesterone. The cycle of estrogen and progesterone creates periods about once a month. With age, the ovaries don’t respond as well to the signalling hormones from the brain. Eventually, the ovaries stop producing estrogen and progesterone, and you no longer have a period.
What are the symptoms of menopause?
Experiences with menopause vary from woman to woman. Not everyone gets all the possible symptoms, and the symptoms affect people to different degrees. Some of these symptoms are more common in the transition to menopause while others are more common after menopause. Symptoms can include:
- Hot flashes, night sweats
- Sleep changes, fatigue
- Worse memory and concentration
- Irritability, anxiety, depression
- Decreased sex drive
- Vaginal dryness and itchiness, pain with sex
- Changes to urination (more often, more urgent, more accidents, more bladder infections, pain or discomfort)
- Hair loss, change in hair growth patterns
- Muscle and joint pain
- Migraines
- Weight gain
How do I survive hot flashes?
About 3 out of 4 people in menopause get hot flashes and/or night sweats. Lowering the room temperature can help, but in places like restaurants or at work that might not be an option. Some options that are more likely to be in your control are drinking cold water at the start of a hot flash and wearing outfits that include layers and breathable materials like cotton. Avoiding coffee and alcohol can also help.
Should I be taking hormones?
If you find the symptoms of menopause especially hot flashes, and night sweats affecting your quality of life there are medications called menopausal hormone therapy (MHT) that are very effective in improving these symptoms.
There are two main forms: Combined (estrogen + progesterone) therapy and estrogen therapy.
Combined (Estrogen and Progesterone) Therapy
This therapy is recommended for women with an intact uterus. Estrogen therapy alone increases the risk of endometrial cancer (cancer of the inner lining of the uterus). Progesterone protects the uterus from this risk.
Benefits
- Reduce hot flashes, night sweats, “brain fog”, vaginal and urinary changes
- Reduced incidence of colorectal cancer or broken bones
Risks
- Increased risk of blood clots in the lungs (pulmonary embolism), breast cancer, stroke, and coronary heart disease
Estrogen Therapy
This therapy is only for people who have had their uterus removed – a hysterectomy. Progesterone is not required when the uterus isn’t present and endometrial cancer is no longer a concern.
Benefits
- Reduce hot flashes, night sweats, “brain fog”, vaginal and urinary changes
- Reduced incidence of colorectal cancer, broken bones, breast cancer, strokes, coronary heart disease
Risks
- Increased risk of blood clots in the lungs (pulmonary embolism)
Whether to take MHT is a personal choice. Your choice might be influenced by how much your symptoms interfere with your quality of life and your background health risks. If you are interested in MHT, talk to your doctor about your options and to help weigh the risks and benefits for you. It is recommended to start MHT in the first few years of menopause and to use it for the shortest time possible and less than 5 years.
In some situations, a class of medications called SSRIs (selective serotonin reuptake inhibitors) that are often used for depression or anxiety can also be helpful for menopausal symptoms like hot flashes and mood changes.
Can natural health products help?
There are many natural health products that contain estrogen-like compounds, such as black cohosh, don quai, and soy that people may recommend for symptoms of menopause. Some of these products may be associated with a reduction in hot flashes and vaginal dryness. There is not strong enough evidence to routinely recommend any of these products. Natural health products also carry some degree of risk as well as potential drug interactions. For example, there is a risk of harm to your liver if you take too much black cohosh. If you are interested in trying natural health products, talk to your doctor or your pharmacist first to ensure you are selecting the safest product for you.
This post was authored by Oriana Shaw, medical student at the University of Alberta. The post was reviewed by Yuliya Koledenko, MD, CCFP, BSc, Stephanie Liu, MD, MSc, CCFP, BHSc and Erin Manchuk, BScPharm, BCGP.
References
Costanian, C., McCague, H., & Tamim, H. (2018). Age at natural menopause and its associated factors in Canada: Cross-sectional analyses from the Canadian Longitudinal Study on Aging. Menopause, 25(3), 265–272. https://doi.org/10.1097/GME.0000000000000990
Crandall, C. J., Hovey, K. M., Andrews, C. A., Chlebowski, R. T., Stefanick, M. L., Lane, D. S., Shifren, J., Chen, C., Kaunitz, A. M., Cauley, J. A., & Manson, J. E. (2018). Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women’s Health Initiative Observational Study. Menopause (New York, N.Y.), 25(1), 11–20. https://doi.org/10.1097/GME.0000000000000956
Franco, O. H., Chowdhury, R., Troup, J., Voortman, T., Kunutsor, S., Kavousi, M., Oliver-Williams, C., & Muka, T. (2016). Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. JAMA, 315(23), 2554–2563. https://doi.org/10.1001/jama.2016.8012
Manson, J. E., Chlebowski, R. T., Stefanick, M. L., Aragaki, A. K., Rossouw, J. E., Prentice, R. L., Anderson, G., Howard, B. V., Thomson, C. A., LaCroix, A. Z., Wactawski-Wende, J., Jackson, R. D., Limacher, M., Margolis, K. L., Wassertheil-Smoller, S., Beresford, S. A., Cauley, J. A., Eaton, C. B., Gass, M., … Wallace, R. B. (2013a). Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA, 310(13), 1353–1368. https://doi.org/10.1001/jama.2013.278040
Manson, J. E., Chlebowski, R. T., Stefanick, M. L., Aragaki, A. K., Rossouw, J. E., Prentice, R. L., Anderson, G., Howard, B. V., Thomson, C. A., LaCroix, A. Z., Wactawski-Wende, J., Jackson, R. D., Limacher, M., Margolis, K. L., Wassertheil-Smoller, S., Beresford, S. A., Cauley, J. A., Eaton, C. B., Gass, M., … Wallace, R. B. (2013b). The Women’s Health Initiative Hormone Therapy Trials: Update and Overview of Health Outcomes During the Intervention and Post-Stopping Phases. JAMA : The Journal of the American Medical Association, 310(13), 1353–1368. https://doi.org/10.1001/jama.2013.278040
Menopausal Hormone Therapy and Cancer—National Cancer Institute (nciglobal,ncienterprise). (2011, May 12). [CgvArticle]. https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/mht-fact-sheet
Newton, K. M., Reed, S. D., LaCroix, A. Z., Grothaus, L. C., Ehrlich, K., & Guiltinan, J. (2006). Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: A randomized trial. Annals of Internal Medicine, 145(12), 869–879. https://doi.org/10.7326/0003-4819-145-12-200612190-00003
Santen, R. J., Allred, D. C., Ardoin, S. P., Archer, D. F., Boyd, N., Braunstein, G. D., Burger, H. G., Colditz, G. A., Davis, S. R., Gambacciani, M., Gower, B. A., Henderson, V. W., Jarjour, W. N., Karas, R. H., Kleerekoper, M., Lobo, R. A., Manson, J. E., Marsden, J., Martin, K. A., … Endocrine Society. (2010). Postmenopausal hormone therapy: An Endocrine Society scientific statement. The Journal of Clinical Endocrinology and Metabolism, 95(7 Suppl 1), s1–s66. https://doi.org/10.1210/jc.2009-2509
Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The Menopause Transition: Signs, Symptoms, and Management Options. The Journal of Clinical Endocrinology & Metabolism, 106(1), 1–15. https://doi.org/10.1210/clinem/dgaa764
Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism,100(11), 3975–4011. https://doi.org/10.1210/jc.2015-2236
Crandall et al., 2018; Franco et al., 2016; Manson et al., 2013a, 2013b; Menopausal Hormone Therapy and Cancer – National Cancer Institute, 2011; Newton et al., 2006; Santen et al., 2010; Stuenkel et al., 2015; Suckling et al., 2006; Santen et al., 2010; Santoro et al., 2021; Costanian et al., 2018)