Department of Psychiatry
Penn Behavioral Health

Penn Center for Women's Behavioral Wellness

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Menopause

older couples

Menopause is a natural event that happens in every woman's life. The average age for menopause in the United States is approximately 52 years, but the menopause transition can last for a number of years. During the menopause transition, women's ovaries produce less and less of the hormone estrogen, until menses stops completely. The loss of estrogen may cause hot flashes, night sweats, insomnia, headaches, irregular periods, and vaginal dryness. In addition, some menopausal women experience moodiness, an inability to concentrate, forgetfulness, trouble being organized and are easily distracted.





The "Menopause Transition"

There are various stages in the menopause transition. Women proceed from being premenopausal to postmenopausal over several years. Some women "go through the menopause" earlier and/or more quickly than others just as some women have bothersome symptoms while others do not. Several large studies of women from across the United States have suggested the following "stages" for the menopause transition.

  • Premenopause: There is no change in cycle length and a woman can predict when she will get her period.
  • Early Transition: There is a decrease in predictability regarding when a woman will get her period because her cycle sare no longer the same length each month. Some women may be able to predict their menstrual cycle for several months, but the length of their "usual" cycle has changed by several days.
  • Late Transition: A woman has experience 2-11 months without a period.
  • Postmenopause: A woman has not had a period in 12 months.

Many women wonder what is happening to their hormones during the menopause. Each month from the time of puberty to menopause, a woman's ovaries are stimulated by a hormone made in the brain called follicular stimulating hormone (FSH). FSH causes ovarian follicles to enlarge and produce estrogen. Over time, fewer and fewer follicles remain to be stimulated and thus estrogen levels decline as a woman ages. This decline in estrogen leads to an increase in FSH as there is not enough estrogen being produced to "turn off" the brain's production of FSH. FSH is sometimes used as a measure of whether a woman is peri or postmenopausal. An FSH level of > 30 IU/L is consistent with the perimenopause, although FSH levels of 70-90 IU/L are not uncommon for postmenopausal women. Many gynecologists base their decision about whether someone is peri or postmenopausal on the woman's menstrual history and the presence of common menopausal symptoms. The FSH test is not considered diagnostic for the menopause. Sometimes women in the early stages of the menopause transition can actually have high estrogen levels because that month the follicles she has remaining in her ovaries were able to responded to the high levels of FSH and produce more estrogen. Thus, the menopause can be characterized by very high and very low levels of estrogen.

 




Natural versus Surgical Menopause

 

 




Treatments for Menopause Related Symptoms

 

  • Hormone Therapy

  • Botanical Supplements

  • Antidepressants

  • Sleep Medications

 


 

 

 

 

 

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