What is menopause?

In your late 30s, your egg supply declines. Then hormone levels fluctuate, and periods become irregular. Over time, your ovaries stop releasing eggs and estrogen levels drop. This causes your periods to stop. After a year of no periods, you've reached menopause. During the next year or so, estrogen levels keep going down.

Menopause symptoms include hot flashes, trouble sleeping, and vaginal dryness. You may have only a few mild symptoms. Or you might have severe symptoms. Symptoms tend to get worse the first year after menopause. But then many of them improve or go away.

If your symptoms are bothering you, there are treatments that can help.

Medicines may include:

• Hormonal birth control before menopause.
• Hormone therapy (HT).
• Antidepressants.
• Clonidine.
• Gabapentin.

Other treatments that may help include cognitive behavioral therapy, hypnosis, and an over-the-counter vaginal lubricant.

Your age, your history of menstrual periods, and your symptoms will tell your doctor if you are near or at menopause. You likely won't need to be tested to see if you have started perimenopause or reached menopause. But if your doctor suspects another medical condition, you may have some tests.

If your symptoms bother you, you may want to ask your doctor about prescription medicines.

All medicines for menopause symptoms have possible risks or side effects. Talk with your doctor about the risks and benefits of treatment options for you.

Hormone medicines include:

• Low-dose vaginal estrogen (cream, tablet, or ring). These forms are mainly used to treat vaginal dryness and other tissue changes in and around the vagina. They may also help prevent urinary tract infections (UTIs) and other urinary symptoms.
• Estrogen and progestin therapy. This form of hormone therapy (HT) sends hormones throughout the body. It can come in the form of a pill, patch, vaginal ring, gel, spray, or cream. It can be used to treat menopause symptoms such as hot flashes and vaginal dryness.
• Estrogen therapy (ET). This is the use of estrogen without progestin. This form of HT also sends hormones throughout the body. It's most often used in people who have had surgery to remove their uterus (hysterectomy).
• Testosterone with estrogen. This is sometimes used for menopause symptoms that don't improve with estrogen therapy.

You may have heard of a form of HT called compounded bioidentical hormones. Treatment with this type of HT is not approved or regulated by the FDA and may have more risk. This type of HT can vary in quality and may be more costly. And studies show that compounded bioidentical hormones are not more effective than FDA-approved HT.

Non-hormone medicines include:

• Antidepressants. These can reduce how many hot flashes you have. They can also make them less severe. And they may help with irritability, depression, and moodiness.
• Clonidine. It can reduce the number of hot flashes and how severe they are. It may cause side effects related to low blood pressure.
• Gabapentin (Neurontin). It can reduce the number of hot flashes and how severe they are. Possible side effects include sleepiness, dizziness, and swelling.
• Ospemifene (Osphena). This is used to reduce vaginal changes that can make sex painful.

A healthy lifestyle can help you manage menopause symptoms. If you smoke, stop. Stopping can reduce hot flashes. Get regular exercise to keep bones strong and lift your mood. Limit caffeine, alcohol, and stress—they can make symptoms worse. Choose a heart-healthy diet. You can also try breathing exercises and yoga.

There are many non-medicine treatments to relieve menopause symptoms.

• Cognitive-behavioral therapy is a type of counseling. It focuses on changing certain thoughts and behavior patterns. It may help you feel less bothered by hot flashes.
• Hypnosis is a state of focused concentration. With it, you become less aware of what is around you. It may reduce the number of hot flashes and make them less severe.
• Mind and body relaxation, such as breathing exercises. This may help with hot flashes and mood symptoms.
• Yoga and biofeedback can help you reduce stress.
• Black cohosh (such as Remifemin) may help relieve symptoms. But the research on black cohosh has had mixed results.
• Soy may improve symptoms. But studies have shown mixed results.

Remember that dietary supplements aren't regulated like medicines, and they may have risks. If you choose to take them, tell your doctor what you take.

Your risks for some health problems increase after menopause. Your doctor can check your overall health and recommend testing as needed.

These health problems include:

• Heart disease and stroke. Your risk of heart disease and stroke is higher after menopause. This higher risk isn't completely understood. But cholesterol, high blood pressure, and fat around the belly—all things that raise the risk for heart disease and stroke—also increase around this time.
• Bone thinning (osteoporosis). As you age, your bones get thinner naturally. Bone loss increases around menopause, when ovaries stop making estrogen. Estrogen is a hormone that protects against bone loss. So the older you get, the more likely you are to have osteoporosis.
• Slowing metabolism. As you age, your metabolism naturally slows down. But your metabolism and weight are not out of your control. One way to boost your metabolism is to be more active. When you exercise, your metabolism speeds up. For a few hours afterward, it stays slightly higher. And over time, regular exercise builds muscle. The more muscle you have, the more of a boost your resting metabolism gets.
• Diabetes. The risk for getting prediabetes and type 2 diabetes increases with age. Your risk may be higher if you are overweight, get little or no exercise, or have type 2 diabetes in your family.
• Thyroid problems. Women have the highest risk for hypothyroidism. Thyroid problems can cause some symptoms, like irregular menstrual periods, that are similar to perimenopause symptoms.

Menopause is the point in your life when you permanently stop having menstrual periods. After 1 year of having no periods, you've reached menopause. In most cases, menopause happens around age 50. But it can happen in your mid-40s or well into your 50s. It's a natural part of growing older.

Normal changes in your reproductive and hormone systems cause menopause. Your body starts to ovulate less often. During this time, your hormone levels go up and down unevenly (fluctuate). This causes changes in your periods and may cause other symptoms. Over time, you stop ovulating, and estrogen and progesterone levels drop. This causes your menstrual cycle to stop.

Certain lifestyle choices and medical treatments are linked to an earlier menopause. They include:

• Smoking.
• Radiation therapy to or removal of the pituitary gland.
• Chemotherapy.
• Radiation therapy or other treatment to the belly or pelvis that damages the ovaries so that they no longer function.
• Genetic and autoimmune diseases.
• Removal of both ovaries (oophorectomy). This causes sudden menopause.
• Low body fat.