Many women experience apprehension about the physical effects of menopause—a normal process of aging—but this life transition can usually be managed effectively. 

At Yale Medicine, our physicians are here to help. First, we listen. Then, we explain what is happening during this biological change and go over various treatment and management options. Our researchers have long been leaders in the exploration of many menopause-related topics, including hormone replacement therapy to treatment common symptoms including insomnia, hot flashes and depression. 

"We are at the forefront of understanding menopause, developing new medications and weighing the benefits and risks of new drugs," says Yale Medicine's Hugh Taylor, MD, chair of Yale Medicine Obstetrics, Gynecology & Reproductive Sciences.

Sometimes called the “change of life,” menopause signals the end of a woman’s ability to have children. This transition usually occurs at some point between age 45 and 55 with the average age of menopause being 51. A woman is considered menopausal when 12 months have passed since her last menses.

Menopause, Dr. Taylor notes, does not come on abruptly. "It's not you are producing hormones one day and you wake up the next with none and hot flashes," he says. "There is a waxing and waning over a period of about a year." 

Perimenopause may begin a few years before menopause is complete. During this time, the ovaries begin to supply fewer and fewer mature eggs. As a result, menstrual cycles may become irregular, occurring more often or less often. Menstrual flow may also become heavy.

When menopause occurs before age 40, it is said to be “premature.” This happens to approximately 1 percent of women. There are many reasons for premature menopause. 

Ovaries may fail because of chemotherapy or radiation treatments for cancer. Menopause may occur early if one or both ovaries need to be removed surgically.

As the ovaries stop working, levels of estrogen fall, causing the symptoms of menopause. Symptoms can vary greatly for women. 

"About a third of women don't have any symptoms. About half experience significant symptoms and another third have severe symptoms," Dr. Taylor says. 

Common symptoms may include:

• Hot flashes: Also called hot flushes, about 75 percent of all women experience brief, sudden increases in body temperature. Heart palpitations or dizziness may accompany the feeling of being hot. If experienced at night, it’s called a “night sweat.” Hot flashes and night sweats typically last one to two years. "I like to emphasize that this is more than a warm, fuzzy feeling that might be nice in winter," Dr. Taylor says. "It's a rise in temperature, usually from the chest up. There is a surge in adrenaline, too, that can cause anxiety. 
• Vaginal dryness: The tissues of the vagina and urethra may become thin and dry. This can lead to pain during intercourse and in some cases, more serious problems such as vaginitis (an inflammation of the vagina that can cause discharge, itching and pain) and cystitis (urinary tract infection).
• Hair changes: Some women may find increased facial hair and scalp hair may become thin.
• Fatigue: Hormonal imbalances during menopause may cause women to feel tired or sluggish.
• Skin dryness: As estrogen levels decrease, fewer of the skin’s natural collagens and oils are stimulated. This can result in dry, itchy skin.
• Insomnia: During menopause a woman’s hormones are in flux, including a hormone called progesterone, which is known to help regulate sleep patterns. "Women might get less REM sleep, and if you are sleep-deprived, that can make a big difference in your well-being," Dr. Taylor says.

Each woman’s experience of menopause is different. For this reason, we offer a number of different treatment options, which include:

Hormone Replacement Therapy: Women may take hormones, or drugs that act like hormones, to minimize the symptoms of menopause. These drugs are combinations of the female hormones estrogen and progesterone. They may be given in pill form, as skin patches or vaginal creams. 

Yale Medicine investigators have been involved in trials identifying new, safer alternatives to traditional hormone therapy. There remains some disagreement on whether hormone replacement therapy is necessary or advisable. In 1991, the National Institutes of Health launched two studies to determine whether hormone therapy is safe. Both studies concluded early when research showed that hormone replacement therapy did not prevent heart disease and increased the risk of breast cancer. 

The Food and Drug Administration advises that hormone replacement therapy can be used to ease moderate-to-severe hot flashes and vulvar and/or vaginal atrophy. The FDA cautions that hormone therapy should only be used at the lowest doses, for the shortest time frame and only after you have thoroughly discussed options with a health care provider. Hormone replacement may also be used to treat osteoporosis (bone weakening) in post-menopausal women who cannot take non-hormone medicines for this condition.

"Hormone replacement therapy has been controversial, and we discuss the pros and cons with each patient," Dr. Taylor says. "For women who are experiencing severe discomfort, there are small risks that she can take if she needs relief." 

Estrogen Therapy: Estrogen therapy involves the administration of estrogen alone, rather than a combination of estrogen and progesterone. In pill or skin patch form, it is often prescribed to women who have had hysterectomies (removal of the uterus). This therapy is not associated with the elevated cancer risk described above. For the treatment of vaginal symptoms, local estrogen creams applied to the vagina are very helpful.

Yale researchers have been involved in studying a new medication that combines estrogen with a progesterone substitute that is an exciting prospect, Dr. Taylor says. 

Non-hormonal treatments: These types of treatments often involve the use of medications that do not contain estrogen. Anti-depressants might help with hot flashes.

"They are far less effective than estrogen but may be a reasonable option if a woman can't take estrogen, such as women who have had breast cancer," Dr. Taylor says.

Additionally, there are numerous drugs that treat osteoporosis. "Women experience a big drop in bone density at the time of menopause," Dr. Taylor says. "Estrogen helps prevent bone loss, so it can preserve bone while treating other symptoms. But there are alternative medications for bone loss that don't contain estrogen, too." 

Homeopathy and herbal treatments are another option, though the FDA does not regulate these supplements, which are not considered drugs. As a result, there is no guarantee that a supplement will deliver a consistent, safe and pure dose of the compound it claims to provide. So called "bioidentical hormones" are simply estrogens that are compounded. They should be considered to have all of the risks of FDA-approved pharmaceutical estrogen preparations.

At Yale Medicine, we offer compassionate, individualized care for women navigating this completely natural—but sometimes stressful—stage of life. 

When you have concerns, our doctors are at the ready to listen closely to develop a treatment plan that meets your needs and lifestyle goals.

Our physicians and researchers are deeply involved in work to further understand menopause and to develop new medications to treat it safely and effectively.