Menopause

Menopause is a natural stage of life marked by the permanent end of menstrual periods. Most women experience menopause between ages 45 and 56, with an average age of 51. Perimenopause is the transitional phase leading up to menopause, during which hormone levels fluctuate and periods become irregular. Our gynecology experts at Houston Methodist offer a full range of treatments to manage symptoms at every stage of the menopause transition.

What Is Menopause?

Menopause is confirmed after 12 consecutive months without a menstrual period, marking the end of a woman’s reproductive years. Its caused by a natural decline in reproductive hormones as a woman ages. Menopause is different from perimenopause, which is the transition phase that can last several years before periods stop completely. Once a woman has gone a full year without a period, she has reached menopause, and her periods will not return. Menopause can occur outside the 45-56 age window. If menopause occurs before the age of 45, it’s considered early menopause.

Why Choose Houston Methodist for Menopause Care

The right care team makes it much easier to manage menopause symptoms during one of the greatest transitions of a woman’s life. Perimenopause can last for years before menopause is confirmed, so symptom management is critical to maintaining a healthy and comfortable lifestyle. At Houston Methodist, our gynecology and women’s health specialists offer everything from hormone therapy to non-hormonal options, and will tailor a treatment plan around your needs as your symptoms change.

Menopause affects every woman differently, so look for a specialist who takes the time to understand the full picture. Our OB-GYN team works closely with other departments like urogynecology and behavioral health, so symptoms like urinary incontinence, depression or anxiety are addressed head-on.
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Common Causes of Menopause

Age, of course, is the primary cause of both perimenopause and menopause, but there are multiple other factors that can play a role in the onset of symptoms:

 

  • Natural decline of reproductive hormones: Ovaries make less estrogen and progesterone as fertility declines, part of the normal hormonal changes that come with age
  • Surgery to remove both ovaries can lead to an early onset of menopause
  • Chemotherapy and radiation therapy for treatment of some cancers
  • Primary ovarian insufficiency: The ovaries do not produce normal levels of reproductive hormones, leading to early menopause

Signs and Symptoms of Menopause

The primary sign of menopause is the end of menstrual periods for a course of 12 months. However, other menopause symptoms begin in perimenopause, often years before periods stop completely.

  • Hot flashes and night sweats: Hot flashes and night sweats are both vasomotor symptoms and are among the most common and recognizable signs of menopause. They can range from a sensation of mild warmth to sudden, intense heat that disrupts sleep and daily activities.
  • Vaginal dryness and painful sex: Lower estrogen levels often cause vaginal dryness, irritation and pain with intercourse. Doctors call this cluster of symptoms genitourinary syndrome of menopause (GSM), which is also accompanied by changes in urination, like a frequent urge to pee, increased urinary tract infections (UTIs) and bladder leaks.
  • Irregular periods and spotting: During perimenopause, irregular periods are common. Many women report spotting or breakthrough bleeding in between cycles as their hormone levels start to fluctuate.
  • Sleep disturbances: Insomnia and other sleep problems are common during perimenopause and menopause, often made worse by night sweats and urinary symptoms.
  • Mood changes: Hormonal changes can bring on mood swings, irritability, anxiety or depression. Dropping estrogen levels impact brain chemicals like serotonin, a happiness neurotransmitter, which can lead to crying spells, fatigue and overall sadness.
  • Difficulty concentrating: Many women notice brain fog, forgetfulness or other memory problems during perimenopause and menopause. Difficulty concentrating and extreme fatigue often show up together, but they do generally ease over time.
  • Body changes: Many women notice weight gain, especially around the abdomen, as metabolism slows during the menopause transition. Some also develop joint pain, with hormonal shifts causing headaches, nausea and general discomfort.
  • Changing hair and skin: Lower estrogen leads to brittle, thinning hair and dry skin. This is caused by a loss of moisture and collagen.

How Menopause Is Diagnosed

Menopause is typically a very simple diagnosis. For most women in the average age window, no special diagnostic testing will be needed. Women who discuss perimenopause symptoms with their doctors often wonder if they’ve reached menopause, but the criterion remains 12 consecutive months with no menstrual period. Before that, a gynecologist may diagnose perimenopause and work on a plan for symptom management. To understand whether a patient is in perimenopause or menopause, a physician will:

 

  • Perform clinical evaluation based on symptoms and physical examination
  • Order blood tests to confirm low estrogen if the diagnosis is uncertain, such as in younger women or after hysterectomy

Treatments Options for Menopause

There is no treatment for menopause, as it is a natural process marked by the end of menstrual periods. There are, however, many treatments for perimenopause symptoms that can ease the transition to menopause. Specific treatments will depend on which symptoms are most disruptive and whether a woman can safely take hormones.

Hormone-Based Treatments

Hormone treatment is common for women who need and can tolerate them.
 
  • Hormone replacement therapy (HRT): Restores estrogen and progesterone levels and relieves hot flashes, night sweats and other symptoms
  • Vaginal estrogen: Helps manage vaginal dryness and control symptoms of genitourinary syndrome of menopause (GSM)

Non-Hormone Treatments

Not every woman needs hormones, and many are unable to take them. In those cases, other treatments may be a better option.
 
  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin or fezolinetant may be prescribed to help women manage mood-based symptoms.
  • Lubricants: These are often recommended to help with vaginal dryness, painful intercourse and genitourinary symptoms.
  • Lifestyle changes: Eating a healthy diet that reduces spicy foods, getting plenty of physical activity, quitting smoking, reducing alcohol intake, talking to a therapist and creating a cool sleep space can all help with symptom management and reduction.

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