Women's Health


Written by Dr. K Sneha and medically reviewed by Sameer Kumar

Image: Menopause


All you need to know about Menopause

Menopause is not a disease or a condition, but a normal part of life when a woman ceases to menstruate and is no longer fertile. Menopausal symptoms occur a few months to years before and after the last period. The average age of menopause is between 49 and 52 years. Although it is a natural process, it causes major changes and triggers a lot of symptoms.

A woman is said to have reached menopause when she does not have any vaginal bleeding for a year. For women who have had surgery to remove the uterus, menopause is said to occur after the surgery or when the levels of hormones produced by the ovaries fall. For most women, specific treatment is not needed for the symptoms seen before menopause, which is caused due to a reduction in the estrogen levels.

What results in Menopause?

A finite number of eggs are stored in the ovaries when a woman is born. The ovaries also control ovulation and menstruation by producing hormones like estrogen and progesterone. During ovulation every month, the ovaries release one or more eggs for fertilization and formation of an embryo. If no fertilization takes place, the uterus lining, that gets ready to receive an embryo, sheds and is called menstruation. When the ovaries no longer have eggs to release every month, menstruation stops and it results in menopause.

What are the Stages of Menopause?

Natural menopause is a gradual process, which has the following three stages:

  • Perimenopause - This stage starts years before menopause. Here, the ovaries make less estrogen gradually, which lessens quickly in the last couple of years before the ovaries stop releasing eggs. Women usually have premenopausal symptoms in the last couple of years of this stage.
  • Menopause - Here, the ovaries stop producing eggs and the woman would have had her last period a year back.
  • Postmenopause - After menopause, all the premenopausal and menopausal symptoms like hot flashes, flushing, and mood swings tend to ease if not disappear. But in this stage, due to less estrogen, health risk related to the low estrogen rises.

What are the Causes of Premature Menopause?

Menopause after 40 years of age is considered normal, but if it occurs before 40 years, no matter what the cause, it is known as premature menopause. The conditions that can cause premature menopause are:

  • Genes.
  • Down’s syndrome.
  • Turner’s syndrome.
  • Addison’s disease.
  • Hypothyroidism.
  • Premature ovarian failure.
  • Surgical removal of both ovaries with the uterus.
  • Ovarian damage due to cancer.
  • Chemotherapy or radiotherapy to the pelvic area.

What are the Symptoms seen during Menopause?

The intensity of menopausal symptoms is different for every woman. The symptoms are usually severe when it occurs over a short period of time or suddenly.

Early symptoms:

  • Less frequent menstruation.
  • Hot flashes.
  • Flushing.
  • Night sweats.

Other symptoms:

  • Vaginal dryness.
  • Depression.
  • Anxiety.
  • Insomnia.
  • Weight gain.
  • Memory problems.
  • Reduced libido.
  • Dry skin.
  • Painful and stiff joints.
  • Hair thinning.
  • Increased hair growth in the face, neck, chest, and back.
  • Headaches.
  • Palpitations.
  • Reduced bone mass.
  • Breast shrinkage.

What are the Complications of Menopause?

Some of the complications seen after menopause are:

  • Painful intercourse (dyspareunia).
  • Cardiovascular disease.
  • Osteoporosis.
  • Urinary incontinence.
  • Breast cancer.
  • Mood swings.
  • Vulvovaginal atrophy.
  • Cataracts.
  • Periodontal diseases.
  • Slow metabolism.

How is Menopause Diagnosed?

If you are 45 years old or younger and experiencing menopausal symptoms, it is best you consult a gynecologist. The doctor should be able to diagnose your condition with the presenting signs and symptoms. In addition, he or she may also tell you to take the following tests:

  • Check the levels of FSH (follicle-stimulating hormone) - Elevated levels of FSH in the blood of equal to or more than 30 mIU/mL along with the absence of menstruation for a year is used to diagnose menopause.
  • PicoAMH Elisa diagnostic test - This is a new test that is FDA approved, and is used to check if the woman is close to or already entered menopause. It works by measuring the anti-Mullerian hormone (AMH) in the blood.

Menopause Treatment

As already mentioned, menopause is not a disease, so there is no treatment for menopause. But in cases of severe premenopausal and menopausal symptoms that affect the quality of life, then the following treatments are indicated.


These medications are available only on prescription, and OTC (over-the-counter) use is not recommended.

  • Hormone replacement therapy (HRT) - The symptoms can be controlled by taking estrogen and progestin supplements.
  • Unwanted hair growth - Eflornithine hydrochloride cream.
  • Depression, anxiety, and hot flashes - Selective serotonin reuptake inhibitors (SSRIs) like Paroxetine.
  • Vaginal dryness - Vaginal moisturizers or lubricants and Ospemifene.
  • Recurrent UTIs - Antibiotics.
  • Insomnia - Sedatives.
  • Osteoporosis - Denosumab, Teriparatide, and Calcitonin, in the recommended dosage.

Home Remedies:

  • Hot flashes can be managed by wearing loose clothes at night, keeping the bedroom cool, and avoid using thick blankets.
  • Exercise 20 to 30 minutes every day.
  • Reduce calorie intake by 400 to 600 calories.
  • Talk to your family members, friends, or a medical professional if you are feeling depressed.
  • Practice relaxation techniques like yoga, meditation, etc.
  • Clean and moisturize your skin properly to avoid dryness.
  • Quit or limit smoking and consuming alcohol.
  • Diet rich in vitamins and minerals will improve menopausal symptoms.
  • Follow sleep hygiene to prevent sleep problems.

If you are experiencing menopausal symptoms, which is not getting better with home remedies, it is best you consult a gynecologist. With the help of online healthcare platforms, you can consult professionally trained and experienced doctors through phone or video consultation, or by posting a query.

Last reviewed at: 13.Mar.2019



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