Causes, stages, symptoms, & treatments

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What is menopause?

Throughout a woman’s life, the female hormones estrogen and progesterone are responsible for reproductive health and for supporting many of the tissues throughout the body. These hormones are produced in the ovary, when stimulated by the brain to do so. As a woman ages, the ovaries stop producing sex hormones at the same rate.

This can happen as early as in the late 30s or early 40s, and women may start to notice symptoms as a result of their changing hormones. Hormonal fluctuations may begin to cause irregularities in menstrual bleeding, mood swings, hot flashes, brain fog, changes in metabolism, and changes in sleep patterns. Some women may suffer from these types of symptoms for up to 10 years, before they finally complete the menopause transition.

What causes menopause?


Normal aging is what leads most women into the menopause transition in their late 30s or early 40s. It’s natural for hormone production in the ovaries to decrease, and the result is a wide spectrum of menopausal symptoms.


When a woman has her uterus removed via hysterectomy, this does not cause any change in hormone production, as the uterus does not produce hormones. Sometimes the fallopian tubes are removed (salpingectomy) and/or the ovaries (oophorectomy) along with the uterus, to reduce risk of future cancers. Removal of the fallopian tubes also has no effect on hormones. However, removal of the ovaries will cause the sudden onset of menopause, since they are the primary source of estrogen in the body.


When a woman has cancer of any part of her body and requires treatment with chemotherapy medications or radiation, exposure to these forms of treatment may cause the ovaries to shut down, prompting the onset of menopause.


For a small subgroup of women, the ovaries shut down prematurely. This causes a woman to enter the menopause transition much earlier than expected. Typically, primary ovarian insufficiency is diagnosed if a women completes menopause before the age of 40.

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The Stages of Menopause


A woman enters perimenopause at the onset of her first menopause-related symptom. It’s a gradual transition between a woman’s reproductive years and menopause. Perimenopause usually lasts many years and can be associated with shorter menstrual cycle intervals, irregular periods, night sweats, mood changes, and hot flashes. Many women will seek treatment for their symptoms during this time, even before they have reached menopause.


Menopause itself is defined as the final menstrual period, and it is generally confirmed after a woman has gone at least 12 consecutive months without a menstrual period naturally (meaning without intervention like birth control). Menopause marks the permanent end of fertility, and it most commonly occurs between the ages of 40-55; the average woman crosses this threshold at age 52. Some women reach natural menopause in their late 30s, and a small number of women don’t until their 60s.


Postmenopause refers to the rest of a woman’s life after she has completed menopause. For many women, this is a good time to reassess their health, focus on wellness, and work to keep their body as strong and healthy as possible.

to discover where you are in the menopause transition take the quiz
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Menopause Symptoms

There are over 100 symptoms associated with menopause, but the following are some of the most common:

Hot Flashes

Hot Flashes

A hot flash is a sudden feeling of warmth in the upper body, usually most intense over the face, neck, and chest. Sometimes women will spontaneously start sweating in these areas, and skin can redden.

Night Sweats

Night Sweats

These are hot flashes that occur during sleep. Many women describe waking up in a sweat, having to throw the covers off themselves during the night. Then once the night sweat passes, they may feel cold.

Sleep Disturbances

Sleep Disturbances / Insomnia

Sleep disturbances can have a wide variety of symptoms. Women might have trouble falling asleep or staying asleep, or they may simply not feel well-rested when they wake up. It’s also common for sleep to be interrupted by night sweats.



Many women report feeling constantly tired. This may result from a lack of quality sleep, disrupted by night sweats and other disordered sleep patterns.

Brain Fog

Brain Fog

Brain fog may appear during perimenopause or menopause as forgetfulness, confusion, difficulty completing tasks/multitasking, or even difficulty recalling information.

Depression / Anxiety / Mood Changes

Depression / Anxiety / Mood changes

The hormone fluctuations in perimenopause/menopause can create a feeling of being out of control. Many women report increased irritability, anxiety, fatigue, depression, and feeling like their moods swing/change without explanation. Any history of depression or anxiety in the past can also increase the risk of recurrence during menopause.

Vaginal Dryness

Vaginal Dryness

Loss of estrogen decreases the vagina’s natural lubrication, causing a feeling of dryness. This is most noticeable when a woman attempts insertional sexual intercourse, which can create irritation or a burning sensation.

Painful Sex

Painful Sex

Less lubrication and loss of elasticity of the vaginal tissues may cause some women to experience pain with penetrative sexual intercourse. Using lubrication and having patience is key to ensuring that intercourse can remain pleasurable for women during the menopause transition.

Overactive Bladder

Overactive Bladder / Incontinence

Overactive bladder is the sensation that causes women to feel an urge to urinate more frequently than normal. This can also lead to incontinence, which is the involuntary leakage of urine. Overactive bladder can result from loss of estrogen to the supportive tissues surrounding the bladder and urethra, where urine exits the body.

Irregular Periods

Irregular Periods

Cycle duration may become shorter or longer, and women may skip periods altogether. The menstrual flow or bleeding itself may increase, decrease, or change quality or color during this time. Many women report not sensing any pattern to their menstrual periods in perimenopause.

Breast Tenderness

Breast Tenderness

Breast tissue can be very sensitive to changes in estrogen. This is the same reason why some women experience breast tenderness just before their period starts in the premenstrual phase of their menstrual cycle. The changes in the release of estrogen during perimenopause and menopause can cause tenderness in the breasts as well.

Weight Gain

Weight Gain

The metabolism slows as we age; throughout adulthood, lean body mass decreases, while body fat accumulates. For many women, the onset of menopausal symptoms also increases stress and our stress hormone, cortisol, exacerbating the weight gain that occurs naturally with age. Often menopausal weight gain presents around the torso and abdomen.

Joint and Muscle Aches

Joint and Muscle Aches

Estrogen protects joints and reduces inflammation. When estrogen levels drop, inflammation can increase, as well as the risk of osteoporosis and osteoarthritis; painful joints can be the result. The joints most frequently affected during menopause are the neck, jaw, shoulders, wrists, and elbows, though other joints may be painful as well. The discomfort is commonly described as stiffness, swelling, shooting pains, and even a burning sensation after exercise.

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Menopause Treatments

Hormone replacement therapy (HRT) or hormonal therapy (HT)

Because decreasing sex hormones is what causes the symptoms of menopause, hormone therapy is by far the most effective way to treat symptoms. This can include hormones taken systemically in the form of pills, patches, or creams, and it may also include topical estrogen used on the vaginal and vulvar tissues to help with vaginal dryness.

Non-hormonal prescription drugs

For some women who have medical or genetic histories or conditions that make taking hormone therapy unsafe, there are other medications that can be prescribed to help with menopausal symptoms. Some examples include venlafaxine or effexor, an antidepressant that is used to help hot flashes and night sweats; clonidine - a blood pressure medication that also has a side benefit of helping hot flashes and night sweats; and gabapentin - an anti-seizure medication that is used for chronic pain conditions and also helps vasomotor symptoms like hot flashes and night sweats.

Herbal treatments

There are several herbal remedies that have been taken historically by women in hopes of helping menopausal symptoms. These include soy, black cohosh, red clover, dong quai, ginseng, kava, evening primrose oil, and vitamin and mineral supplements. The benefit to these is that they are widely available over-the-counter. However, herbal supplements are not as closely regulated as prescription drugs, so you can never be 100% sure that what you are buying actually contains the herbal treatment you are hoping to take.

Lifestyle changes

Eating well, maintaining a healthy weight, exercising, relaxation techniques, and general self-care can go a long way in helping to ease the symptoms of menopause for many women. Making small changes to clothing and bedding can help some women cope and adjust to hot flashes and night sweats as well.

Cognitive Behavioral Therapy (CBT)

CBT is a non-medical approach that can be helpful for many health problems including anxiety, depression, stress, hot flashes, sleep problems, night sweats, fatigue, and more. CBT helps patients develop strategies, techniques, and coping skills for managing their concerns.

Lubricants and moisturizers

The decline of hormones affects the quality of skin, and in particular, vaginal tissue. The vagina loses its rugations - or folds - and elasticity, and without estrogen, the vagina also loses the ability to self-lubricate. Using lubricants for every act of penetrative intercourse becomes crucial for comfort and pleasure during and after menopause.

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Take charge towards a happy life in menopause!

Knowledge is power. Becoming educated about the symptoms and signs to look for will help you recognize when you’re going through the menopause transition. By seeking treatment when you need it, and choosing treatment options that fit your lifestyle, you can make this transition a smooth one.

Register for a free online visit with Winona, if you’re ready to start feeling better. Our physicians are available and eager to help you, and our community of Winona Women is here to support you. Don’t suffer with symptoms alone; take ownership of your health and wellness, and rediscover your best self.

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