Sexual Conditions Health Center

Your Guide to Menopause

What Are the Signs of Menopause?

When you begin to notice the signs of menopause, either you or your doctor will suspect the approach of menopause. Two tests can help to determine what's going on and what stage of menopause you're in. Your follicle stimulating hormone (FSH) levels will dramatically rise as your ovaries begin to shut down; these levels are checked through a blood test.

In addition, your vaginal walls will thin, and the cells lining the vagina will not contain as much estrogen. The only way to check for this is through a Pap-like smear to check for thinning and drying out of the vagina, but it is rarely done. 

It helps if you keep track of your periods and chart them as they become irregular. Your menstrual pattern will be an added clue to your doctor about whether you are pre- or perimenopausal.

The most accurate way to determine if you are in menopause is to observe your menstrual cycles for 12 consecutive months when you are in the appropriate age group. Use protection during the perimenopausal period, when cycles are irregular. Although there is a decline in fertility, pregnancy is still possible until menopause is reached.

Are There Any Treatments to Help Alleviate the Symptoms of Menopause?

There are a number of different treatment options to consider.

• Lifestyle changes. A healthy diet and regular exercise program will go a long way towards minimizing the symptoms of menopause and helping to maintain overall good health. It is also a good idea to finally kick any old, unhealthy habits, such as smoking or drinking too much alcohol. Other interventions that may be helpful for hot flashes are to dress lightly and in layers and avoid potential triggers like caffeine and spicy foods.

  For vaginal dryness, moisturizers and non-estrogen lubricants such as KY Jelly, Replens, and Astroglide are available. Remaining sexually active may also help to preserve the lining of the vagina.

• Prescription medication. Treatment with estrogen and progesterone, called combination hormone therapy (HT), or hormone replacement therapy (HRT), can be prescribed for women who still have their uterus. HT reduces symptoms of menopause like hot flashes and night sweats, and may help prevent osteoporosis. Estrogen alone is the prescribed regimen for women who have had a hysterectomy (no longer have their uterus).

  In the past, hormone therapy was widely recommended for the treatment of menopausal symptoms and for the prevention of osteoporosis and heart disease. A large study known as the Women's Health Initiative (WHI) shed new light on how hormone therapy is viewed.

  According to the WHI study results, long-term combination hormone therapy increases the risk of heart disease, breast cancer, blood clots, and stroke. Estrogen-only hormone therapy was found to increase the risk of blood clots and stroke, but it decreased a woman's chance of getting breast cancer and did not increase the risk of getting heart disease. Although the WHI study found an increase in the risk of heart disease in women taking combination HT, a more recent study suggests this finding may not be relevant to all postmenopausal women.

  This study, published in the January/February 2006 issue of The Journal of Women's Health, showed that the risk of heart disease demonstrated in the WHI may be related more to the advanced age of the participants as opposed to the hormone therapy. The study also found that hormone therapy given to younger women, at the onset of menopause, appeared to decrease the risk of heart disease.

  Another study, published in the February 13, 2006, issue of the Archives of Internal Medicine, looked at nearly 11,000 women aged 50 to 79 taking only estrogen. Researchers reported no overall difference in heart attack risk among women who took the hormone and those who did not. In addition, there appeared to be a lower overall risk of heart disease in the women who began taking the estrogen between the ages of 50 and 59, suggesting a heart-healthy benefit to taking the therapy, if begun at a younger age.

  More studies are underway to investigate the relationship between hormone therapy and heart disease. In addition, many women may not be candidates for hormone therapy. These women include those with current or past breast or uterine (endometrial) cancer, blood clots, liver disease, stroke, women who may be pregnant, or who have undiagnosed vaginal bleeding.