An overview of Menopause

Menopause is the time that marks the end of your menstrual cycles. It's diagnosedafter you've gone 12 months without a menstrual period. Menopause can happen in your40s or 50s.

Menopause is a natural biological process. But the physical symptoms, such as hotflashes, and emotional symptoms of menopause may disrupt your sleep, lower yourenergy or affect emotional health. There are many effective treatments available,from lifestyle adjustments to hormone therapy.

Natural menopause is the permanent ending of menstruation that doesn’t happen becauseof any type of medical treatment. The process is gradual and happens in threestages:

Perimenopause or “menopause transition : Perimenopause can begin eight to 10years before menopause when your ovaries gradually produce less estrogen. It usuallystarts when you’re in your 40s. Perimenopause lasts up until menopause, the pointwhen your ovaries stop releasing eggs. In the last one to two years ofperimenopause, the drop in estrogen accelerates. At this stage, many people mayexperience menopause symptoms. But, you’re still having menstrual cycles during thistime and can get pregnant.

Menopause : Menopause is the point when you no longer have menstrual periods.At this stage, your ovaries have stopped releasing eggs and stopped producing mostof their estrogen. A healthcare provider diagnoses menopause when you’ve gonewithout a menstrual period for 12 consecutive months.

Postmenopause : This is the name given to the time after you haven’t had aperiod for an entire year (or the rest of your life after menopause). During thisstage, menopausal symptoms, such as hot flashes, may get better. However, somepeople continue to experience menopausal symptoms for a decade or longer after themenopause transition. As a result of a lower estrogen level, people in thepostmenopausal phase are at an increased risk for several health conditions, such asosteoporosis and heart disease.

Naturally declining reproductive hormones : As you approach your late 30s,your ovaries start making less estrogen and progesterone — the hormones thatregulate menstruation — and your fertility declines.In your 40s, your menstrualperiods may become longer or shorter, heavier or lighter, and more or less frequent,until eventually — on average, by age 51 — your ovaries stop releasing eggs, and youhave no more periods.

Surgery that removes the ovaries (oophorectomy) : Your ovaries producehormones, including estrogen and progesterone, that regulate the menstrual cycle.Surgery to remove your ovaries causes immediate menopause. Your periods stop, andyou're likely to have hot flashes and experience other menopausal signs andsymptoms. Signs and symptoms can be severe, as hormonal changes occur abruptlyrather than gradually over several years.Surgery that removes your uterus but notyour ovaries (hysterectomy) usually doesn't cause immediate menopause. Although youno longer have periods, your ovaries still release eggs and produce estrogen andprogesterone.

Chemotherapy and radiation therapy : These cancer therapies can inducemenopause, causing symptoms such as hot flashes during or shortly after the courseof treatment. The halt to menstruation (and fertility) is not always permanentfollowing chemotherapy, so birth control measures may still be desired. Radiationtherapy only affects ovarian function if radiation is directed at the ovaries.Radiation therapy to other parts of the body, such as breast tissue or the head andneck, won't affect menopause.

Primary ovarian insufficiency : About 1% of women experience menopause beforeage 40 (premature menopause). Premature menopause may result from the failure ofyour ovaries to produce normal levels of reproductive hormones (primary ovarianinsufficiency), which can stem from genetic factors or autoimmune disease. But oftenno cause of premature menopause can be found. For these women, hormone therapy istypically recommended at least until the natural age of menopause in order toprotect the brain, heart and bones.

Irregular periods

Vaginal dryness

Hot flashes

Chills

Night sweats

Sleep problems

Mood changes

Weight gain and slowed metabolism

Thinning hair and dry skin

Loss of breast fullness

Signs and symptoms, including changes in menstruation can vary among women. Mostlikely, you'll experience some irregularity in your periods before they end.

Skipping periods during perimenopause is common and expected. Often, menstrualperiods will skip a month and return, or skip several months and then start monthlycycles again for a few months. Periods also tend to happen on shorter cycles, sothey are closer together. Despite irregular periods, pregnancy is possible. Ifyou've skipped a period but aren't sure you've started the menopausal transition,consider a pregnancy test.

There are several ways your healthcare provider can diagnose menopause. The first isdiscussing your menstrual cycle over the last year. Menopause is unique in that yourprovider diagnoses it after it occurs. If you’ve gone a full year (12 straightmonths) without a period, you’ve entered menopause and may be postmenopausal.

Menopause is a natural process that your body goes through. In some cases, you maynot need any treatment for menopause. When discussing treatment for menopause withyour provider, it’s about treating the symptoms of menopause that disrupt your life.There are many different types of treatments for the symptoms of menopause.

The main types of treatment for menopause are:

1. Hormone therapy.

2. Nonhormonal treatments.

It’s important to talk to your healthcare provider while you’re going throughmenopause to craft a treatment plan that works for you. Every person is differentand has unique needs.