What Is Menopause? When Does It Usually Begin? What Are the Common Symptoms and Warning Signs?

The term “menopause” is commonly used in everyday conversations, often jokingly to describe someone who is moody or irritable. However, many people may not fully understand what menopause truly means.

Today, let’s learn more about menopause — what causes it, at what age it typically begins, what symptoms and warning signs appear before menopause, and how to manage this stage of life effectively.

Menopause is the stage when a woman reaches the end of her menstrual cycles. During menopause, the ovaries stop functioning and no longer produce the hormones estrogen and progesterone. Ovulation ceases, which leads to the complete stop of menstruation. Women typically enter menopause between the ages of 45 and 55.

Generally, menopause is divided into 3 stages as follows:

1. Perimenopause
   Perimenopause is the initial stage leading up to menopause. During this period, women experience irregular menstrual cycles and physical symptoms such as hot flashes, dizziness, fatigue, and mood swings. This stage usually lasts about 2–3 years.
2. Menopause
   Menopause is defined as the stage when menstruation has stopped for a continuous period of 1 year. During this stage, symptoms like mood swings, hot flashes, fatigue, and insomnia persist due to the body’s cessation of estrogen and progesterone production.
3. Postmenopause
   Postmenopause begins after a woman has gone 1 year without menstruating. This stage brings changes such as vaginal atrophy (narrowing of the vaginal canal), osteoporosis, and an increased risk of various health complications.

Short-term symptoms:

• Irregular menstruation: Periods may come too close together or be spaced far apart; some women may experience abnormal bleeding.
• Hot flashes: Caused by hormonal fluctuations, leading to poor body temperature regulation. These symptoms are most intense during the first 2–3 years after menopause and gradually decrease within 1–2 years.
• Insomnia: Often caused by hot flashes interfering with sleep.
• Emotional changes: Common symptoms include depression, irritability, and increased anxiety.
• Vaginal dryness: Due to decreased estrogen levels, causing discomfort during intercourse, itching, inflammation of the vagina and uterus, vaginal laxity, and decreased sexual desire.
• Reduced fertility: Ovulation becomes irregular and eventually stops permanently after 1 full year without menstruation.
• Dry, wrinkled skin: Loss of skin elasticity, prone to wounds and pigmentation.
• Breast changes: Breasts may become smaller, saggy, and less firm.

Long-term symptoms:

• Cardiovascular system risks: After menopause, women have a higher risk of coronary artery disease due to lack of estrogen, which normally helps reduce bad cholesterol.
• Osteoporosis: Estrogen deficiency causes bone loss of about 5% per year, leading to osteoporosis, especially in the spine, wrists, and hips.
• Urinary tract problems: Decreased spinal bone density causes thinning of the urethral lining and bladder prolapse, resulting in burning sensation during urination and urinary incontinence.
• Weight gain and obesity: Reduced estrogen affects metabolism, leading to increased fat accumulation around the abdomen.

Menopause, or the cessation of menstruation, occurs because a woman’s body stops ovulating. This happens when the ovaries stop functioning and no longer produce the sex hormones estrogen and progesterone. This condition results from several factors, especially as women age and enter old age. The body undergoes various changes, and the internal systems begin to decline in efficiency.

Premature menopause occurs when the ovaries stop functioning or deteriorate faster than usual. This condition can happen in women under 30 years old. In some cases, it may be due to genetics—if there are family members who experienced early menopause, there is a higher chance that it may happen early as well.

• Avoid smoking, alcohol, and all intoxicating substances.
• Choose to eat nutritious food. Eat a balanced diet with all five food groups. Avoid oily and fried foods, and increase intake of dietary fiber from vegetables and fruits instead.
• Supplement calcium for the body. Calcium is abundant in foods such as beans, sesame seeds, green leafy vegetables, and low-fat dairy products. Calcium tablets can also be taken as supplements.
• Exercise regularly. Exercise at least 3 times a week, 30 minutes each time. For those with chronic diseases, consult a doctor to choose appropriate exercise types.
• Get proper rest. Take breaks from daily work and engage in activities you enjoy to help relieve stress.
• Have an annual health check-up. Basic health screenings should include blood pressure measurement, blood tests, urine and stool tests. For women, breast exams, pelvic exams, and cervical cancer screenings are also recommended.

• Eat more calcium-rich foods, such as all kinds of green leafy vegetables, white and black sesame seeds, milk, dried shrimp, small fish, and foods containing phytoestrogens like soybeans, soy milk, red beans, pumpkin, cabbage, broccoli, carrots, and brown rice. These help prevent osteoporosis and reduce the risk of breast cancer.
• Avoid or reduce intake of starches, fatty and fried foods, salty foods, sugary drinks, tea, coffee, and any foods containing caffeine because they may cause mood swings and increased anxiety. Also avoid alcoholic beverages and smoking.
• Exercise appropriately, such as brisk walking, cycling, swimming, or yoga. As you age, avoid strenuous exercises or activities that put too much pressure on the knees or joints, since this may cause joint deterioration.
• Get enough sleep and rest. Try to go to bed at regular times and sleep at least 6–8 hours a day. Proper sleep helps improve memory and supports overall good health and longevity.
• Manage stress properly. Practice relaxation techniques and mindfulness. Meditate when you have free time. Avoid stress because it negatively affects both yourself and those around you.

1. Treatment of Menopausal Symptoms Without Hormones

Treatment for Hot Flashes:

• Identify and avoid triggers that cause hot flashes.
• Avoid staying in hot environments or exposure to high temperatures.
• Avoid spicy foods, hot drinks, and stimulants that dilate blood vessels, such as caffeine and alcohol.
• Eat foods rich in vitamin E and B-complex vitamins, including supplements of these nutrients.
• Stop smoking.
• Relax and avoid stress, as stress can increase body temperature.

Treatment for Vaginal Dryness and Frequent Urination:

• Use estrogen creams to increase blood flow to the vagina.
• Allow natural stimulation during sexual intercourse to improve blood circulation and increase vaginal elasticity.

Treatment for Insomnia and Mood Swings:

• Use antidepressant medications, such as SSRIs.
• Engage in recreational activities to reduce stress and improve mood.

Treatment for Osteoporosis:

• Avoid heavy exercise or strenuous work.
• Consume foods rich in calcium and vitamin D.
• Hormone therapy may be used but can increase the risk of cancer.

Treatment for Hair Loss:

• Take estrogen to inhibit the production of dihydrotestosterone (DHT), which weakens hair roots.
• Wash hair regularly to remove and prevent bacteria that may damage hair roots and scalp.
• Use shampoos containing ingredients that promote hair regrowth and nourish hair.

2. Treatment of Menopausal Symptoms With Hormone Therapy

Hormone replacement therapy (HRT) commonly uses estrogen, which the body lacks during menopause. Other substances with effects similar to estrogen or progesterone may also be used, including:

• Oral medications: Raise good cholesterol but may cause unstable hormone levels due to liver metabolism.
• Injections: Bypass the liver, so good cholesterol levels may not increase as with oral drugs.
• Estrogen patches: Applied to the arm or buttocks, effective for several days.
• Hormone implants: Deliver 2-3 times higher hormone levels than normal.
• Hormone creams: Applied to the skin.
• Vaginal estrogen creams: Suitable for treating vaginal dryness.

Benefits of Hormone Replacement Therapy:

• Prevents osteoporosis.
• Prevents heart disease.
• Reduces menopausal symptoms such as hot flashes.
• Reduces vaginal dryness and itching, making the vagina more elastic and moist.
• Reduces urinary leakage.
• Treats hot flashes.
• Reduces mood swings and insomnia.
• Helps prevent heart disease, dementia, colon cancer, and complications from diabetes.

Who Should Avoid Hormone Therapy:

• Women with a history of breast or uterine cancer.
• Those with liver disease.
• Those with blood clots in the legs.
• Those with unexplained abnormal vaginal bleeding.

Side Effects of Hormone Therapy:

• Breast tenderness.
• Bloating due to liver problems.
• Vaginal bleeding.

Risks of Hormone Therapy:

• Increased risk of uterine and breast cancer, especially with high doses and continuous use for 10-15 years. Hormone therapy should not be used continuously for more than 5 years.
• Increased risk of gallstones, especially with oral therapy. To reduce this risk, patches or creams are preferred.

As women approach menopause, the quantity and quality of their eggs decline. The natural chance of getting pregnant during this time decreases significantly, often leading to infertility.

If pregnancy is desired, assisted reproductive technologies such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) may be necessary. This is because, during the menopausal transition, sex hormone levels drop drastically, causing the body's internal systems to function less efficiently than before.

Menopause is the permanent cessation of menstruation in women, caused by the ovaries stopping their function, which leads to no more ovulation. Menopause typically begins between the ages of 45 and 55. The early signs and symptoms before menopause include irregular menstrual cycles.

To prepare for menopause, it is recommended to: increase calcium intake, exercise regularly, get enough rest, and have annual health check-ups. The menopausal phase usually lasts only 3 to 5 years. If properly and appropriately managed, the bothersome symptoms of menopause will gradually improve more quickly.

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