These two terms, which define phases of menopause, are often mistakenly interchanged. Menopause usually occurs between the ages of 45 and 55, but for some women, menopause can happen as early as the 30s or 40s. Menopause is a reflection of complete, or near complete, ovarian follicular depletion, with resulting low estrogen and changes in other sex hormones.
Medically, a woman is considered in menopause when 12 consecutive months go by and she has not experienced menstruation, according to Cleveland Clinic. However, the level of sex hormones produced in the body after the ovaries stop making estrogen will be significantly lower. Under normal circumstances, a woman does not suddenly experience menopause. Instead, it occurs gradually and involves different phases. Perimenopause usually occurs during the 40s.
The most significant sign that a woman is in the perimenopausal phase of her reproductive cycle is that she has visible symptoms that occur due to the decrease in estrogen and other sex hormones.
Some healthcare providers may refer to this phase "menopause transition. Note, the symptoms of perimenopause are the same after menopause, but they begin to worsen as a woman gets closer to menopause. Perimenopause usually occurs over an eight to year time span, with estrogen gradually decreasing over time. This phase does not involve any of the classic signs or symptoms of menopause such as night sweats, insomnia, or missed periods. A person experiencing premenopause has periods that may or may not be regular, and she is still considered fertile or in her reproductive phase of life.
During premenopause, there are no noticeable changes in the body, but hormonal changes may start to occur. Theoretically speaking, a woman is considered in the premenopause phase any time before she enters menopause. In some instances, a woman can experience menopause earlier than her 40s, perhaps even before her 30s. Although the age that a woman begins her menses has nothing to do with when she will enter the perimenopausal phase of her fertility cycle, perimenopause and menopause can be influenced by several factors, including:.
Amenorrhea simply means the absence of monthly periods. For example, it may increase the risk of blood clots, liver problems, and some types of cancer. Minor adverse effects include headaches, painful breasts, and fluid retention. In most cases, the discomfort of menopause will resolve in time. However, some challenges may remain. Some tips for staying healthy during postmenopause include :. For specific problems, such as vaginal dryness, OTC treatments may help. If not, a healthcare professional may prescribe or recommend an alternative.
Healthcare professionals can also advise on supplements, dietary measures, and lifestyle choices to help manage these risks as a female moves beyond menopause. Can vitamins help during menopause? Perimenopause refers to the time before menopause, when hormone changes start to occur but menstruation is also still occurring. When perimenopause ends, menopause occurs and postmenopause follows.
Leading up to and during menopause, people often notice weight gain. For those who wish to lose this weight, it can be more difficult than usual. When does menopause start? Is it still possible to become pregnant? Here, find out the answers to these and other questions about menopause. The body produces vitamin D in response to sun exposure. Vitamin D has a range of benefits.
It protects the teeth and bones and defends against…. Many people experience hot flashes and other symptoms around menopause, but essential oils may help. Learn more here, including which ones to choose.
The menopause is not a condition but a series of symptoms that can cause discomfort for a woman as the ability of her ovaries to produce eggs winds…. Comparing premenopause and perimenopause. But women complain of a wide variety of symptoms that strike them during this time , including having an odd taste in the mouth or the feeling of zaps under their skin. Of course, some women get them earlier. Women who have moderate to severe hot flashes may experience them beyond the perimenopause stage.
In fact, research published in September in the journal Menopause found that many women continue having hot flashes for nearly a decade after menopause, although the severity of the symptoms begins declining after about two years. Women who are younger when they start perimenopause typically experience symptoms longer than women who are older, Santoro says. Hormone therapy is still the best treatment for most perimenopausal symptoms.
Other women find relief from making lifestyle changes or trying natural remedies. A small number of women enter menopause much earlier than the average. When it occurs in women age 40 or younger, it is termed premature menopause, according to NAMS. This happens to about 1 percent of women in the United States. Before starting HT, your doctor should give you a comprehensive physical exam and take your medical history to evaluate your risks for:. While taking HT, you should have regular mammograms and pelvic exams and Pap smears.
Current guidelines recommend that if HT is needed, it should be initiated around the time of menopause. Studies indicate that the risk of serious side effects is lower for women who use HT while in their 50s.
Women who start HT past the age of 60 appear to have a higher risk for side effects such as heart attack, stroke, blood clots, or breast cancer. HT should be used with care in this age group. Women who experience premature menopause are usually prescribed HT or oral contraceptives to help prevent bone loss.
These women should be reevaluated when they reach the age of natural menopause around age 51 to determine whether they should continue to take hormones. When a woman stops taking HT, perimenopausal symptoms may recur. When a woman reaches full menopause, symptoms will eventually go away.
Because HT offers protection against osteoporosis, when women stop taking HT their risks for bone thinning and fractures increases. For women who have used HT for several years, doctors should monitor their bone mineral density and prescribe bone-preserving medications if necessary. Until , doctors used to routinely prescribe HT to reduce the risk of heart disease and other health risks in addition to treating menopausal symptoms. The WHI, started in , is an on-going health study of nearly , postmenopausal women.
Part of the study focuses on the benefits and risks of hormone therapy. As new data are released and analyzed, there have been a number of changes in the way HT is prescribed and a better understanding of its risks. HT pills and skin patches are considered "systemic" therapy because the medication delivered affects the entire body.
The risk for blood clots, heart attacks, and certain types of cancers is higher with hormone pills than with skin patches or other transdermal forms. Vaginal forms of HT are called "local" therapy. Doctors generally prescribe vaginal applications of low-dose estrogen therapy to specifically treat menopausal symptoms such as vaginal dryness and pain during sex.
This type of ET is available in a cream, tablet, or ring that is inserted into the vagina. Bioidentical hormones are typically compounded in a pharmacy. Some compounding pharmacies claim that they can customize these formulations based on saliva tests that show a woman's individual hormone levels.
The FDA and many professional medical associations warn patients that "bioidentical" is a marketing term that has no scientific validity. Formulations sold in these pharmacies have not undergone FDA regulatory scrutiny. Some of these compounds contain estriol, a weak form of estrogen, which has not been approved by the FDA for use in any drug. In addition, saliva tests do not give accurate or realistic results, as a woman's hormone levels fluctuate throughout the day.
FDA-approved hormones available by prescription come from different synthetic and natural sources, including plant-based. For example, Prometrium is a progesterone derived from yam plants. Systemic HT is mainly recommended for relieving menopausal symptoms such as hot flashes, night sweats, and sleep problems, as well as vaginal dryness. Local HT delivered vaginally is used specifically for treating vaginal dryness and atrophy; and accompanying pain during sexual intercourse.
HT does not prevent certain other problems associated with menopausal changes, such as thinning hair or weight gain. It is unclear whether HT helps improve mood. Estrogen increases and helps maintain bone density. HT may be useful for some women at high risk for osteoporosis, but for most women the risks do not outweigh the benefits.
Other drugs, such as bisphosphonates, should be considered first-line treatment for osteoporosis. Duavee is a drug that contains a combination of conjugated equine estrogen and the selective estrogen receptor modulator SERM bazedoxifene. It is approved to treat hot flashes and prevent osteoporosis in women with a uterus.
Although HT may have some benefits in addition to menopausal symptoms, results from the Women's Health Initiative WHI studies strongly indicate that HT should be used only for relief of menopausal symptoms, not for prevention of chronic disease. HT may increase the risk of heart disease and heart attack in older women, or in women who began estrogen use more than 10 years after their last period.
HT is probably safest in healthy women under age 60 who begin taking it within 10 years after the start of menopause. Taking HT in order to prevent heart disease is not recommended. Women who have a history of heart disease or heart attack should not take HT. HT may increase the risk of stroke. HT increases the risk for formation of blood clots in the veins deep venous thrombosis or in the lungs pulmonary embolism.
The risk for blood clots is higher with oral forms of HT than with transdermal forms skin patches, creams. There appears to be little, if any, increase in the risk of blood clots when transdermal forms of HT are used. Estrogen- progestogen therapy EPT increases the risk for breast cancer if used for more than 3 to 5 years. This risk appears to decline within 3 years of stopping combination HT. Estrogen-only therapy ET does not significantly increase the risk of developing breast cancer if it is used for less than 7 years.
If used for more than 7 years, it may increase the risk of breast and ovarian cancers, especially for women already at increased risk for breast cancer. The North American Menopause Society does not recommend ET use in breast cancer survivors as it has not been proven safe and may raise the risk of recurrence. Both estrogen-only and combination HT increase breast cancer density, making mammograms more difficult to read. This can cause cancer to be diagnosed at a later stage. Women who take HT should be aware of the need for regular mammogram screenings.
The North American Menopause Society recommends that women who are at risk for breast cancer avoid hormone therapy and try other options to manage menopausal symptoms. Long-term use more than 5 to 10 years of estrogen-only therapy ET may increase the risk of developing and dying from ovarian cancer.
The risk is less clear for combination estrogen-progesterone therapy EPT. Taking estrogen-only therapy ET for more than 3 years significantly increases the risk of endometrial cancer. If taken for 10 years, the risk is even greater. Adding progesterone to estrogen EPT helps to reduce this risk. Women who take ET should anticipate uterine bleeding, especially if they are obese, and may need endometrial biopsies and other gynecologic tests.
No type of hormone therapy is recommended for women with a history of endometrial cancer. It is not clear if HT use is associated with an increased risk of lung cancer, women who smoke and who are past or current users of HT should be aware that that EPT may possibly promote the growth of lung cancers. The Women's Health Initiative Memory Study and other studies suggest that combined HT does not reduce the risk of cognitive impairment or dementia and may actually increase the risk of cognitive decline.
Researchers are continuing to study the effects of HT on Alzheimer disease risk. Despite its risks, hormone therapy appears to be the most effective treatment for hot flashes.
There are, however, nonhormonal treatments for hot flashes and other menopausal symptoms. The antidepressants known as selective serotonin-reuptake inhibitors SSRIs are sometimes used for managing mood changes and hot flashes. A low-dose formulation of paroxetine Brisdelle is approved to treat moderate-to-severe hot flashes associated with menopause. Other SSRIs and similar antidepressant medicines are used "off-label" and may have some benefit too.
They include fluoxetine Prozac, generic , sertraline Zoloft, generic , venlafaxine Effexor , desvenlafaxine Pristiq , paroxetine Paxil, generic , and escitalopram Lexapro, generic. Several small studies have suggested that gabapentin Neurontin , a drug used for seizures and nerve pain, may relieve hot flashes.
This drug is sometimes prescribed "off-label" for treating hot flash symptoms. However, in the FDA decided against approving gabapentin for this indication because the drug demonstrated only modest benefit.
Gabapentin may cause:. Clonidine Catapres, generic is a drug used to treat high blood pressure. Studies show it may help manage hot flashes. Side effects include dizziness, drowsiness, dry mouth, and constipation. Some doctors prescribe combinations of estrogen and small amounts of the male hormone testosterone to improve sexual function and increase bone density.
Side effects of testosterone therapy include:. Testosterone also adversely affects cholesterol and lipid levels, and combined estrogen and testosterone may increase the risk of breast cancer. Many experts do not consider testosterone safe or effective for treatment of menopausal symptoms. Vaginal lubricants such as KY Jelly and Astroglide and moisturizers such as Replens can be purchased without a prescription and are safe and helpful for treating vaginal dryness and dyspareunia painful sexual intercourse.
Dyspareunia is a result of thinning vaginal tissues vaginal atrophy due to low estrogen levels. The North American Menopause Society recommends lubricants and long-acting moisturizers as first-line treatments for vaginal atrophy. For women who still experience discomfort, low-dose vaginal local estrogen is the next option. Ospemifene Osphena is approved as a non-hormonal prescription drug for treating menopausal-associated vaginal dryness and dyspareunia.
Ospemifene is an oral drug pill that acts like an estrogen on vaginal tissues to make them thicker and less fragile. However, this drug may cause the lining of the uterus endometrium to thicken, which can increase the risk for uterine endometrial cancer. Because of this and other risks, ospemifene should only be taken for a short amount of time. Common side effects of ospemifene include hot flashes, vaginal discharge, and excessive sweating.
North American Menopause Society -- www. American College of Obstetricians and Gynecologists. ACOG committee opinion no.
Obstet Gynecol. PMID: www. Committee opinion no. Acupuncture for menopausal hot flushes. Cochrane Database Syst Rev. Hormone therapy and other treatments for symptoms of menopause.
Am Fam Physician. Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med. Endocrinology and aging. Williams Textbook of Endocrinology. Philadelphia, PA: Elsevier; chap Phytoestrogens for menopausal vasomotor symptoms. Lobo RA. Menopause and care of the mature woman: endocrinology, consequences of estrogen deficiency, effects of hormone therapy, and other treatment options. Comprehensive Gynecology.
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