A woman is considered to be in menopause when she has not had a menstrual period for one year. Menopause occurs when the ovaries stop producing estrogen and progesterone, hormones that are necessary for pregnancy. After menopause, a woman can no longer become pregnant.
Most women experience menopause in their 40s or 50s. The average age is 51.
The symptoms of menopause begin months to years earlier. During this time, called perimenopause, fluctuations in hormone levels can cause a change in menstrual cycles, including lighter or heavier menstrual flow and fewer or more periods.
Symptoms include hot flashes, night sweats, vaginal dryness or atrophy, reduced interest in sexual activity, difficulty sleeping, fatigue, weight gain, changes in mood and concentration, and memory loss. In addition, a woman may experience hair loss on the head and hair growth on the face.
Sometimes, menopause occurs after surgery to remove both ovaries, called an oophorectomy. This procedure may be performed as a treatment for certain types of cancer, such as ovarian cancer, as well as for fibroids, which are noncancerous growths.
Your NYU Langone doctor asks when your mother experienced menopause and assesses your medical history. He or she asks how often your periods occur and whether the duration or flow of menstruation has changed.
Your doctor then performs a physical and a pelvic exam. He or she may also order certain tests.
Blood tests can help determine if you have reduced levels of certain hormones or nutrients, which can indicate that you are nearing menopause.
Levels of estradiol and progesterone in the blood can fluctuate as you age and sometimes increase before decreasing prior to menopause. Testing your blood for these reproductive hormones can help to determine if your symptoms are caused by perimenopause.
Your doctor may also test follicle-stimulating hormone (FSH) levels, which increase during menopause.
Your doctor may check for low levels of thyroid-stimulating hormone, which can lead to hypothyroidism. This condition can cause symptoms similar to those of menopause, such as hair loss and weight gain.
Levels of estrogen decrease sharply in menopause and can cause bone loss. For this reason, your doctor may check vitamin D levels. This vitamin helps to maintain bone health by promoting calcium absorption in the intestines. If your vitamin D levels are low, your doctor may recommend taking vitamin D supplements.
Because an increase in the frequency and amount of vaginal bleeding can be a sign of cervical cancer, your doctor may perform a Pap test to collect and examine cervical cells for changes.
In this procedure, the doctor uses a device called a speculum to open the walls of the vagina and inserts a small brush to collect cells from the cervix. The cells are then examined under a microscope in a laboratory.
Saline Infusion Sonohysterogram
If you are experiencing unusually heavy vaginal bleeding during perimenopause or bleeding after menopause, your doctor may recommend a saline infusion sonohysterogram.
Championed by doctors at NYU Langone, this procedure involves the use of saline and high frequency sound waves to highlight the lining of the uterus on a monitor. This allows your doctor to determine the source of any abnormal uterine bleeding without the need for more invasive testing or procedures, such as dilation and curettage, in which the cervix is dilated and part of the lining of the uterus is removed.
The doctor uses a special tiny plastic catheter to insert a small amount of saline through the vagina and into the uterus. Next, he or she inserts a transvaginal ultrasound probe into the vagina. It produces images of the lining of the uterus, which are viewed on a monitor.
Bone Density Test
At NYU Langone, our doctors may recommend baseline bone density testing in women experiencing the symptoms of menopause. This is because reduced levels of estrogen can lead to bone loss, particularly in the first five years after the onset of menopause.
In a dual X-ray absorptiometry test, also known as DXA, a doctor measures the density, or thickness, of your bones. He or she retests you two years later to determine if you have experienced bone loss.
In this procedure, two X-ray beams, each with different energy levels, pass through bones, typically in the hip and spine. The difference between the two beams’ measurements indicates a bone’s density.
If the results of your second test show significant bone loss—at least 3 percent in the spine and 5 percent in the hip—your doctor may recommend treatment for osteoporosis and bone loss. This may include estrogen replacement therapy or medications that either slow bone loss or speed up the rate at which bone forms.
This noninvasive test takes less than 10 minutes to complete.