by Alice Berry, University of Virginia

Credit: Pixabay/CC0 Public Domain

Even though about half of the population will experience it at some point, what menopause entails and what treatments are available remain fuzzy.

It's difficult to cut through the noise of changing medical advice and an influx of products and devices promising to relieve symptoms. University of Virginia assistant professor of nursing Emily Evans, an expert on women's health, agreed to answer some of UVA Today's questions.

What are perimenopause and menopause?

Menopause is characterized by cessation of menses and is generally diagnosed retrospectively. So, if a woman has not had a period for 12 months, is otherwise healthy and is over 45, she has graduated to the menopausal phase of her life. It is a time of great freedom, productivity and refocus as they navigate their lives without estradiol (a form of estrogen) and progesterone, the two hormones that drive the menstrual cycle and have been a part of their lives since puberty.

Perimenopause is the time preceding menopause and is characterized by the body's transition to life without estradiol and progesterone. As you can imagine, estradiol does not just cease being produced one day, but decreases over time, in fits and spurts, as ovarian function declines. This generally happens in a woman's 40s, with the average duration of this stage being two to eight years.

What are the symptoms of each?

Some of the symptoms during perimenopause are a direct result of the tissues of the reproductive system adapting to less estradiol and progesterone. The lining of the uterus is no longer stimulated in a predictable, regular pattern, so menstrual cycles vary in timing and length. The skin in the vulva and vagina adapts and feels relatively dry and fragile. There is less lubrication and moisture to support sexual activity and genitourinary health, so painful sex and change in urination are common issues women take proactive steps to deal with.

The most notorious of all physical changes are the vasomotor symptoms of perimenopause: hot flashes and night sweats, which as many as 75% of women experience. These may continue even after menopause for some women. The part of the brain that controls temperature regulation is also closely connected to the part of the brain that controls hormone production.

Other changes to be aware of coincide with the declining influence of estradiol on the rest of the body. Some women notice mood changes, memory dysfunction and cognitive alterations as neural pathways of the brain once supported by estradiol are adjusted. Estradiol also has a protective influence on the bones, so declining levels can lead to joint and muscle aches as well as an increased risk of fractures.

Is hormone therapy for menopause safe?

Although some controversy about hormone therapy was generated by the preliminary results reported from the Women's Health Initiative, the most recent evidence supports using it for menopausal symptoms in women under age 60 who do not have a history of cancer or other contraindications. You can replace the hormones with a pill or transdermal patch, or local replacements with creams, gels, rings or tablets.

What options are there for women with contraindications?

For women who are not candidates for hormone replacement therapy (with a history of breast cancer, other hormone-responsive cancers, liver disease or arterial thromboembolic disease), some low-dose antidepressants and drugs like Gabapentin may offer vasomotor symptom relief and are generally well-tolerated.

In addition, the FDA recently approved another non-hormonal drug, Veozah (fezolinetant), for use in treating vasomotor symptoms of menopause. This drug acts directly on the thermoregulatory center of the brain to decrease vasomotor responsiveness. Although considered a breakthrough, this drug has yet to gain widespread use because it is expensive and not covered by many insurance companies.

What about homeopathic treatments?

Non-hormonal therapies that have begun to be examined, including acupuncture, nerve blocks, vaginal laser treatments, plant-derived estrogens and black cohosh (a woodland herb), but a significant body of research giving strong, clear direction has yet to be built up.

Relaxation, stress reduction, yoga, exercise and cognitive behavioral therapy are mainstays of maintaining emotional and mental health and are well-supported as beneficial in many areas of health, with the possibility of improving menopausal symptoms as well.

What advice would you give women experiencing menopause?

My recommendation to women is to educate yourself about these changes and understand what is going on in your body. I remember a woman in her 40s sitting in my office as I explained the nature of perimenopause and what was happening in her body and mind, and she said, "How come no one has ever told me this before?"

Don't be afraid of these changes. You have many tools at your disposal to sail through them and start this next chapter of life on solid footing. The body is designed to adapt and thrive. Do those things that maximize your health in all areas—physical, mental, emotional and spiritual—and I believe you will find yourself entering menopause with power and freedom to live life to its fullest.

Provided by University of Virginia