Most women experience hot flashes and other relatively minor symptoms. Some women suffer from severe menopause symptoms that affect their quality of life, their relationships, their jobs and their overall health. Bleeding during menopause or the time leading up to it may be irregular.
Women may skip periods for months in a row, only to be surprised by one at the most inconvenient time. Some women experience very heavy menstrual bleeding during the years leading up to menopause, which is technically when a woman has not menstruated for 12 consecutive months.
Sometimes, when a woman is experiencing severe menopause symptoms like irritability, depression or mood swings that are affecting her relationship with her family or her co-workers, her doctor will recommend hormone replacement therapy. Hormone replacement therapy may also be recommended for women who are experiencing signs of osteoporosis, vaginal dryness causing painful intercourse and night sweats that are interrupting normal sleep cycles.
As menopause approaches, the ovaries begin to produce less of the hormone estrogen. Needed during a woman's reproductive years to thicken the lining of the uterus, estrogen also influences the body's ability to absorb calcium and use it for rebuilding bones and keeping them strong. It has an influence on cholesterol levels, keeping them normal. And, it is responsible for maintaining the vagina. Without estrogen the walls of the vagina become thin and dry. This can lead to painful intercourse, vaginal tearing and bleeding during menopause after or during sex.
Estrogen taken alone increases a woman's risk for cancer of the endometrium, which is the lining of the uterus. Taking progesterone decreases that risk by causing the endometrium to be shed each month or monthly bleeding during menopause. After taking estrogen and progesterone continuously for several months or more depending on the woman, monthly bleeding during menopause may be lessened or stop completely.
Although hormone replacement therapy was the treatment of choice for moderate to severe menopause symptoms for many years, the Women's Health Initiative study indicates that the risks may outweigh the benefits. The benefits, other than relieving severe menopause symptoms, are believed to be a reduced risk of osteoporosis, colon cancer and heart disease. But, the study concluded that long-term hormone replacement therapy actually increased the risk of heart disease, breast cancer, blood clots and stroke.
In estrogen only therapy, which does not cause bleeding during menopause, there is an increased risk of endometrial cancer, blood clots and stroke, but there appears to be no increased risk of breast cancer or heart disease. Because of the risks, hormone replacement therapy is not recommended as often, nor recommended for long term use. Women who have a family history of certain types of cancer may be discouraged from using it at all. Women who have had breast cancer are generally discouraged, as well.
Since many women can not take hormone replacement therapy or choose not to, researchers have evaluated some of the herbs and plants that were used historically to relieve hot flashes and other more severe menopause symptoms. Black cohosh, among others was found to be effective.