Menopause, Perimenopause and Postmenopause
What is menopause?
Menopause is a stage in life when a woman stops having her monthly period. It is a normal part of aging and marks the end of a woman's reproductive years. Menopause typically occurs in a woman's late 40s to early 50s. However, women who have their ovaries surgically removed undergo "sudden" menopause.
What are the hormonal changes during menopause?
The traditional changes we think of as "menopause" happen when the ovaries no longer produce high levels of hormones. The ovaries are the reproductive glands that store eggs and release them into the fallopian tubes. They also produce the female hormones estrogen and progesterone as well as testosterone. Together, estrogen and progesterone control menstruation. Estrogen also influences how the body uses calcium and maintains cholesterol levels in the blood.
As menopause nears, the ovaries no longer release eggs into the fallopian tubes, and the woman has her last menstrual cycle.
How does natural menopause occur?
Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For women undergoing natural menopause, the process is gradual and is described in three stages:
- Perimenopause or "menopause transition." Perimenopause can begin eight to 10 years before menopause, when the ovaries gradually produce less estrogen. It usually starts in a woman's 40s, but can start in the 30s as well. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, the drop in estrogen accelerates. At this stage, many women can experience menopause symptoms. Women are still having menstrual cycles during this time, and can get pregnant.
- Menopause. Menopause is the point when a woman no longer has menstrual periods. At this stage, the ovaries have stopped releasing eggs and producing most of their estrogen. Menopause is diagnosed when a woman has gone without a period for 12 consecutive months.
- Postmenopause. These are the years after menopause. During this stage, menopausal symptoms, such as hot flashes, can ease for many women. But, as a result of a lower level of estrogen, postmenopausal women are at increased risk for a number of health conditions, such as osteoporosis and heart disease. Medication, such as hormone therapy and/or healthy lifestyle changes, may reduce the risk of some of these conditions. Since every woman's risk is different, talk to your doctor to learn what steps you can take to reduce your individual risk.
How long does perimenopause last?
The average length of perimenopause is four years, but for some women this stage may last only a few months. Perimenopause ends when a woman has gone 12 months without having her period.
What is premature menopause?
Menopause, when it occurs between the ages of 45 and 55, is considered "natural" and is a normal part of aging. But, some women can experience menopause early, either as a result of a surgical intervention (such as removal of the ovaries) or damage to the ovaries (such as from chemotherapy). Menopause that occurs before the age of 45, regardless of the cause, is called early menopause. Menopause that occurs at 40 or younger is considered premature menopause.
What are the symptoms of menopause?
You may be transitioning into menopause if you begin experiencing some or all of the following symptoms:
- Hot flashes (a sudden feeling of warmth that spreads over the body)
- Night sweats and/or cold flashes
- Vaginal dryness; discomfort during sex
- Urinary urgency (a pressing need to urinate more frequently)
- Difficulty sleeping (insomnia)
- Emotional changes (irritability, mood swings, mild depression)
- Dry skin, dry eyes or dry mouth
Women who are still in the menopause transition (perimenopause) may also experience :
- Breast tenderness
- Worsening of premenstrual syndrome (PMS)
- Irregular periods or skipping periods
- Periods that are heavier or lighter than usual
Some women might also experience:
- Racing heart
- Joint and muscle aches and pains
- Changes in libido (sex drive)
- Difficulty concentrating, memory lapses (often temporary)
- Weight gain
- Hair loss or thinning
These symptoms can be a sign that the ovaries are producing less estrogen. Not all women get all of these symptoms. However, women affected with new symptoms of racing heart, urinary changes, headaches, or other new medical problems should see a doctor to make sure there is no other cause for these symptoms.