Menopause: Definition, Types, Symptoms, Diagnosis and Treatment

It is the period in a woman’s life marked by hormonal changes that cause the end of the menstrual cycle and the reproductive years.

Menopause is usually the result of a sudden drop in estrogen production , to about half the normal amount that is too low to produce another egg, thus stopping menstruation.

However, prior to this, progesterone levels have decreased for approximately 15 years (from the age of 35) and it is during this time that many of the symptoms associated with menopause, as well as osteoporosis from bone disease can begin to develop.

The term perimenopause or climacteric , means the time from when menstrual periods begin to decrease up to a year after the last menstrual period.

In the past, menopause was often treated as a disease, a topic that was only discussed behind the doors of a medical ward.

Women have physical changes in their bodies, with bothersome symptoms.

Menopause has an impact on the risk of long-term chronic diseases.

There is a wealth of information available today for women asking questions about menopause, particularly questions about hormone replacement therapy, since menopause is not reversible.

Once the ovaries have stopped producing hormones, menopausal signs and symptoms will occur that are caused by changes in the function of your ovaries.

Types of menopause

There are three different ways your body can enter menopause.

  1. Natural menopause – This is the most common progression to menopause. Every woman will eventually stop having her period. This usually occurs around the age of 52. However, it is completely normal for menopause to occur between the ages of 40 and 58.
  2. Premature menopause: it is the menopause that occurs before the age of 40. Unlike natural menopause, premature menopause is considered abnormal. It is often associated with other autoimmune disorders and puts you at higher risk for osteoporosis.
  3. Induced menopause: This type of menopause occurs when there is an injury to the ovaries, which is generally related to medical treatments such as surgery, chemotherapy or radiation.

Symptoms of menopause

The symptoms of menopause are caused by what is called a hormonal imbalance that is usually between the ages of 40 and 50.

A woman will experience different symptoms during the menopausal stages.

The menopause symptoms listed below are the ones that have been found to be the main ones when the reproductive system has started to come to an end.

Some women experience severe nervous symptoms and become irritable, anxious, or depressed.

They may have headaches, abdominal pain, blood discharges to the head and upper body, known as hot flashes, backaches, leg cramps, nosebleeds, frequent bruising, varicose veins, and ulcers.

They are also extremely fatigued or experience night sweats, vaginal dryness, dry skin, brittle hair, poor concentration, crying, rheumatic arthritic symptoms, constipation, fractures, and irregular bleeding are other symptoms.

Poor diet, lack of exercise, and emotional stress can exaggerate the symptoms and discomfort of menopause.

Most women find that these symptoms can last for several months, but others may find that it takes years for the body to readjust and the symptoms to disappear.

Although menstrual periods may stop, a woman’s normal sexual needs remain after menopause.

Common symptoms of menopause include:

  • Reduced fertility
  • Changes in menstrual periods.
  • Insomnia .
  • Emotional changes.
  • Libido changes.

Most of these symptoms will stop after menopause is complete.

However, menopause also increases your risk for heart disease or osteoporosis, which continues after menopause is complete.

Although it is not associated with menopause, cancer is associated with advancing age in women.


Menopause is usually diagnosed by reviewing a woman’s medical history and symptoms. In most cases, hormone tests are not necessary.

If there is a question about hormone levels, a blood test may be done to measure the amount of follicle stimulating hormone in the blood.

Other tests may also be done to ensure that a particular symptom is the result of menopause and not other underlying causes.


Only 1 in 10 women see a doctor when they go through menopause, and many do not need any treatment.

However, if the symptoms of menopause are severe enough to interfere with daily life, there are treatments that can help.

Treatment options are:

  • Hormone replacement therapy.
  • Tibolona.
  • Clonidine.
  • Vaginal lubricants.
  • Antidepressants

The type of treatment that can be taken will depend on the symptoms, medical history and preferences of the patient.

Hormone replacement therapy and tibolone do not provide adequate contraceptive protection, and although fertility levels usually decline at menopause, a woman may still be able to conceive at this stage.

Therefore, you should continue to use contraceptives:

  • For one year after your last period if you are over 50 years of age.
  • For two years after your last period if you are under 50 years of age.

Treatments for menopause are detailed below.

Hormone replacement therapy

As the name suggests, hormone replacement therapy works by replacing estrogen, which naturally begins to wane on the menopausal focus, causing menopausal symptoms. There are three main types:

  • Estrogen-only hormone replacement therapy for women who have had their uterus and ovaries removed.
  • Cyclic hormone replacement therapy, for women who are experiencing menopausal symptoms but still have periods (estrogens and progestogens are taken).
  • Continuous hormone replacement therapy for postmenopausal women.

Hormone replacement therapy can be used as a cream or gel, a tablet, a skin patch, or an implant.

La tibolona

Tibolone works the same as hormone replacement therapy contains estrogens and progestogens. It is used in postmenopausal women to end periods.

Tibolone, like hormone replacement therapy, is recommended to treat menopausal symptoms.

It can also improve decreased sexual desire and other sexual problems.

Tibolone has side effects such as an increased risk of breast cancer, uterine cancer, or stroke.


Clonidine is a drug originally designed for the treatment of hypertension, but it has also been used to treat bothersome symptoms of menopause.

But it can usually cause side effects so it should be taken for a trial period of two to four weeks to observe its effectiveness and the occurrence of side effects.

Vaginal lubricants

For vaginal dryness, your doctor may prescribe a vaginal lubricant or moisturizer.


There are some antidepressant medications that can be effective for symptoms of menopause such as:

  • Venlafaxine.
  • Fluoxetine.
  • Citalopram.
  • La paroxetine.

Nutrients needed during menopause

If long-term nutrient deficiencies have left the body unprepared for the stress of menopause, and particularly if the symptoms are severe, all the necessary nutrients must be taken to overcome this situation and to support the adrenal glands.

Diet changes early in symptoms can help. Vitamin E is often recommended during menopause.

It has been used to help symptoms such as: night sweats, hot flashes, back pain, fatigue, nervousness, insomnia, dizziness, shortness of breath and palpitations.

When synthetic estrogens are taken, the need for vitamin E increases even more.

Foods that contain vitamin E and should be included in the diet are wheat germ, walnuts, peaches, whole grains, broccoli, dried plums, spinach, avocados, vegetable oils, and seeds.

As estrogens, naturally produced by the ovaries, decrease, the adrenal glands begin to produce estrogens and androgens.

At this time, calcium is less absorbed and more is excreted. A deficiency can cause nervousness, irritability, insomnia, headaches, and depression.

A long-standing deficiency can contribute to osteoporosis, a decrease in bone density. Vitamin D, zinc, boron and magnesium are necessary for a correct absorption of calcium.

Vitamin A, vitamin C, vitamin B complex and zinc are important for the maintenance of the skin. The B complex, especially pantothenic acid, can help relieve nervous irritability.

Vitamin C together with bioflavonoids increases capillary strength. The calcium-phosphorus balance must be carefully maintained during and even after this stage.

The B vitamins are found in wheat germ and fruits. Your doctor may recommend a B complex supplement.

Three servings of calcium-rich foods such as low-fat milk, cheese, yogurt, green leafy vegetables such as kale and mustard greens, cooked beans, tahini, and whole grains are recommended daily.

Adequate protein should be consumed (one serving with each main meal). Whole grains and fruits and vegetables are good options.

Caffeine, added sugar, salt, spicy foods, alcohol, chocolate, and refined and processed foods are not good choices and should be kept to a minimum as they can trigger hot flashes and overload the liver.

Foods that have been shown to help increase estrogen levels are soy milk, textured soy protein, soy flour, and flax seed, organic tofu may help.

These are foods that can be beneficial for a menopausal woman as they are rich in phytoestrogens, which are converted by intestinal bacteria into hormone-like substances, and have weak estrogenic activity. They can also help lower cholesterol.

Boron helps increase estrogen levels when replacement therapy is used.

Foods that are rich in this mineral are grapes, dates, peaches, soybeans, almonds, hazelnuts, honey, apples, pears, and raisins.

Wheat bran, legumes, and cruciferous vegetables like broccoli, Brussels sprouts, cauliflower, and cabbage are also estrogenic foods.

Researchers recommend a beer (even alcohol-free), a glass of wine, or a shot of hard liquor every other day can increase estrogen levels, prevent heart disease, and protect against osteoporosis in older women.

Aerobic exercise is vital to the health of menopausal women and is best when combined with yoga.

Walking, swimming, or any enjoyable activity that gets your heart rate up is beneficial.

Vaginal bleeding after menopause

Bleeding after menopause is also called postmenopausal bleeding. After reaching the menopause stage, in rare cases, bleeding begins again.

It can be confusing and somewhat scary to occur. When the woman reaches her menopausal stage, regular menstruation is expected to stop.

But in some cases, bleeding after menopause occurs due to certain underlying factors.

Characteristics of bleeding after menopause

  • Postmenopausal bleeding is considered if a woman has gone a year without a period and then has it again.
  • Postmenopausal bleeding can occur as a heavy flow.
  • About 20 to 30% of women experience this type of condition.
  • A postmenopausal hemorrhage can be caused by a hormonal change, the rare scene of postmenopausal hemorrhage is abnormalities in the cells within the uterus.
  • This can be a symptom of hyperplasia of the uterus, a minor abnormality, or a serious condition such as uterine cancer.

Causes of bleeding after menopause

Bleeding after menopause can be caused by the following factors:

  • Trauma – Trauma can be the result of sexual intercourse or any foreign body.
  • Vaginal lubrication: poor vaginal lubrication due to hormonal changes present in menopause. Because of this, sexual intercourse can be painful or cause bleeding.
  • Hormone replacement therapy: Hormone replacement therapy can cause vaginal bleeding due to fluctuations in estrogen and progesterone levels.
  • Steroids and anticoagulants: These can also cause postmenopausal bleeding due to the alteration of the blood clotting mechanism.
  • Cancer Drugs: Cancer treatments, specifically breast cancer, can cause postmenopausal bleeding as a side effect.
  • Clotting problems – As a result of kidney, thyroid, or liver disease – These conditions often lead to bleeding due to impaired synthesis of clotting factors.
  • Infections: Infections in the reproductive tract, such as chlamydia, can also cause postmenopausal bleeding.
  • Malignant Neoplasms: Cancer in the reproductive tract also leads to postmenopausal bleeding.
  • Poor nutritional status: diet, exercise, and stress .
  • Endometriosis: Endometriosis is an overgrowth of the lining of the uterus that leads to dysfunctional bleeding.