Menopause

Published: May 28, 2014

Menopause is the point in a woman’s life when menstruation stops permanently, signifying the end of fertility.  It defined as the absence of a menstrual period for twelve consecutive months (1 year). On average, menopause occurs at age 51, give or take 5 years. A general knowledge of what is happening in your body can reassure you that menopause is a normal and natural event. It’s important for you to be aware of any changes in your menstrual cycle and consult with your clinician.

Short-Term Menopausal Changes

• Changes in menstrual cycle
• PMS
• Hot flashes
• Sleep changes
• Mood changes, irritability, anxiety
• Vaginal dryness
• Changes in sex drive
• Joint aches
• Crawling skin
• Headaches
• Memory loss
• Heart palpitations
• Fatigue
• Skin changes
• Hair changes
• Dry eyes
• Body changes (weight)

Long-Term Effects of Menopause

• Decreased estrogen production may cause some of these physical effects:
• Coronary heart disease (CHD)
• Osteoporosis
• Genitourinary problems, especially Stress Urinary Incontinence

Tests to Confirm Menopause

Always check with your clinician to exclude other medical causes that may have caused you to skip your menses.  Your clinician will discuss your symptoms, your personal medical history, give you a physical exam, and may suggest you have laboratory tests to determine whether you are actually in menopause.

The best way to confirm menopause is by evaluating your symptoms. Your clinician will take a thorough medical history and do a physical exam to include having discussion about your changes in menstrual patterns (number of missed periods) and symptoms that you are having. Your physical exam will also include an assessment of your vaginal tissues to see if estrogen loss caused your vagina to become thin, pale, dry, less alkaline or if it appears red and bleeds easily.

Follicle Stimulating Hormone (FSH) Test

FSH is a hormone produced by the pituitary gland that kicks off ovulation by stimulating the ovaries to develop follicles.  An FSH test measures the amount of follicle stimulating hormone in a blood sample.  This analysis is given to a woman to help evaluate menstrual problems and it is also helpful to determine whether the woman has gone through menopause.  The test is available as a blood test or a urine test.

During the normal menstrual cycle, FSH levels rise slowly a few days before your period begins in order to develop a follicle.  The follicle then works with another hormone (lutenizing hormone), of LH) to release an egg. Afterwards, FSH levels fall and progesterone kicks in, preparing for your next period (for pregnancy).

During perimenopuase, when the ovary can’t make estrogen in response to the FSH, the brain says “keep on going!”  So, the pituitary gland produces more FSH in hopes of stimulating the ovary to its former function.  Therefore, the theory behind the FSH tests is that high levels can indicate menopause, during a particular day within your cycle.  Levels measuring greater than 30IU/L are elevated and are often used to indicate menopause.

It sounds straight forward enough, right?  Sure, FSH levels will tell you when your ovaries are getting close to shutting down follicle production.  But, how do you know they are not just in a wild state of confusion and fluctuating (typical of the years leading up to menopause, perimenopause)?  Or, if you are not in menopause, the FSH test will only tell you where in your cycle you are.  Higher levels could just indicate your body’s getting ready to ovulate.

I’m sorry to say that just because you haven’t had your menstrual period for 3 months and are continuing to feel the fiery inferno of hot flashes on a regular basis; it may just be a peak at the top of the perimenopause roller coaster.  Elevated levels can occur even as long as 10 years before menopause.  In the Massachusetts Women’s Health Study, 20% of midlife women who experienced 3 months without their period, began menstruating again.  See how a single measurement of FSH greater than 30IU/L may not be enough to determine menopause?

If you are still set on getting an FSH test to determine where exactly you are in the menopause transition, ask your clinician about getting one.  FSH that clinicians give are blood tests.  Since FSH fluctuates, it is best to have this test within the first 3 days of your menstrual period when FSH levels are at lower levels.  What clinicians are looking for with this test is a confirmation of menopause that substantiates a high level of FSH.  Menopausal women typically have FSH levels higher than 30, and sometimes even in the 100s.

The Estradiol Test

The estradiol test is another blood test clinician’s use to diagnose menopause. This test will tell you exactly how much estrogen your ovaries are producing.

One of the many types of estrogen circulating the body is estradiol.  This test looks for an estradiol level lower than 50 pg/ml (picograms per milliliter).  Clinicians usually agree that an estradiol of 20 or 30 confirms menopause.

The following tests are not accurate ways in diagnosing, predicting or confirming menopause:

• pH test
• Saliva test
• Urinary test

Treatment Options

There are many ways to deal with menopausal symptoms which include adopting healthy a healthy lifestyle which includes exercise, healthy eating and quitting smoking.  Your clinician should discuss with you hormone therapy and other medicines, such as antidepressants that are FDA approved to treat the symptoms associated with menopause.  Your discussion should also include over the counter treatments such as black cohosh and soy.