Many middle-aged women who experience sudden symptoms of hot
flashes and sweating may wonder if they are undergoing menopause. Some women experience such severe symptoms that they seek medical attention to find relief.  These symptoms are sometimes not only physically debilitating but can also take an emotional toll.

Menopause (meno- borrowed from Greek, where it meant “month,” & paûsis  a halt) is defined as the cessation of menstrual periods. This date is fixed, and is derived only once 12 months have gone by with absolutely no menstrual flow. It reflects complete, or near complete, depletion and absence of the ovarian estrogen source, called the follicle (which houses the eggs).

Menopause occurs at an average age of ~50 in normal women, but can start as soon as age 40. In fact, for 5% of women, it occurs after age 55 (late menopause), and for another 5%, between ages 40 to 45 years (early menopause). Menopause occurring prior to age 40 years is called, premature ovarian failure.  Talk to your doctor if you are 40 or younger and experience menopausal signs or symptoms (see below).

The menopausal transition, peri-menopause (means “around the menopause”), begins with variation in menstrual cycle length and an elevated blood level of an important hormone, abbreviated FSH, which stimulates eggs and estrogen to be released.  Later, women have skipped cycles and periods of no menstrual flow, called amenorrhea, for ?60 days.  At this stage, women often, but not always, have hot flashes.

Hot flashes are almost always due to the menopause.  They occur in about 75% of menopausal women in the U.S. The flashes most often begin in the peri-menopausal period, although in some women they do not begin until after menopause.  While there is evidence of a genetic connection to the timing of menopause, the development or severity of symptoms has no such genetic component.  For example, mother may have developed severe hot flashes, while her daughters have none at all.  Importantly, women who smoke start the menopausal transition, and potentially hot flashes, roughly 2 years earlier than non-smokers.

Other symptoms of menopause:

Heavy and/or irregular bleeding
Sleep disturbances
Vaginal dryness
Dyspareunia (painful intercourse)
Sexual dysfunction
Mood symptoms
Dry Skin
Breast Tenderness

After menopause, a period called post-menopause, defined as the
first 5 years after the final menstrual period, is characterized by complete termination of ovarian function.  At this time, women are more susceptible to things like, accelerated bone loss (osteoporosis) and increased risk for heart disease events (heart attacks), compared to pre-menopause. Many women in this stage continue to have hot flashes.

Treatment Options for Symptoms of Menopause

  1. Short-term estrogen therapy* (pill) is often the treatment of choice.  Short-term therapy is considered to be 2-5 years.
  2. Women with contraindications to estrogen therapy, like breast cancer and severe heart disease, may not take estrogens. Some doctors will suggest therapy with GABAPENTIN.
  3. Other medicines, used for depression, can also help the symptoms of menopause. NOTE: this is not to say that you have depression as the cause for your symptoms.  Instead, scientists have learned that some of the same biochemical processes occur during symptoms of menopause are seen during certain psychiatric illnesses.  These medicines work quite well for many women.  Check with your doctor.

*Ask your doctor if estrogen therapy (or estrogen-like substances like phyto-estrogens found in soy products or black cohosh) or other alternatives are right for you.

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