What is menopause?

Every woman experiences menopause differently, with different impressions and feelings.

Menopause is the ending of the monthly cycle and fertility. Menopause has happened once a woman has had her last period. This does not happen suddenly. It usually starts with the periods getting irregular. This means you can only tell with hindsight when it has definitely happened. It is not until a woman has not had a period for 12 months that she can know for sure that menopause is over.

On average, women experience menopause sometime around 51 years of age, although it is often a few years earlier or later.

Menopause happens because the ovaries stop releasing eggs. The ovaries also produce hormones, so a change in the ovaries affects the balance of hormones in the body. This can cause a variety of symptoms, and it can take the body a while to adjust to the changing hormones.

What symptoms can menopause cause?

Somewhere between a half and two-thirds of women will have hot flashes and sweats when they go through menopause. These are the most common symptoms women have. If they happen at night, they can disturb sleep. Hot flashes usually last about three minutes on average. But for most women, the hot flashes and sweats are so mild that they do not cause a lot of problems. Yet sometimes they are very severe. How strong these hot flashes are can also vary a lot from day to day.

For most women, hot flashes will stop by themselves within a year or two. But for one in three women, these could continue for as long as five years. For some women, they will go on even longer.

About three out of every ten women experience vaginal dryness during or after menopause. This can cause discomfort during sexual intercourse, and it can also make vaginal infections more frequent.

As women get older, their risk of bone fracture increases. Around the same time as menopause, many women also gain a bit of weight. But not every change in the body that happens at this time of a woman's life is because of menopause. Menopause does not directly cause symptoms such as mood changes, problems with sexuality, urinary problems or back pain, for example.

What can help women manage?

Exercise probably does not reduce symptoms, but it can help overweight women lose weight. It also improves heart and circulation health, as well as strength and flexibility. Many women try relaxation or breathing training, meditation, yoga or tai chi. These have not been tested enough to see if they can relieve menopausal symptoms.

There are no particular changes to diet that have been shown to either worsen, or improve, menopausal symptoms. The results of trials of soy-based foods and soy dietary supplements are contradictory.

If women have discomfort during sexual intercourse, lubricants and vaginal moisturizers are available.

Do any complementary or alternative therapies work for menopausal symptoms?

There are many preparations and products offered for menopausal symptoms. None have yet been proven to work, so more research needs to be done.

Of the herbal and dietary products on the market, the ones which have been tested the most are called plant estrogens, or phytoestrogens. These include soy-based products. Phytoestrogens are sold as dietary supplements in pharmacies or drugstores, and over the internet. More research is needed to be sure whether or not they could help reduce menopausal symptoms. There is not enough evidence on the benefits of red clover and black cohosh (cimicifuga racemosa). Some people have experienced serious liver damage after using drugs containing black cohosh.

What about hormone therapy?

Hormone therapy (HT) is sometimes also called hormone replacement therapy (HRT). It is usually based on the hormone estrogen. For women who have not had their uterus removed, the estrogen is usually combined with another type of hormone called progestin to protect the uterus from cancer.

HT is available in several forms, including tablets, patches, nose sprays, and injections. It is not known whether any is more effective or safer than others. Vaginal dryness can be treated with special creams, suppositories and soft rings that are inserted in the vagina. The success rate of this treatment is not exactly known, however.

HT with estrogen, with or without progestin, is the most effective treatment known to help relieve hot flashes and the sweats that come with them. Most women who take hormone therapy will either have no more hot flashes (8 out of 10 women), or their hot flashes will be less severe. However, for about 5 out of these 8 women, the hot flashes would have stopped on their own. That means that HT prevents hot flashes in about an additional 3 out of every 10 women who use it.

HT might cause menstrual-like bleeding or spotting, breast tenderness and/or nausea in many women in the first months of using it.

One alternative relatively seldom used in Germany is the synthetic hormone tibolone. Tibolone has effects similar to those of both estrogen and progestin. There is evidence that tibolone can relieve menopausal symptoms. The side effects are similar to the side effects expected when using estrogen.

There are also some other drugs that are sometimes used to try to relieve menopausal symptoms. None of these other drugs are approved for use in Germany, however, and all have side effects that make their use in treatment problematic.

What are the adverse effects of hormone therapy?

A combination of estrogen and progestin is usually given to women who have not had their uterus removed (hysterectomy) to help prevent cancer developing in the uterus. But women who have had a hysterectomy typically have estrogen alone. These two types of hormone therapy have different side effects and risks.

Combined estrogen-progestin therapy:

Taking combined estrogen-progestin HT increases a woman's risk of some serious health problems within the first year. These include heart attacks and thromboembolism (a blood clot blocking a blood vessel). Over the long term, the risk of stroke and breast cancer also increases. It also increases the risk of gallbladder problems that need surgery to remove both the gallstones and the gallbladder.

After about five years, daily use of combined estrogen-progestin HT lowers the risk of bowel cancer and broken bones. However, in total, long-term hormone therapy causes more health problems than it prevents.

Estrogen alone:

If a woman takes estrogen alone (without progestin), within about seven years her risk of stroke and gallstones that will require surgery also increases. At the same time, her risk of broken bones will fall. As with combined therapy though, overall it causes more health problems than it prevents. You can read more about this in the research summary “Menopause: What are the benefits and risks of long-term hormone therapy?”.

According to current knowledge, if hormone therapy is stopped after a few months, there will be no increased risk of serious health problems. But hot flashes may return.

How do women adjust to menopause?

Some women like to talk with others about what is happening to their bodies and about their feelings. And some prefer not to. For many women, menopause is the start of a new phase of life. Many find new freedom and possibilities in life.

Would you like more information?

If you would like more information, we have more detailed information about menopause on our website. You can also read about other women's experiences.

References

• "Menopause". Cologne: Institute for Quality and Efficiency in Health Care (IQWIG), 2006. [Full text] [Informed Health Online summary]