What is menopause?

Menopause is the time in a woman's life when her periods stop and she can't have children anymore. This happens because as a woman ages, her ovaries stop making enough of the female hormones estrogen and progesterone.

When does menopause occur?

The average age for women to have their last period is about 50. But it's normal for menopause to occur any time from age 41 to 59. A woman often goes through menopause at about the same age as her mother.

Women who have both ovaries removed will go through "surgical menopause" at the time of their surgery. If the uterus is taken out but the ovaries are left, a woman won't have periods but she will only go through menopause when her ovaries stop making estrogen.

If you stop having periods early--before age 40--your doctor can do a blood test to see if you're going through menopause.

Menopause is a gradual process that can take several years. You're not really through menopause until you haven't had a period for 12 months. (During this time, keep using birth control if you don't want to become pregnant.)

Some women just stop having periods. Others experience symptoms, such as the following:

A change in your menstrual cycle. This is one of the first signs of menopause. You may skip periods or they may occur closer together. Your flow may be lighter or heavier than usual.

Hot flashes. Hot flashes are the most common symptom of menopause. When you have a hot flash, you'll feel warm from your chest to your head, often in wave-like sensations. Your skin may turn red and you may sweat. You may feel sick to your stomach and dizzy. You may also have a headache and feel like your heart is beating very fast and hard.

Thinning of your vagina and vulva (the area around your vagina). The skin of your vagina and vulva becomes thinner with menopause. Your vagina also loses its ability to produce as much lubrication (wetness) during sexual arousal. These changes can lead to pain during sex. You can use a cream (put in and around your vagina) or a lubricant prescribed by your doctor to make sex less painful.

Urinary tract problems You are more likely to have bladder and urinary tract infections during and after menopause. Talk to your doctor if you have to go to the bathroom often, feel an urgent need to urinate, feel a burning sensation when urinating or are not able to urinate.

Headaches, night sweats, trouble sleeping and tiredness are other symptoms. Trouble sleeping and feeling tired may be caused by hot flashes and night sweats.

Many women experience emotional symptoms during menopause. These symptoms may include sadness, anxiety and loss of sleep. For some women, symptoms can be severe. If you find that you're having emotional problems, talk to your doctor.

What is hormone replacement therapy?

Hormone replacement therapy (HRT) involves taking estrogen alone or estrogen combined with another hormone, progestin. Some women have found that HRT can relieve symptoms such as hot flashes, vaginal dryness and some urinary problems. However, HRT is not for everyone. Talk to your doctor about the risks and benefits of HRT.

What is osteoporosis?

In osteoporosis, the inside of the bones becomes porous from a loss of calcium (see the picture below). This is called losing bone mass. Over time, this weakens the bones and makes them more likely to break.

Osteoporosis is much more common in women than in men. This is because women have less bone mass than men, tend to live longer and take in less calcium, and need the female hormone estrogen to keep their bones strong.

Once total bone mass has peaked—around age 35—all adults start to lose it. In women, the rate of bone loss speeds up after menopause, when estrogen levels fall.

What are the signs of osteoporosis?

You may not know you have osteoporosis until you have serious signs. Signs include broken bones, low back pain or a hunched back. You may also get shorter over time because osteoporosis can cause your vertebrae (the bones in your spine) to collapse. These problems tend to occur after a lot of bone calcium has already been lost.

Am I at risk for osteoporosis?

Risk factors for osteoporosis include:

	Menopause before age 48
	Surgery to remove ovaries before menopause
	Not getting enough calcium
	Not getting enough exercise
	Smoking
	Osteoporosis in your family
	Alcohol abuse
	Thin body and small bone frame
	Hyperthyroidism .
	Long-term use of oral steroids

Will I need a bone density test?

Check with your doctor. For many women, osteoporosis (or the risk of it) can be diagnosed without testing. When testing is appropriate, doctors use equipment that takes a “picture” of the bones to see if they are becoming porous.

Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,000 mg of calcium per day if you're taking estrogen and 1,500 mg of calcium per day if you're not taking estrogen. It’s usually best to try to get calcium from food. Nonfat and low-fat dairy products are good sources of calcium. If you don’t get enough calcium from the food you eat, your doctor may suggest taking a calcium pill. Take it at meal time or with a sip of milk. Vitamin D and lactose (the natural sugar in milk) help your body absorb the calcium.

Tips to keep bones strong

	Exercise.
	Eat a well-balanced diet with at least 1,000 mg of calcium a day.
	Quit smoking. Smoking makes osteoporosis worse.
	Talk to your doctor about HRT or other medicines to prevent or treat osteoporosis