Menopause is a normal physiological process in every woman’s life. It is not a disease or a condition, but rather a constellation of symptoms associated with significant biological changes.
What is menopause?
Menopause is defined as going 12 months without a menstrual cycle in a woman of menopausal age or in a woman experiencing medication, surgery, or disease-related menopause. Younger women can experience a lack of menses; for example, related to an eating disorder, PCOS, or overtraining, but that is not defined as menopause. The timing, onset, and duration of natural menopause is different for every woman, but it typically occurs between ages 44 and 55, with the average woman in the United States experiencing menopause at age 51. Medically-induced menopause can occur in women of any age because of surgical procedures, such as a hysterectomy or chemotherapy.
Although menopause signals the end of a woman’s reproductive years, it can also signal other aspects of aging, like decreased skin elasticity and increased risk for certain health conditions – ranging from heart disease to osteoporosis to urinary tract infections. During this time, the level of estradiol, the strongest form of the hormone estrogen, falls to a very low level. Other hormones that decrease with menopause include progesterone and testosterone. Because estrogen is a cardio-protective hormone, when its level declines, cholesterol and blood pressure can increase along with an increase in cardiovascular-related events.
Experiencing natural menopause at a later age is associated with greater life expectancy and reduced all-cause mortality – including decreased risk for heart disease, osteoporosis, stroke, angina, myocardial infarction, and atherosclerosis. A woman who experiences menopause at an older age also experiences less bone loss and fracture risk, which can be exacerbated by decreased levels of estrogen, progesterone, and testosterone.
What factors predict your menopause age?
Menopause occurs at different times because hormones are tightly correlated with lifestyle factors, such as sleep, diet, and exercise. There is also evidence that personal history, as well as family history, particularly maternal age of menopause, is a reliable indicator of what to expect. If your mother experienced early menopause, for example, then you also have a greater chance of experiencing early menopause. In addition, if you started menses at an early age, then you will be more likely to start menopause at an earlier than average age.
Other factors might contribute to age of menopause. For example, women who smoke tend to experience earlier menopause than women who don’t. And in general, menopause has been occurring slightly later with each generation.1
Researchers have found some indications that level of education, urban versus suburban living, job status, and profession have some correlations with how menopause is experienced, symptom severity, and age of menopause onset. The thought is that exposure to environmental substances, experiencing years of disrupted sleep, emotional or financial stress, and other lifestyle factors directly impact the endocrine system.1
One interesting study found regional differences contribute to age of menopause in the United States. In a study of 22,484 menopausal women, Southern women experienced earlier menopause than women from other regions of the country – 10.8 months earlier than Northeastern women, 8.4 months earlier than Midwestern women, and 6.0 months earlier than Western women. The same study found no difference in menopause age of onset between black and white women.2
What are the signs I am entering menopause?
Perimenopause is the name of the time when menopause-related symptoms begin, even though you may still be menstruating. Although symptoms of menopause can occur 10 years before menstruation stops, symptoms typically begin 4-5 years before menses stops. During perimenopause, a woman’s estrogen level starts to decline as her body prepares itself to stop releasing eggs; at the same time, follicle-stimulating hormone (FSH) levels begin to rise.
Hot flashes tend to be the most common symptom of menopause, experienced by more than 50 percent of women. Other common symptoms include night sweats, fatigue, headache, depression, irritability, impatience, nervousness, sleep disturbances, memory loss, and joint pain. Some women experience decreased libido, vaginal dryness, and body image issues.
Research has examined how cultural issues relate to the way a woman experiences menopause – cultural expectations of menopause can influence symptoms for better or worse. In some cultures, or in a family where females are considered the matriarch, the topic of aging and menopause is considered taboo, few women talk about it openly, and reported symptoms are less severe.3
Here’s some good news. Research in 1999 found 80 percent of women did not report any change in the quality of life, and 75 percent of women experienced no change in their perceived attractiveness. Almost two-thirds of women reported positive attitudes toward menopause itself, considered menopause inconsequential, and reported this mid-life event to be less significant than other events.4
What happens after menopause?
Postmenopause is the time that begins one year after menses stops. Women now live 30+ years beyond menopause, which is about one-third of their lives. And because menopause is now better understood and more openly discussed than ever before, it provides the opportunity for a woman to work with her health-care practitioner to evaluate and improve her personal health.
General considerations during postmenopause include doing weight-bearing exercises to support healthy bone density, eating a healthy diet that supplies a day’s essential nutrients, and maintaining a healthy weight and muscle mass – all to support healthy aging.
How to manage menopause symptoms?
Management strategies for menopause vary from consulting a health-care practitioner to seeking help from friends. Most commonly, women tend to manage the symptoms with healthy diet changes, exercise, and dietary supplements.3
Women can be prescribed hormone replacement therapy (HRT) to support changing hormone levels and respond to the common menopause-related symptoms. HRT is also prescribed to reduce the risk of bone loss and fractures; however, other medications, like bisphosphonates, are more often prescribed these days5 because of the increased risk for cardiovascular disease and certain types of cancer with HRT. Risk factors and family history should be taken into account when considering therapeutic approaches.
The following are some daily lifestyle habits you can incorporate to support the uncomfortable symptoms and changes happening.
Do your best to minimize daily stressors. Although environmental, emotional, and physical stressors are unavoidable aspects of life, you can do your best to minimize exposure to them. And stress reduction techniques can be helpful, such as yoga, meditation, exercise, having fun with friends and family, and getting a good night sleep.
Exercise to reduce symptoms.
Participate in both aerobic exercise and strength training. Aerobic exercise helps your regulate your body temperature and has been shown to help manage hot flashes and reduce the incidence of night sweats. Try exercises that are weight bearing – jogging, tennis, hiking, or dancing – to support healthy bone density. Strength training also helps support bone strength as estrogen levels are changing. And exercise will support cardiovascular health, a healthy brain, and a good mood.
Maintain the body’s balance of micronutrients.
With changes in your hormone levels, your body needs appropriate nutrients to support good health. Eat a variety of fruits and vegetables every day to achieve your daily requirements and consider a multi-vitamin/mineral supplement if you fall short.
Support your changing hormones.
Because of the side effects and health issues associated with conventional HRT, many women desire a natural approach to allaying the unpleasant aspects of menopause: hot flashes, mood swings, sleeplessness, night sweats, and memory lapses. For example, there are botanical options that support the normal ebbing of the hormones associated with menopause.
Consider Thorne’s Menopause Bundle, which consists of three products: (1) a multi-vitamin/mineral formula; (2) a nutrient and botanical formula to mitigate the symptoms associated with the normal ebbing of hormones; and (3) a comprehensive bone support formula.*
Seek support from friends, family, and professionals.
Break a cultural norm and ask for advice from individuals you trust. It is perfectly normal to have questions, seek answers, and want someone with whom you can converse openly.
Embrace the aging process.
It happens to all women, each in their unique way.
- Gold E. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am 2011;38(3):425-440.
- McKnight K, Wellons M, Sites C, et al. Racial and regional differences in age at menopause in the United States: findings from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Obstet Gynecol 2011;205(4):353.e1-353.e8.
- Im E, Seung L, Chee W. Subethnic differences in the menopausal symptom experience of Asian-American midlife women. J Transcult Nurs 2010;21(2):123-133.
- Sommer B, Avis N, Meyer P, et al. Attitudes toward menopause and aging across ethnic/racial groups. Psychosom Med 1999;61(6):868-875.
- Osteoporosis treatment. https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis-treatment/art-20046869 [Accessed 5.16.19]