Menopause is the time when the menstrual period ceases and the ovaries permanently stop releasing eggs. Menopause is considered complete when a woman has been without her period for a full year. Although menopause can occur anytime between ages 40 to 58, the average age is 51 years old.

Natural menopause is a gradual process. The ovaries begin producing lower amounts of estrogen and other steroid hormones prior to menopause during a phase called perimenopause.

When menopause occurs before the age of 40 it is called premature menopause. Premature menopause can occur naturally but may also be the result of several conditions, including:

• Family history of premature menopause
• Autoimmune diseases
• X-chromosome abnormalities
• Medical treatments (pelvic surgery, surgical removal of ovaries, chemotherapy , or pelvic radiation therapy)
• Medications that lower estrogen levels
• Smoking

A risk factor is something that increases your chance of getting a disease or condition. As menopause is a natural process associated with aging, there are no risk factors. Risk factors for premature menopause include:

• Family history of premature menopause

As menopause approaches, women often experience a number of physical and emotional symptoms including:

• Irregular menstrual periods
• Hot flashes and night sweats
• Disturbed sleep patterns, insomnia
• Anxiety
• Significant mood changes
• Depression
• Dry skin
• Irritability
• Vaginal dryness and pain with sexual intercourse
• Difficulty concentrating
• Trouble remembering things
• Diminished interest in sex
• Frequent urination or leaking of urine
• Headaches
• Achy joints
• Fatigue
• Early morning awakening

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor may perform 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.

Some women have had a hysterectomy before menopause, and they no longer have periods. For these women, if menopause is suspected but needs confirmation, the test considered most accurate for the diagnosis of menopause is the measurement of follicle stimulating hormone (FSH) . High levels of FSH (greater than 40) may indicate menopause.

Menopause is a natural part of life and does not necessarily require treatment. Symptoms and health risks associated with low estrogen can be treated. These include hot flashes, vaginal dryness, and osteoporosis (loss of bone mass).

A number of different types of hormones are available. They include:

• Natural, synthetic, and plant-derived estrogens
• Progesterone
• Combinations of estrogen and progesterone
• Addition of small 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 . Some of these include cancer ( endometrial , breast , ovarian ), heart disease, gallstones , and gastroesophageal reflux disease (GERD). *¹

A high intake of phytoestrogens (or plant estrogens) may help menopausal women. They may reduce the risk for diseases associated with estrogen. Phytoestrogens are found in soybeans, black cohosh , *³rhubarb extract (a supplement), *² whole grains, legumes, tempeh, and flax seed. They are also found in concentration in capsule form.

A healthful diet during menopause can improve a woman's sense of well-being. It may also reduce the risk of heart disease, osteoporosis, and certain cancers. The diet should be low in fat and high in fruits, vegetables, whole grains, calcium , and vitamin D .

Cutting back on caffeine and alcohol may reduce symptoms of anxiety, insomnia, and loss of calcium.

Giving up smoking can reduce the risk of early menopause, heart disease, and osteoporosis.

Regular exercise may reduce hot flashes. Weight-bearing exercises such as walking, climbing stairs, and resistance exercises such as lifting weights help strengthen bones and decrease the risk of osteoporosis.

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

Moisturizers and lubricants are used to help vaginal dryness.

• 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) * 4
  • Note: SSRIs and SNRIs should not be used if you are taking tamoxifen (Nolvadex), a medication to reduce the risk of breast cancer recurrence.