Menopause—also known as “climacteric” or “the change of life”—is the time when the ovaries stop producing sex hormones estrogen and progesterone that regulate menstruation, while other parts of the body (e.g., fatty tissues and adrenal glands) decrease the production of sex hormones. Menopause persists over a successive timespan of 12 months during which a woman has not experienced cyclical vaginal bleeding. Thereafter, these cycles stop permanently and the ability to bear children ceases.

Menopause Symptoms

Irregular periods—longer, shorter, heavier, or lighter vaginal bleeding—are signs for perimenopause, which is the transitional phase before the onset of menopause. During menopausal transition, a woman may experience a few or more of the following vasomotor symptoms in varying degrees and based on her menopausal status:

• Hot flashes
• Vaginal dryness
• Weight gain due to a slower metabolism
• Thinning hair
• Thinning, dry skin
• Flaccid breasts
• Joint soreness
• Back pain
• Night sweats
• Insomnia caused by mood disturbances and hot flashes
• Mood changes and irritability
• Anxiety or depression
• Low sex drive
• Lethargy

Menopause Complications

A number of factors can disrupt the typical transition from menstruation to menopause. The following risk factors may also worsen menopausal symptoms:

• Smoking tobacco: Women who smoke cigarettes tend to experience menopause one to three years earlier than women who do not smoke. In 2015, HHS Public Access published data that indicated escalated ovarian aging for women exposed to smoke “both prenatally and around the time of menopause.”
• Obesity, pollutants, and poor diet: Women with excess fat cells are at higher risk for developing menopause earlier than normal, as are women who regularly adhere to a poor diet. Synthetic phytoestrogens, such as the industrial pesticides sprayed in the air and on foods, are known endocrine disruptors that can trigger antiestrogenic effects and damage to reproductive organs. Long-term exposure to synthetic phytoestrogens in plastics and canned food containers may be unavoidable for certain low-income individuals. A 2015 study identified 15 endocrine-disrupting chemicals (EDCs) and highlighted potentially detrimental effects of EDCs on ovarian health, in particular.
• Surgically induced menopause: Some medical problems may require the removal of the uterus and both ovaries. Removal of the uterus, alone, does not typically cause menopause. Without a uterus, you will no longer menstruate, but you may not experience menopausal symptoms immediately with your ovaries intact. Once the ovaries are removed, sex hormones decrease rapidly. The normal gradual transition leading to the last menstrual period does not take place, and menopause happens instantaneously after surgery.
• Medication-induced menopause: Certain types of chemotherapy, radiation, or pharmaceuticals may damage ovaries and cause a more rapid decrease in sex hormone production, eventually causing menopause in a shorter span of time than usual. Menopausal symptoms may occur during or immediately after chemotherapy and radiation treatments, but this is not always the case or may not be permanent. Medication- or surgically-induced menopause symptoms are generally more acute than normal.
• Ovarian failure: It is rare, but a small percentage of women experience premature menopause (before the age of 40) due to abnormal ovarian function—that is, ovaries that fail to produce sufficient levels of sex hormones. As with induced menopause, conditions such as fragile genetics, thyroid disease, diabetes, endometriosis, certain cancers of the female reproductive organs, or autoimmune disease may predispose women to experience poor ovarian function. There are also unknown causes for ovarian failure. Premature menopausal patients tend to experience aggressive menopausal symptoms, and they are at high risk for developing peculiarly degenerative forms of cardiovascular disease, bone disease, and neurological illness.
• Celiac disease: If left untreated, complications stemming from celiac disease can adversely affect fertility and increase the risk for menopause. Celiac disease is an autoimmune disorder of the gastrointestinal system when it is unable to properly process gluten, which is a protein found in wheat.
• Vulvovaginal atrophy: Vulvovaginal atrophy (VVA) can affect any woman, though it is most prevalent in postmenopausal women. It is a complication that stems from a decrease in estrogen of the vaginal tissue that can induce vaginal deformities. Symptoms for VVA include dryness, pain during sex, incontinence, and accelerated urinary frequency.
• Chronic disease: The Iranian Red Crescent Medical Journal documented in 2011 that cardiovascular disease and osteoporosis (a disease characterized by abnormally low bone mass density and higher-than-normal incidences of bone fractures) are more prevalent in early menopause, while cancers of the breast and uterus are more common with delayed menopause. Heavy-to-moderate vaginal bleeding or spotting during postmenopause is a sign of uterine cancer. Menopause has been linked to a decline in lung function, as well.

Menopause Positives

It is good practice to take preemptive, as well as remedial, measures during all phases of womanhood to help stave off complications and ease menopause symptoms. Make every effort to enjoy this special time in your life as much as possible. The following points can help dim menopause stigma and redefine common preconceptions regarding this estimable phase in a woman’s life.

Medication

If you experience severe menopause symptoms, you should consult your physician for treatment options. Hormone replacement therapy (HRT) delivered as a skin patch is most effective for treating vasomotor symptoms and preventing bone loss, which are conditions linked to low estrogen levels. The Women’s Health Initiative (WHI) issued a 2017 report positing benefit-to-risk ratios for HRT users. Women younger than 60 years old who receive HRT within 10 years of menopause onset have a more favorable benefit-risk ratio for treatment of vasomotor symptoms than women age 60 years or older who receive treatment 10 to 20 years from menopause onset.

Natural remedies like isoflavone supplements, black cohosh, and vitamin E, remain popular alternatives, especially in light of HRT side effects that include higher risks for heart disease, blood clots, dementia in patients 65 years or older, as well as breast and endometrial cancers. Melatonin supplementation has shown favorable for addressing menopause-related depression and menstrual disturbances in perimenopausal women.

Education

Frank discussions about sexuality—female reproductive health and sexuality, in particular—are often taboo in many societies. Lack of honest communication often hinders societies from properly supporting elderly people, in general. In the absence of necessary education, myths and assumptions run rampant and become embedded in the culture, which can be psychologically damaging. It is no coincidence that elderly couples in Western societies often complain of irritability, anxiety, and depression in menopausal woman.

Japan currently boasts a large aging population that the country has mobilized great efforts to accommodate through progressive social programs. Logically, such conscientious support of the aging has produced great results. Japan’s elderly tend to live longer, healthier lives and do not experience as many chronic illnesses that plague Western societies. Japanese menopausal women do not suffer psychological stress as severely as American women do. Vasomotor symptoms, like hot flashes and insomnia, are common in America; whereas, they are rare for most Japanese females who tend to report back and joint pain—symptoms largely attributable to aging.

Rituals

Rites of passage ceremonies, like bat mitzvahs, cotillions, sweet sixteen celebrations, and quinceaneras, celebrate the transition from girlhood to womanhood, but similar transitional rituals for elderly females are lacking. For the most part, rites of passage ceremonies assist participants in psychologically transitioning to new phases in life. Retirement celebrations are significant but value materialism and what someone has produced, rather than a woman’s intrinsic value. Create your own rituals for menopause transition and be sure to involve devoted family and friends to mark the special occasion.

Sex

Menopause does not mean the end of sex. The risk of pregnancy diminishes greatly during this time, so there is a potential for a liberating sex life. Consider Kegel exercises to strengthen vaginal muscles that may thin and weaken as a result of low estrogen levels. Pain and discomfort during intercourse due to vaginal dryness are common complaints among elderly couples. Water-based lubricants and local vaginal estrogen treatments (rings, cream, or tablets) help remedy vaginal dryness. Low sex drive among menopausal women may be due to psychological and/or hormonal reasons. If you suffer an impaired libido, talk with your doctor about somatic and mental health remedies. Have honest discussions with your partner about changing or steadying expectations to help nurture your confidence during your physical and psychological transition.

Diet

It is never too late to try new foods that promote good health, especially those that include isoflavones that are chemically linked to the amino acid phenylalanine. Isoflavones were used to treat hot flashes and other vasomotor symptoms in a 2014 study, and these nutrients exhibited very promising results. Natural phytoestrogens are plant-derived and not produced by the endocrine system. Although more research is required to better substantiate the ameliorative effects of phytoestrogens, they may help remedy the effects of low estrogen levels in menopausal females. Soybeans, sesame seeds, oats, lentils, ginseng, and carrots are some dietary sources of phytoestrogens.

Embrace Change

Unfortunately, the stereotypical elderly woman in Western society is perceived as an immobile, asexual being void of curiosity. Talk with members of your support system—church, community center, family, friends—about your plans no matter what they may be. You would be surprised at how well your newfound desires are received. At the same time, understand your physical limitations. Remain enthusiastic about your new exercise regimen, but be mindful of low bone density and a higher risk of injury, for example.

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