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Following are some questions to ask your doctor about menopause.

What is the difference between perimenopause and menopause?

Menopause begins with the final menstrual period and is confirmed after one year of no menstrual bleeding.

Perimenopause is the transition leading up to the end of periods otherwise known as menopause. Before perimenopause, periods usually occur at the same time each month. This happens because the ovaries produce regular amounts of the hormones estrogen and progesterone. During perimenopause, periods change and become less regular or predictable. These changes occur because the ovaries stop producing regular amounts of those hormones. Menopause happens when periods stop altogether because the ovaries are no longer making estrogen and progesterone. The symptoms of perimenopause can start up to ten years before menopause. Since the average age of menopause is about 51 years, perimenopause can start in a person’s mid-30s and early 40s. Typically, by the late 40s, most women have experienced some perimenopausal symptoms.

What are the symptoms of perimenopause and menopause?

In perimenopause, hormone levels can go up and down without much rhyme or reason. One day the levels might be high. High hormone levels may result in symptoms like bloating, mood swings, and breast tenderness. Low hormone levels over an extended period may cause hot flashes, night sweats, and vaginal dryness. The fluctuations in hormone levels also cause irregular and often heavy, prolonged menstrual cycles, along with mood swings.

Hot flashes, poor sleep, and vaginal dryness/dyspareunia, adverse mood, are appreciated as being linked to the menopausal transition.

During a hot flash, you might have:

  • A sudden feeling of warmth spreading through your chest, neck, and face

  • A flushed appearance with red, blotchy skin

  • Rapid heartbeat

  • Perspiration, mostly on your upper body

  • A chilled feeling as the hot flash lets up

  • Feelings of anxiety

The frequency and intensity of hot flashes vary among women. Hot flashes may be mild or so intense that they disrupt daily activities. They can happen at any time of day or night.” I remember one of my patients saying, She was in the middle of a meeting and had an episode of hot flash”.She was drenched in sweat and all colleagues were watching. She felt very embarrassed. So it can be very bothersome for some females. Nighttime hot flashes (night sweats) may wake you from sleep and can cause long-term sleep disruptions.

So it's important to seek help from your doctor if these symptoms affecting day to day activities.

Women begin to experience changes in their sleep patterns in their 40s, and these tend to worsen with entry into the menopausal transition. Sleep disturbances have been associated with hot flashes. The symptoms of vaginal dryness, irritation, and dysuria( painful urination) have been named Genitourinary syndrome of menopause (GSM). Vaginal symptoms appear relatively early in the transition. Unlike hot flashes and adverse mood, which tend to improve over time, vaginal dryness, similar to sleep difficulties, does not get better without specific ongoing treatment. Vaginal dryness results in dyspareunia (painful sexual intercourse).Adverse mood changes discussed in the next question.

The symptoms of perimenopause and menopause vary in each woman. For some, it may be a smooth process without realizing it, for some it may give hardships.

Is it possible that menopause is causing me to feel irritable, or causing other mood or mental health changes?

In my opinion, not enough attention is given to mental health in menopause. Just as the decrease in estrogen causes hot flashes, night sweats, and vaginal dryness, it can also contribute to mood swings, forgetfulness, anxiety, and depression. Women who have a history of depression are even more likely to relapse during the menopause transition. The hormonal changes coupled with other stressors like carrying for aging parents, children leaving home, financial strain, and marriage woes, can negatively impact the quality of life.


I know firsthand that this is easier said than done. Many years of taking care of the gynecologic health needs of women have shown me that most women put themselves last. Hormones, antidepressants, counseling, exercise…all help. Treatment looks different for everyone and changes over time. Just as you wouldn’t consider not treating cancer, don’t neglect mental health. Depressed mood, increased anxiety, and irritability is symptoms of menopause.

How might menopause affect my sexual function, including my interest in sex?

The short answer is “yes.” The long answer is “it’s complicated.” As a gynecologist, I spend a lot of my time with patients trying to fill basic gaps in knowledge about sex and menopause. My patients over forty commonly talk about their loss of sex drive. They say, “If I never had sex again it would be ok.”

“Once I’m in the act, my body responds, the issue is finding the motivation to start.”

“My marriage is suffering because I have a zero interest. It was never this way before.”

Hormones play a huge role in libido, arousal, and orgasm. During perimenopause, changes in the normal hormonal cycles can interfere with all aspects of sexual function.

Besides hormone changes, other factors in the lives of adults in midlife can also affect sex. Many patients live with a great deal of stress in midlife. They are working full-time, taking care of their children and aging parents all while trying to maintain a healthy relationship with their partners. In my clinical experience, I see that poor sleep, busy lifestyles, and other midlife stressors can negatively affect sexual function. It can be hard to sort out how much of the problem comes from these factors or from hormone changes. There are many treatment options, hormonal and nonhormonal, so it is best to discuss with a healthcare professional which option is best for you. Adhering to a healthy diet, engaging in regular exercise, maintaining adequate sleep, and practicing stress reduction techniques help improve overall well-being and sexual function.

Will menopause cause weight gain?

This is the most common question I come across in clinical practice. As you get older, you might notice maintaining your usual weight becomes more difficult. In fact, many women gain weight around the menopause transition.

The hormonal changes of menopause might make you more likely to gain weight around your abdomen than around your hips and thighs. But, hormonal changes alone don’t necessarily cause menopause weight gain. Instead, the weight gain is usually related to aging, as well as lifestyle and genetic factors.

For example, muscle mass typically diminishes with age, while fat increases. Losing muscle mass slows the rate at which your body uses calories (metabolism). This can make it more challenging to maintain a healthy weight. If you continue to eat as you always have and don't increase your physical activity, you're likely to gain weight..

Other factors, such as a lack of exercise, unhealthy eating, and not enough sleep, might contribute to menopause weight gain.

Are there specific health concerns that I should be aware of after menopause?

There are long-term complications linked to the decreased levels of estrogen associated with menopause.

  • Bone: There is a rapid loss of bone density (osteoporosis) during the immediate years following menopause from the lack of estrogen. This can lead to the weakening of bones and an increased risk of fracture from trivial injury, especially fractures of the hip, wrist, or spine. A balanced diet and routine exercise can help maintain bone integrity.

  • Heart and blood vessels: The estrogen produced before menopause protects against heart attacks and stroke. The decline in estrogen, along with other risk factors, such as high cholesterol, high blood pressure, and a sedentary lifestyle, leads to an increased risk of heart attacks and stroke. Thus, it is important to eat healthily and maintain a normal diet.

  • Bladder and vaginal tissue: With decreasing estrogen, the lining of the vaginal canal becomes thinner, dryer, and less elastic. This can lead to pain during sexual intercourse and increased susceptibility to vaginal infections. This same lack of estrogen can lead to the urethra becoming inflamed and irritated, leading to more frequent urination and urinary infections.

Are there any safe and effective medical treatments for my bothersome menopausal symptoms?

Menopause is a normal part of a woman's life and doesn’t always need to be treated. However, menopausal symptoms can be disruptive.

Medical treatments for menopausal symptoms include hormone replacement therapy, antidepressants, and anti-seizure medications. Estrogen replacement is the most effective treatment for menopausal symptoms. While there have been concerns in the past about the safety of hormone therapy, for most healthy women who are seeking help with menopausal symptoms, it is safe, low-risk, and effective.

What are the benefits and risks of hormone replacement therapy?

Hormone replacement is treatment with estrogen and progesterone with the aim of alleviating hot flashes, night sweats, vaginal dryness, and osteoporosis (weak bones). It is safest to start HRT in women who are less than 60 years old or who are within 10 years of menopause onset. There are no hard rules on the duration of HRT use; however, results from studies suggest that 5-10 years of therapy from the onset of menopause is safe.

HT is prescribed to relieve:

  • Hot flashes

  • Vaginal dryness that can result in painful intercourse

  • Other problematic symptoms of menopause, such as night sweats and dry, itchy skin

Other benefits of taking HT include:

  • Reduced risk of developing osteoporosis and reduced risk of bone breakage

  • Improvement of mood and overall sense of mental well-being in some women

  • Decreased tooth loss

  • Lowered risk of colon cancer

  • Modest improvement in joint pains

  • The lower death rate for women who take hormone therapy in their 50s.

What are the risks of taking hormone therapy (HT)

  • Heart disease

  • Stroke

  • Blood clots

  • Breast cancer

These risks vary depending on:

  • Age. Women who begin hormone therapy at age 60 or older or more than 10 years from the onset of menopause are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks.

  • Type of hormone therapy. The risks of hormone therapy vary depending on whether estrogen is given alone or with progestin, and on the dose and type of estrogen.

  • Health history. Your family history and your personal medical history and risk of cancer, heart disease, stroke, blood clots, liver disease, and osteoporosis are important factors in determining whether hormone replacement therapy is appropriate for you.

Are there any safe and effective complementary and alternative medicine(CAM) treatments for menopause?

CAM interventions for menopause, including mind-body practices, herbal products, and other whole system alternative medicine approaches are commonly used to treat menopausal symptoms. Not all CAM interventions are efficacious and safe. It is important for women to be informed about the risks and benefits of CAM for menopausal symptoms.

Mind and body practices including hypnosis and cognitive-behavioral therapy (CBT) have been demonstrated to be safe for treating some of the most common and problematic symptoms of menopause (eg, hot flashes, sexual dysfunction, sleep regulation). Other mind and body practices (biofeedback, MBSR, relaxation techniques) may reduce stress and improve quality of life for women transitioning through menopause, but have not shown efficacy for specific menopausal symptoms.

Herbal products are frequently used. However, there is no consistent evidence to support their efficacy and safety. There is the added concern that when used in combination with other medications, some herbal products could pose serious health risks. Vitamins and minerals may be important for women who are at risk for deficiencies but do not seem to reduce menopausal symptoms.

What health maintenance tests, including cancer screenings, do I need after menopause?
  • Blood pressure

  • Blood glucose tests

  • Body mass index

  • Bone density screening

  • Mammography

  • Lipid profile

  • Pap smear and HPV testing

  • Visual and hearing check-up

  • Colon cancer early detection

  • To test blood in the stool

  • Dental health check-up

Weighing Benefits & Risks

There is no single way to ensure the best possible quality of life around menopause and beyond. Each woman is unique and must weigh her discomfort against her fear of treatment. Risk is defined as the possibility or chance of harm; it does not indicate that harm will occur. Generally, HT risks are lower in younger women than originally reported in all women ages 50 to 70 combined. Many factors will be part of a woman’s decision to use a particular hormone product—her age, her risks, her preferences, available treatment options, and the cost of the product. Do her potential benefits outweigh her potential risks? Only after examining and understanding her own situation and after a thorough consultation clinician can make the best treatment choice.

Thank you for reading

All queries and suggestions are welcome.

Stay Safe and stay healthy

Dr. Archana Salve

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