Menopause

Menopause is the time in a woman's life when she no longer has a menstrual cycle. It is a normal body process that occurs in all women at an average age of 52. The menopause transition can span years before and after the final menstrual period, referred to as the menopause transition.

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Menopause is when your menstrual cycle permanently stops. It is a gradual transition as your body naturally begins to produce less reproductive hormones. You have entered menopause when you’ve been without your period for a full year, meaning you have not had any bleeding for 12 months in a row.

While menopause is most often a natural process and does not require treatment, many of the side effects of the transition can cause discomfort or lead to other health complications that can be treated with the right care plan.

At University of Iowa Health Care, our OBGYN specialists can assess your menopausal symptoms and help you explore therapies that can improve your quality of life. Home to an experienced team of specialists who are all certified through the North American Menopause Society, our providers will find a treatment plan that works for you.

Symptoms of menopause

Each individual will confront their menopause experience uniquely. In the months or years leading up to your transition into menopause, you may experience some or all of the following symptoms:

Hot flashes
Night sweats
Sleep disturbances
Mood changes
Irregular menstrual periods
Vaginal dryness
Vaginal irritation or discomfort
Pain during sex
Low libido
Changes in body composition, challenges with weight loss and weight gain

Phases of menopause

If your transition to menopause is due to natural decline of hormones as you age, you will experience gradually menopause in three phases:

This marks the period when your body begins to transition to menopause. It can begin as early as your 30s and can last for years. During this time, your ovaries begin to produce less hormones, your menstrual cycle changes, and your fertility begins to decline. This phase includes the first year following the final menstrual period.

At this point, you have stopped having your menstrual periods for at least 12 months and your ovaries have stopped releasing eggs and making estrogen.

This period is after you’ve gone 12 consecutive months without your menstrual period. While some symptoms of menopause may improve at this point, some patients do experience symptoms for years following menopause.

Other types of menopause

Early and premature menopause. While menopause for most individuals happens for people at age 50 or older, people experiencing early menopause begin their menopause transition in their 40s. In some rare cases, people may begin menopause before age 40. If an individual experiences menopause before the age of 40, this is called primary ovarian insufficiency.
Surgical menopause. Those who have had their ovaries removed experience immediate menopause. This is because your ovaries produce the hormones needed to regulate your menstrual cycle. Without them, you are likely to experience the symptoms associated with menopause.
Induced menopause. Some cancer therapies such as chemotherapy and radiation therapy can induce menopause in patients, although it is not always permanent.

Causes of menopause

Naturally declining hormones. As you age, your body starts to make less of your reproductive hormones such as estrogen and progesterone. This will cause your menstrual periods to change, your fertility to decline, and, eventually, your eggs will stop releasing.
Primary ovarian insufficiency. This condition occurs when the ovaries stop making typical amounts of hormones and fail to release eggs regularly. This condition can lead to infertility and can be a contributing factor to premature menopause in some patients.
Surgery or other medical treatments. Surgeries or medical treatments, such as radiation therapy, on the ovaries can induce menopause regardless of age.

How menopause is diagnosed

Most of the time, your provider will be able to diagnose you by discussing the frequency of your menstrual cycle. If it’s been 12 months since your last period, you’ve entered menopause or are postmenopausal.

While tests usually are not necessary when diagnosing menopause, your doctor may order blood tests to check your hormone levels.

Menopause treatment options from UI Health Care

Menopause does not require any specific treatment, but there are treatments that focus on relieving symptoms you are experiencing.

Hormone therapies

Different hormone replacement therapies can help regulate hormones and relieve some symptoms of menopause while also helping to prevent osteoporosis. These include:

Estrogen therapy (ET). This therapy involves receiving low doses of estrogen.
Estrogen progestin therapy (EPT). This therapy combines estrogen and progesterone (or progestin). If an individual still has a uterus, then they need to use both estrogen and progesterone.
Tissue selective estrogen complex (TSEC). This therapy partners a selective estrogen receptor modulator with one or more estrogens.

Nonhormonal prescription therapies

Certain nonhormonal medications can help relieve or reduce the vasomotor symptoms of menopause such as hot flashes, night sweats, and sleep issues. These include:

Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Typically used as antidepressants, these medications can also help manage menopause symptoms.
Gabapentin. While approved to treat seizures, it has been shown to also help relieve menopause symptoms.
Oxybutynin. Most commonly used for overactive bladder, this medication can reduce menopause symptoms and is usually well tolerated.
Fezolinetant (Veozah). Works in the temperature control region in the brain by blocking certain receptors (NKB) that are responsible for hot flashes and night sweats.

Non-prescription therapies

If medications or prescription therapies are not right for you, there are other ways to manage your symptoms. These include:

Cognitive behavioral therapy (CBT). Even a brief (four to six weeks) stint of CBT therapy has been shown to reduce the vasomotor symptoms of menopause, relieve anxiety and depression symptoms, and help patients sleep better.

Clinical hypnosis. Some studies have shown that hypnotherapy has been successful in reducing the length and severity of hot flashes in menopausal women. It can also improve mood and sleep.

Weight loss. Losing weight can also help relieve symptoms, improve mood, and help you sleep better. And, because menopause can put you at greater risk for complications such as cardiovascular disease, losing weight can help you manage your risk for more serious conditions.

A team approach to menopause

Menopause can affect many aspects of your life and health. Our OBGYN specialists will collaborate with a range of departments to provide a comprehensive treatment plan to meet your unique needs.