Menopause is a natural process that refers to a decline in a woman’s reproductive hormones (estrogen and progesterone), resulting in a permanent stop to menstrual periods and ability to get pregnant. The transition period leading up to menopause is actually known as perimenopause. During perimenopause and after menopause, you may suffer a variety of symptoms due to the change in estrogen levels, but with the right steps and treatment, you can relieve symptoms and maintain your general comfort.1
How Long Does Menopause Last?
Perimenopause can last from two to eight years. On average, perimenopause will last four years. You have officially reached menopause when you go a full 12 months without experiencing a menstrual period, including any spotting.2 Most women will begin perimenopause in their 40s or 50s. The average age of the beginning of perimenopause is 47, while the average age of menopause is 51.3
In the years leading into menopause, you may experience a variety of physical and emotional symptoms as your body attempts to cope with hormonal imbalances. Common symptoms of perimenopause include:
- Hot flashes (sudden feelings of extreme body heat)
- Vaginal dryness
- Chills and night sweats
- Fluctuating mood
- Slowed down metabolism which may result in weight gain
- Dry skin
- Thinning hair
- Bones becoming weak and brittle (osteoporosis)
- Reduced fullness of breasts4
Irregular periods are also common. You may skip a month and have a period the next or even skip several months only for your periods to return to their normal monthly cycle for a few months. These periods may also occur in shorter cycles, meaning they will may be closer together. Specific symptoms and their severity can vary from woman to woman. While none of these symptoms are particularly life-threatening, they can disrupt your sleep, affect your emotional health, and reduce your general energy levels.4
How Long Do Menopause Symptoms Last?
Symptoms of perimenopause can persist even after reaching menopause. The two most common symptoms are hot flashes and vaginal dryness, both of which result from a lack of estrogen. Most women should stop having hot flashes within five years of their last menstrual period. However, some studies have found that over a third of post-menopausal women still experienced moderate to severe hot flashes for at least 10 years. Women who had hot flashes as they began perimenopause were shown to experience them for an average of 11.6 years.5
Unlike other symptoms, vaginal dryness, which may also be accompanied by vaginal itchiness and burning, tends to worsen with age. Less than 30 percent of women experience vaginal dryness during perimenopause or even early menopause. However, about half of women report vaginal dryness as they age and reach later stages of postmenopause.4
Other symptoms, including sleep disruptions, fluctuating mood, cognitive changes, and pain in the joints and muscles, may continue throughout postmenopause. However, these symptoms may also be attributed to the natural aging process as opposed to reduced estrogen levels.4
Pharmaceutical Options for Menopause Symptoms
If your menopause symptoms are causing you discomfort or interfering with your personal health and wellbeing, your doctor may suggest certain pharmaceutical options to reduce symptoms.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are medications that are commonly prescribed for symptoms of depression and anxiety. However, studies show that treatments with low-dose SSRIs or SNRIs may reduce the frequency and severity of hot flashes for menopausal women. Studies cite paroxetine, citalopram, and escitolapram as the most effective SSRIs for hot flashes with venlaxafine as the most effective SNRI. Common side effects of SSRIs include nausea and constipation, while SNRI use may result in increased blood pressure.6
Hormone Replacement Therapy
Hormone replacement therapy involves using medication that contains female hormones to replace those that your body has stopped creating due to menopause. Hormone replacement therapy has been shown to effectively reduce common menopausal symptoms, particularly hot flashes and vaginal dryness and discomfort.7
Hormone replacement therapy comes in two basic forms. Estrogen-only therapy (ET) provides the most relief for menopausal symptoms and is usually prescribed for women who have undergone a hysterectomy. If you still have your uterus, your doctor will likely prescribe EPT, or combined estrogen plus progesterone therapy. Estrogen alone that is not balanced out by progesterone can stimulate the growth of tissue on your uterine lining, potentially increasing the risk of uterine cancer.8
Hormone replacement therapy also comes in the form of systemic therapy and low-dose vaginal products. Systemic hormone therapy often comes in the form of pills gels, creams, patches, and sprays and can help with hot flashes, night sweats, and vaginal symptoms. Some studies also suggest that systemic therapy may protect against heart disease and osteoporosis and support general bone health.7
Low-dose vaginal products appear as creams, tablets, and ring form. These are more effective in helping vaginal symptoms and urinary issues while minimizing absorption of estrogen into the body. However, low-dose vaginal products are less effective in helping night sweats, hot flashes, or bone loss.7
Talk to your doctor if you are interested in hormone replacement therapy. Your doctor will evaluate your health and weigh out the potential benefits and risks involved with taking HRT to determine the best form and preparation for your needs.
Natural and Herbal Remedies for Menopause
If you are suffering from symptoms of menopause or perimenopause but do not want to go the route of pharmaceutical treatments, you may find relief in several herbal remedies that we will summarize here:
An herb native to North America, black cohosh has become the most popular natural supplement for menopause in the country. While historically used for cognitive and inflammatory conditions, black cohosh has gained popularity in its potential to reduce the vasomotor symptoms associated with menopause, primarily night sweats and hot flashes. Black cohosh has been found to be safe to use. Contrary to popular belief, black cohosh does not influence estrogen levels. Instead, it has been shown to work in the brain through serotonin, dopamine, and opioid channels. Meta-analyses of existing studies have found that black cohosh overall improved symptoms by about 26 percent.9
Evening Primrose Oil
Evening primrose has historically been used for a variety of ailments, including treatment for minor wounds, sore throat, and bruises. In modern applications, evening primrose oil has been suggested for eczema, breast pain, and menopausal symptoms.10 Evening primrose oil is rich in a compound known as gamma-linolenic acid (GLA), an essential omega-6 fatty acid. Along with its potential to reduce inflammation, GLA has been shown to play a role in the production of prostaglandins, which are lipids that have hormone-like effects. Studies suggest that by increasing prostaglandin levels, evening primrose oil may help to counteract hormonal imbalances caused by menopause, thereby reducing night sweats, hot flashes, vaginal dryness, and other symptoms.11
Licorice refers to plants belonging to the Glycyrrhiza family. Licorice has been found to contain compounds that interact with natural hormone levels. Licorice root has also been found to contain phytoestrogenic compounds, which are plant-based compounds that have a similar chemical structure as human estrogen. Glabrene has been shown to activate estrogen receptors, while glabridin acts as a selective estrogen receptor modulator. This modulation of estrogen levels may help to reduce symptoms associated with menopause.12
Red Clover Extract
Red clover, botanically known as Trifolium pretense, is rich in isoflavones, particularly the two soy isoflavones genistein and daidzein, as well as their methylated forms biochanin A and formononetin. Isoflavones are a class of phytoestrogens and have the potential to modulate natural estrogen activity. Some studies suggest that isoflavones in red clover extract may promote estrogenic effects after oral ingestion. This may result in reduced frequency and severity of hot flashes and night sweats. Red clover extract may also reduce symptoms of anxiety, which may suggest potential for it to regulate mood changes associated with menopause, though more research is required.13
Wild Yam Extract
Known as Dioscorea villosa, wild yam has been studied for its potential to reduce menopausal symptoms. While the exact mechanisms still require further study, research suggests that compounds in wild yam extract have similar molecular structures as steroid-like compounds. Wild yam extract may also pose similar effects as dehydroepiandrosterone (DHEA), a naturally occurring hormone in the human body. While it can act on its own to exert benefits, DHEA has the ability to turn into either testosterone or estrogen depending on the body’s needs. This suggests that compounds in wild yam extract may help to modulate hormone levels. Wild yam extract may help to reduce hot flashes and night sweats.14
Sage is commonly thought of as an herb used for cooking but it also has therapeutic properties for menopause as well. Compared to placebo, sage was found to reduce the number of hot flashes in menopausal women.15
Chasteberries are the fruits produced by the chaste tree (Vitex agnus-castus) which is native to the Mediterranean. It is thought to inhibit FSH and promote the secretion of LH which regulate the production of estrogen and progesterone. The stimulation of LH is thought to increase the body’s production of progesterone.16 In a 3-month placebo controlled trial, 20mg of chasteberry/day increased progesterone levels and decreased symptoms of PMS.17
DrFormulas’ Herbal Remedies for Menopause
DrFormulas Menopause Support is a menopause relief supplement that containing 12 herbs for mood swings, hot flashes, and night sweats. In addition to the herbs mentioned above it also contains dong quai (a women’s health herb used in Traditional Chinese Medicine (TCM)), blessed thistle, raspberry, and resveratrol which all act to provide relief of menopause symptoms such as mood swings, hot flashes, and night sweats.
DrFormulas Progester-ONE Cream is a lotion infused with natural progesterone combined with herbal ingredients for menopause. This unique combination addresses the low progesterone levels that cause menopause symptoms.
If herbal and over-the-counter solutions have not relieved your menopausal symptoms, consult your doctor to find a treatment plan that works best for you.
- Bohnert KJ. The use of Vitex agnus castus for hyperprolactinemia. Quar Rev Nat Med 1997; Spr:19-21.