FAQs & Patient Resources

How early natural menopause starts is slightly different for every woman, but for most it starts when you are between 45 and 50 years old.

There are three stages of menopause:

1. Perimenopause or early menopause:

• This can start years before menopause, generally in your mid to late 40s.

• Your menstrual cycle or periods will be more irregular but haven’t stopped.

• You might start noticing symptoms like hot flashes.

• You can still get pregnant during perimenopause, even if your periods are irregular.

2. Menopause:

• Your ovaries will stop releasing eggs and stop producing estrogen.

• You will have your final menstrual period.

3. Post menopause:

• Once you have gone 12 months in a row without a period, you are considered postmenopausal.

• Some of the symptoms you experienced during menopause may continue for years after your transition.

Focusing on your heart health, strength and bone density is important after menopause. Loss of estrogen post menopause can cause loss of bone density and muscle mass, as well as increased risk of heart disease.

You might be pre-menopausal or menopausal if you are experiencing:

• Hot flashes

• Irregular periods or menstrual cycle changes

• Insomnia or trouble sleeping

• Mood swings, irritability, anxiety or stress

• Changes to your sexual desire and arousal

• Vaginal dryness or discomfort

• Night sweats

• Bladder control issues

• Palpitations

• Joint pain

• Tender breasts

• Forgetfulness

• Weight gain

• Thinning hair or hair loss

• Dry skin, eye or mouth issues

Menopause that starts before age 40 is called premature menopause. This can happen naturally or due to a medical reason. Some of the more common medical reasons premature menopause can happen include:

• Chemotherapy or radiation treatment for cancer

• Surgery that removes your ovaries

• Autoimmune diseases

• Smoking cigarettes

Estrogen and progesterone are hormones that are produced by the ovaries and work together to regulate certain body processes. During the stages of menopause, you will no longer produce high levels of these hormones, which can cause uncomfortable symptoms.

• Estrogen helps your body use calcium to support bone health and prevent osteoporosis. It also helps maintain healthy cholesterol levels and keeps your vagina healthy.

• Progesterone helps regulate your blood pressure, improves your mood and helps you sleep.

As you transition into menopause, there are several therapies that can help manage symptoms, including menopausal hormone therapy (HT).

Generally, there are two approaches to hormone therapy, depending on whether or not you have a uterus:

• If you no longer have a uterus: Your provider may recommend Estrogen Therapy (ET). With ET, you will take only estrogen as you may not need progesterone. ET can be prescribed as a pill, a patch, a cream or gel, or a vaginal ring.

• If you do have a uterus: Your provider may recommend Estrogen/Progesterone Therapy (EPT). You’ll take a combination of estrogen and progesterone. Progesterone is added to help reduce the risk of uterine (endometrial) cancer for women who have a uterus. EPT can be prescribed in a several different combinations including pills, or a combination of pills and patches, creams, gels or a vaginal ring.

Other important areas for focus when treating menopause include:

• Strength training, cardiovascular exercise and exercise focused on maintaining a sense of balance

• Good sleep habits

• Pelvic floor (Kegel) exercises

• Sexual health and intimacy

• Healthy nutrition and supplementation, if needed

• Healthy lifestyle modifications

If you are not able to take hormones or prefer not to take them, some non-hormonal drugs have been approved to treat symptoms like hot flashes.

Post menopausal menstrual bleeding is not normal so if you experience this, see your provider as soon as you can. There are a few reasons you could be experiencing bleeding, including vaginal dryness, polyps (or non-cancerous growths) or other changes in your reproductive system. Sometimes, bleeding can be a sign of uterine (endometrial) cancer. We can help you identify the cause of the bleeding through a pelvic exam or Pap test, and perform further testing, if needed.

Many women notice a change in the distribution of weight with more weight being carried around the abdomen as they move through menopause. This is a result of the hormonal shifts associated with menopause. Healthy eating and staying active, particularly strength training to maintain muscle mass, are important for women going through menopause. Food and exercise can also help you manage some of the other symptoms you might have, including mood swings and insomnia.

Presbyterian Community Health offers a variety of accessible healthy eating, active living, and support resources free of charge for the community, to support and promote your personal wellness.

Hair loss and thinning during the stages of menopause are caused by changes in the proportions of hormones. The natural decrease in estrogen leads to a decrease in hair growth cycles. An increase in the proportion of testosterone can result in unwanted hair growth on the face for some women.

You can talk to your primary care or menopause provider about treatment options for hair loss.

Yes! If you are menopausal or post menopausal, you should continue to get regular Pap and HPV tests, as well as mammograms. Regular screenings are important to help diagnose and treat health conditions earlier, such as cervical cancer or breast cancer. Breast cancer is more common in post menopausal women.

• Pelvic exams are recommended once a year

• Pap and HPV tests are recommended once every five years

• Mammograms are recommended once every one or two years

If you have had a total hysterectomy for a non-cancerous condition, or if you are 65 or older, you may not need to continue Pap tests. However, it is important for all women to continue receiving regular pelvic exams.

Estrogen is important for keeping the uterus, vagina, bladder and pelvic floor muscles strong and flexible. As your estrogen levels drop during menopause, your pelvic floor muscles may become weaker. Pelvic organ prolapse, vaginal and vulvar dryness, recurrent urinary tract infections and incontinence issues are more common during menopause and for post-menopausal women.

Symptoms of genitourinary syndrome of menopause (GSM) can include:

• Vaginal dryness

• Burning/itching

• Urge to urinate

• Urinary incontinence

• Bladder infections

• Recurrent urinary bladder infections

• Pain with urination (dysuria)

• Pain or discomfort with sexual intercourse (Dyspareunia)

• Loss of libido

• Pelvic organ prolapse

Along with changes to the pelvic floor, menopausal and post-menopausal women may notice changes in their sex lives, including lower desire and decreased ability to become aroused. Lower estrogen hormone levels can cause your vagina to be drier and thinner, which can make sex uncomfortable or painful.

• Pelvic floor training can help improve your pelvic health, bladder and bowels, and your sexual arousal and satisfaction.

• Over the counter, vaginal lubricants may be helpful during sex.

• Vaginal moisturizers can be used like other skin creams to preserve the health of your vaginal and vulvar tissues.

• For more severe vaginal dryness, your provider may prescribe you a vaginal estrogen cream, estrogen tablets or rings, or other medications