Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

Menopause is the time in a woman's life when her periods stop and she can't have children anymore. This happens because as a woman ages, her ovaries stop making enough of the female hormones estrogen and progesterone. You may have heard menopause called "the change of life" or even just "the change".

Some things you might have heard about menopause aren't true. For example, women don't lose interest in sex because of menopause. Many women feel better with no more periods to worry about. Many women also enjoy sex more without having to worry about pregnancy.

When does menopause occur?

The average age for women to have their last period is about 50. But it's normal for menopause to occur any time from age 41 to 59. A woman often goes through menopause at about the same age as her mother did.

Women who have had both of their ovaries removed will go through menopause after this surgery. If the uterus (womb) is taken out but the ovaries are left, a woman won't have periods but she won't go through menopause until her ovaries stop making estrogen.

Some women have an early menopause without surgery - before age 40 - for no clear reason. If you stop having periods, your doctor can do a simple blood test to see if you're going through menopause.

See your doctor if you have

	A major change in your monthly cycle
	Heavy bleeding
	Bleeding that lasts longer than usual
	Bleeding more often than every three weeks
	Bleeding after sex
	Spotting between periods

Menopause is a gradual process that can take several years. You're not really through menopause (or "postmenopausal") until you haven't had a period for 12 months. During this time, keep using birth control if you don't want to become pregnant.

What are the common signs and symptoms of menopause?

Some women just stop having periods. Others can have symptoms for years.

A change in your menstrual cycle. This is one of the first signs of menopause. You may skip periods or they may occur more often. Your flow may be lighter or more than usual.

Hot flashes. Hot flashes are the most common symptom of menopause. Hot flashes can range from being a minor nuisance to a major problem that affects your sleep and daily life. Hot flashes can occur for at least a year but not for more than five years for most women.

When you have a hot flash, you'll feel warm from your chest to your head, often in waves. Your skin may turn red and you may sweat a lot. Along with the hot flash you may feel sick to your stomach and dizzy. You may have a headache and feel like your heart is beating very fast and hard. After, you may feel chilled.

A hot flash can last just a few seconds or go on for an hour. You may have as many as 10 in 24 hours. They're much more common at night.

Thinning of your vagina and vulva. The skin of your vagina and the area around your vagina (vulva) becomes thinner with menopause. Your vagina also loses its ability to produce as much lubrication (wetness) during sexual arousal. These changes may mean you'll need some gel during sex.

If sex hurts, there is help. Your doctor may prescribe an estrogen cream (to put in and around your vagina) or suggest you try a water-based lubricant (such as K-Y jelly). Don't use petroleum jelly (Vaseline) because it can damage condoms or diaphragms, may promote infections in the vagina, and is not water-based and doesn't wash off right.

Help for hot flashes

	Turn your heat down in the winter. Sleep in a cool room.
	Wear layers, so you can remove clothing when you get too warm.
	Wear cotton and other natural fabrics that "breathe" so you don't get too hot. Put cotton sheets on your bed, too.
	Drink cool water or other drinks when a hot flash starts. Keep a jug of ice water beside your bed.
	Avoid very hot fluids and foods.
	Avoid alcohol.

Urinary tract problems. You're more likely to have bladder infections after menopause. Sometimes you may have symptoms without infection - having to go to the bathroom often, feeling an urgent need to void (pee), feeling a burning sensation when voiding, not being able to go or having to go often during the night.

Headaches, night sweats, trouble sleeping and tiredness are other symptoms. Trouble sleeping and feeling tired may be caused by hot flashes and night sweats.

Does menopause cause mood swings?

Emotional symptoms have often been linked with menopause. But sadness, nerves and mood symptoms have other causes too. Life changes also occur during the years of menopause, such as children leaving home or retirement. Hot flashes may disrupt your sleep so you get overtired and this too can affect your mood. These changes may also cause sadness, anxiety and loss of sleep.

Are other problems more common after menopause?

Your risk goes up for osteoporosis (thinning of the bones), heart disease, and breast cancer. You still need to get your Pap smears and breast exams and start mammogram screening of your breasts.

Osteoporosis means a loss of density in bones. Bones lose calcium and become more brittle, to the point of breaking easily. Osteoporosis causes broken hips and other fractures.

Osteoporosis is most common in women after menopause. You're more likely to develop osteoporosis if you're white or Asian, have a small bone frame, went through early menopause, have a family history of osteoporosis, smoking, abuse alcohol, don't exercise or don't get enough calcium in your diet.

Heart disease also becomes more of a risk after menopause. You're more likely to have heart disease if you have a family history of it, or if you have a history of high cholesterol levels, high blood pressure or diabetes. Other risk factors include smoking, early menopause and lack of exercise.

Cut your risk for osteoporosis

	Get 1200 mg of calcium a day (an 8-oz glass of milk or 1.5 oz of cheese contains 300 mg and one antacid tablet, like Tums, contains 200 mg).
	Exercise at least ½ hour per day three times a week.
	Don't smoke (smoking increases your risk for both osteoporosis and heart disease).
	Eat a diet low in fat.

What is hormone replacement therapy?

Hormone replacement therapy can relieve the symptoms and problems of menopause. The therapy involves taking estrogen alone or estrogen combined with progestin, the synthetic form of progesterone.

Hormone replacement therapy can relieve symptoms such as hot flashes, dry vaginal and some bladder problems. It can also slow down the rate of osteoporosis. It seems to help calcium and exercise work to prevent osteoporosis. Depending on your health, your doctor may suggest hormone therapy.

Should every woman have hormone replacement therapy?

You and your doctor can discuss the benefits and risks of hormone replacement therapy, along with any symptoms you have, and your health risks.

What are the risks of hormone replacement therapy?

When estrogen is used alone, it can increase a woman's chance of getting endometrial cancer (cancer of the lining of the uterus (womb)). Of course, if you've had your uterus out, you aren't at risk for this cancer. If you have your uterus, taking progestin, along with estrogen, can lower this chance of cancer.

Taking cycles of estrogen and progestin will cause many women to have a period again each month. It's not a real period, but some women don't like this bleeding. Other side effects of hormones include tender breasts, fluid retention, swelling, moodiness and cramps. You can take your hormones every day and not cycle so you don't bleed. Hormone therapy comes now as pills, combined pills, patches and gels.

Some women may be at a slightly higher risk of heart disease the first year they begin HRT. Breast cancer risk may also be a concern for some women. Talk to your doctor about your own health and risks. Most doctors agree that you shouldn't have hormone replacement therapy if you've had endometrial cancer, breast cancer, blood clots, stroke, bleeding from the vagina for unclear reasons or liver disease.

Are there other treatments?

Other treatments may help some of the problems with menopause. Discuss these options with your doctor. Some treat the symptoms of menopause and others may work to prevent osteoporosis related to menopause.

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.