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Before and After Menopause

by | October 25th, 2009

Before and After Menopause

The average age of menopause, the cessation of menstruation caused by failure of the ovaries to secrete estrogen, is 51 years of age for women in the United States. Menopause will occur between the ages of 45 and 55 for the majority of women. The time between the onset of irregular menses and permanent cessation of menstruation is the perimenopausal period. The median age of perimenopause is 47 and the average duration is about 4 years.

Before The Pause

The perimenopausal period, the years prior to the actual onset of menopause, may occur as early as a woman’s early 40’s and can pose many problems. Many of the same symptoms of menopause may be present in the perimenopausal transition. Hot flashes, concentration gaps, mood swings, difficulty sleeping, headaches, irritability, and memory loss may all occur to some extent. Not all symptoms may occur, and 10 % of women will not experience this transition period at all. Those that do most certainly will experience some change in their menstrual cycle. Their cycles may become irregular, skipping cycles, or the time between cycles may become shorter. These changes are brought about by changes in hormones produced by the ovaries.

As a woman ages, the ovaries’ ability to produce eggs decreases. A hormone produced in the brain’s pituitary gland called follicle-stimulating hormone stimulates the production of eggs in the ovary and the secretion of estrogen. As the ovary becomes unable to respond, the levels of follicle-stimulating hormone rise. This hormone level called FSH is often measured in an attempt to diagnose menopause. The measurement of this hormone during the perimenopausal period is less useful because a woman’s hormone level may fluctuate from week to week. This fluctuation in the ovaries’ ability to produce estrogen results in many of the symptoms associated with perimenopause.

What can women do to alleviate the symptoms of perimenopause? Many are seeking help from their doctors. The practice of using low dosages of estrogen in the form of birth control pills has decreased dramatically since the publication of the Women’s Health Initiative study. The results of this study have caused patients and doctors to look to nonhormonal therapies. The use of Selected Serotonin Reuptake Inhibitors (SSRIs) has been shown to be effective in alleviating some symptoms. In some instances, short term low dose estrogen may be used in select patients.

Women who reject these options often turn to “natural hormone replacement.” According to the journal of the American Medical Association, 40 percent of patients have tried some form of alternative medicine. Many patients find it hard to understand why physicians practicing modern medicine often provide little information with regards to alternative medicine. Many doctors in practice today struggle with the lack of good reliable information concerning these products. Many products are available and often claim to help a variety of perimenopausal and menopausal symptoms. Most are poorly studied and have little scientific evidence to back their claims. Unlike prescription drugs, which must undergo testing to prove they are effective and safe, and the over-the-counter drugs, which must be shown to be safe when taken according to directions, dietary supplements are not currently evaluated and approved by the FDA before going to market.

Most “natural” products available today to treat perimenopausal and menopausal symptoms center around a group classified as phytoestrogens. The term phytoestrogens refers to any plant source that has an estrogenic effect. The two most commonly taken to relieve perimenopausal and menopausal symptoms are dong quai and black cohosh. A controlled study done at Kaiser Permanente Medical Center in California in 1997 showed that dong quai had no effect on hot flashes. Several German studies have indicated that black cohosh provides some relief of hot flashes, but those studies are small and poorly controlled. Another popular product is ginseng. It is often prescribed by alternative practitioners to treat perimenopausal and menopausal women experiencing hot flashes, but has not been shown by studies to be effective. Others such as fennel, red raspberry leaf, and sage have sometimes been given, but there is little evidence that any of these have any effect.

Researchers have noted that some women throughout the world, particularly Japanese women, are known to suffer less than American women with regards to perimenopausal and menopausal symptoms. Studies suggest that these differences have something to do with diet and lifestyle, but how much of that can be attributed to diet has not been established. The Asian diet is typically higher in soy intake and lower in animal fat and sugar when compared to American diets. Soy foods contain high amounts of substances called isoflavones that are considered phytoestrogens. Animal studies have shown that soy can lower cholesterol and may have some estrogenic effects. In addition, soy is an excellent source of plant protein and fiber. However, soy is unlikely to prove an adequate alternative for women seeking estrogens full well document long-term benefits. Soy’s estrogen like activity is hundreds of times weaker than that of commonly prescribed estrogens. While soy appears to be the richest source of phytoestrogens, small amounts can also be found in oat, peas, red beans, peanuts, and whole grains.


Menopause has been defined as the end of a woman’s monthly menstrual period. It marks the end of a woman’s reproductive years and the failure of the ovary to produce estrogens. The average age of menopause in women in the United States is 51. The age which menopause occurs is genetically predetermined and is not related to race, social economic conditions, weight, or number of pregnancies. If a woman stops menstruating before age 40, the condition is termed premature ovarian failure instead of premature menopause. Menopause prior to the age 40 occurs in approximately 1 percent of U.S. women, and about 10 percent undergo menopause before the age 46. Women in the United States currently have a life expectancy of about 80 years. Given these statistics, about 29 years, or more than one-third of a woman’s life will be spent in menopause.

Many signs and symptoms may be experienced during menopause and are related to the lack of estrogen being produced from the ovaries. The most common symptom of menopause is hot flashes. As many as 75 percent of menopausal women will have them. A hot flash is a sudden feeling of heat that spreads over the body. They may happen at any time and may be mild or severe in nature. They usually last 30 seconds to several minutes and a woman may experience them for a few months to several years. Hot flashes may disturb sleep, which can affect your moods, and ability to cope with daily activities. The loss of estrogen causes changes in the vagina and the lining may become thin and dry. These changes may cause pain during sexual intercourse and can make the vagina more prone to infection. Bone loss, which is a natural part of aging, accelerates after menopause. Significant bone loss is called osteoporosis, and increases the risk of bone fracture primarily of the hip, wrist, and spine. During menopause the lack of estrogen causes women to be at increased risk for heart attack and stroke. Mood swings, irritability, decreased libido, memory loss, and fatigue are also common complaints of women experiencing menopause.

Many of the symptoms of menopause can be treated by taking estrogens. Some of the more commonly available natural products have been discussed earlier in this article. Estrogens in the form of estrogen alone or in combination with progesterone have traditionally been prescribed dependent upon your clinical situation. Estrogen alone is usually given to women who have had their uterus removed. Estrogen combined with progesterone is usually prescribed in women whom still have their uterus present. The use of estrogen alone in a woman, who still has her uterus present, can cause excessive growth of the lining of uterus and cause problems. Symptoms such as hot flashes and vaginal dryness are usually treated quite effectively with estrogen replacement therapy. Estrogen in combination with progesterone can lower the risk of endometrial cancer and help control abnormal uterine bleeding. Estrogen benefits the tissues of the urinary tract decreasing infection and irritation. Some studies suggest hormone replacement therapy may protect against Alzheimer’s disease and reduce the incidence of colon cancer.

Risk Of Hormone Replacement Therapy

The National Institute of Health (NIH)-sponsored Women’s Health Initiative stopped its combined estrogen and progesterone arm of the study citing an increased risk in breast cancer and cardiovascular events including stroke and heart attacks. The study showed an increased risk in patients taking estrogen and progesterone in combination. It has become clear that initial interpretations of the Women’s Health Initiative and Heart and Estrogen/Progestin Replacement studies substantially overestimated the risk of hormone replacement for the treatment of perimenopausal and menopausal symptoms. Patients on estrogen replacement alone are continuing in the study to further evaluate the relative risk without progesterone. The decision to continue the use of hormonal replacement, is ultimately the patients. For more information please refer to the following links. Women’s Health Initiative The North American Menopausal Society

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Dr. J. Kyle Mathews is an expert in the field of Urogynecology, minimally invasive laparoscopic and robotic surgery, and reconstructive gynecologic surgery. Dr. Mathews is board certified and a Fellow of the American College of Obstetrics and Gynecology as well as the American College of Surgeons. With over two decades of experience, Dr. Mathews is one of the most experienced surgeons in north Texas.

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