When does menopause begin?

A woman is said to have reached menopause when she has not had a period for a full year.  The average age of menopause is 51, but can be earlier or later in some families of women.  Menopause is preceded by a transition period called perimenopause, which lasts from three to eight years and is characterized by irregular periods, mood instability and hot flashes. It is possible for a woman to move directly into menopause with none of the perimenopause symptoms.

What are the typical symptoms of someone who has entered the menopause phase?

Eighty five percent of women have minor or no symptoms.  The other fifteen percent experience hot flashes, mood disorders, vaginal dryness, insomnia, and/or memory problems.

What are the most common approaches to treating the symptoms that come with menopause?

Mild symptoms are managed with good diet, exercise, black cohosh, progesterone cream, and melatonin to help with sleep.  When symptoms affect a woman's ability to carry on her daily routine, we consider hormone replacement therapy – estrogen and progesterone, for women who have a uterus and estrogen only for women without a uterus.  We may add testosterone if depression and decreased libido are problems. The creams, gels, or patches are the preferred routes of delivery because  they bypass the GI tract and get directly into the bloodstream.  There is currently no evidence that bio-identical hormone preparations, made by compounding pharmacies, should be used. A predisposition for osteoporosis may also influence our decision to recommend hormone replacement therapy.

Do most women experience the same menopause symptoms?

Menopause symptoms can vary from woman to woman.  Most women have very minor or no symptoms.  The rest will have moderate to severe symptoms in a variety of combinations that include hot flashes, night sweats, vaginal dryness, pain during intercourse, depression, memory loss and insomnia.  It is important to note that many other medical conditions can mimic the symptoms of menopause, so patients should undergo a thorough physical exam to rule out other underlying medical conditions.

If I am well into the menopause phase and I have not experienced any symptoms, am I likely to experience them later?

The symptoms of menopause can last for several years after you have stopped having periods, but they usually go away with time.  It is unusual for you to develop symptoms for the first time years after you stop menstruating.

Most women aren't aware that osteoporosis is a silent condition that can accelerate after menopause and can cause back pain, curvature of the spine, and loss of height.  In worse cases, it can cause hip or vertebral fracture, that can lead to limited mobility, pneumonia and even death.  Women can be predisposed to osteoporosis due to genetic factors.  For instance, women from European descent with fair skin, small frame and  light eye and hair color are more prone to this condition.  In addition, factors such as low body weight, Vitamin D and Calcium deficiency, the presence of certain medical conditions, such as thyroid disease, and the use of certain medications, such as Prednisone,  may also increase the probability of osteoporosis.  Certain life style habits like the lack of weight bearing exercise, excessive alcohol intake, and smoking are also risk factors. 

 Osteoporosis may  already be present prior to menopause, but bone loss increases for the first 10 years after menopause, which occurs at an average age of  51 for most women, therefore; we  recommend that women get a baseline bone density study once they have ceased to menstruate for a period of one year.  If a woman has thinning bones or osteopenia, a precursor to osteoporosis, we perform a risk assessment and discuss lifestyle factors that can reduce her risk of progressive bone loss.  If she already has osteoporosis, we immediately start treatment with a bisphosphonate and if she complies with this treatment, her osteoporosis often reverts to normal bone density.  At the very least, we are able to stop any further bone loss.  

 A bone density study will yield a “T” score, used to gauge the presence of this condition.  Also, at the time  that we perform a bone density study, we calculate the patient’s FRAX Score.  The FRAX Score was developed by the World Health Organization to assess the various factors that may predispose someone to fracture even if he/she DOES NOT have osteoporosis.  The FRAX Score was necessary because statistics show that some patients may incur fractures even when their “T” scores are greater than -2.5, which is he cut off for osteoporosis.  If your FRAX Score shows an overall fracture risk of greater than 21% or a hip fracture risk of > 3%, then you should be treated for osteoporosis regardless of your “T” score.

 Some patients cannot take bisphosphonates once per week or once per month because they experience  severe gastroesophageal reflux.  In these cases, there are other treatments available including a yearly intravenous  infusion of the drug  Reclast or an injection every 6 months of the drug Prolia. There are also other drugs and medications currently under  development. 

Osteoporosis surveillance is an important aspect of mid-life care.  To maximize your bone health now, do weight bearing exercises 45minutes to one hour most days, take Calcium and Vitamin D (amount of Calcium depends on daily dietary intake) and discuss other risk factors you may have with your doctor.