What is Menopause?

Menopause is the natural end of menstruation and fertility. It's officially diagnosed after 12 consecutive months without a period. The average age is 51, but normal range is 45-55 years.

Stages of Menopause:

• Perimenopause: Transition phase (2-10 years before menopause); irregular periods, fluctuating hormones, symptoms begin.
• Menopause: The point in time (last period + 12 months).
• Postmenopause: The years after menopause.

Common Symptoms:

Vasomotor Symptoms:

• Hot flashes (sudden warmth, sweating)
• Night sweats
• Palpitations

Genitourinary Symptoms:

• Vaginal dryness, itching, pain with intercourse
• Urinary urgency, frequency, recurrent UTIs

Other Symptoms:

• Sleep disturbances
• Mood changes (irritability, anxiety, depression)
• Cognitive changes ("brain fog")
• Joint aches
• Weight gain (especially abdominal)
• Thinning hair, dry skin

Diagnosis:

Menopause is a clinical diagnosis—based on age and symptoms. Hormone testing is usually NOT needed.

Labs (if diagnosis unclear):

• Elevated FSH (>30-40 IU/L)
• Low estradiol (<20 pg/mL)
• TSH (to rule out thyroid issues mimicking menopause)

Treatment Options:

1. Hormone Replacement Therapy (HRT/MHT):

• Most Effective Treatment for moderate-to-severe symptoms
• Estrogen alone (if no uterus) or Estrogen + Progestin (if uterus present)
• Benefits: Reduces hot flashes, prevents bone loss, improves vaginal health
• Risks: Small increase in breast cancer (with long-term use), blood clots, stroke (varies by age/type)
• Best started within 10 years of menopause or before age 60

2. Non-Hormonal Medications:

• SSRIs/SNRIs: Paroxetine, venlafaxine (for hot flashes, mood)
• Gabapentin: For hot flashes, night sweats
• Fezolinetant (Veozah™): New non-hormonal option targeting hot flash mechanism

3. Vaginal Estrogen:

• Low-dose local estrogen (creams, tablets, rings)
• Safe for genitourinary symptoms even in women avoiding systemic HRT

4. Lifestyle Modifications:

• Regular exercise
• Healthy diet (calcium, Vitamin D, limit caffeine/alcohol)
• Weight management
• Stress reduction (yoga, meditation)
• Smoking cessation (triggers hot flashes, increases health risks)

Long-Term Health After Menopause:

• Bone Health: Increased osteoporosis risk; get DEXA scan, take calcium/Vitamin D, consider bone medications if needed.
• Heart Health: Cardiovascular risk increases post-menopause; manage cholesterol, BP, diabetes.
• Cancer Screening: Continue mammograms, colonoscopy, cervical screening as recommended.

Personalized Care:

Treatment should be individualized based on symptoms, health history, and personal preference. Discuss risks and benefits with your healthcare provider to find the best approach for YOU.