Menopause, Perimenopause and Postmenopause
What is menopause?
Menopause is a stage in life when you stop having your monthly period. It’s a normal part of aging and marks the end of your reproductive years. Menopause typically occurs in your late 40s to early 50s. However, women who have their ovaries surgically removed undergo "sudden" surgical menopause.
Why does menopause happen?
Natural menopause—menopause that happens in your early 50s and is not caused by surgery or another medical condition—is a normal part of aging. Menopause is defined as a complete year without menstrual bleeding, in the absence of any surgery or medical condition that may cause bleeding to artificially stop (use of hormonal birth control, overactive thyroid, etc.) As you age, the reproductive cycle begins to slow down and prepares to stop. This cycle has been continuously functioning since puberty. As menopause nears, the ovaries make less of a hormone called estrogen. When this decrease occurs, your menstrual cycle (period) starts to change. It can become irregular and then stop. Physical changes can also happen as your body adapts to different levels of hormones. The symptoms you experience during each stage of menopause (perimenopause, menopause and postmenopause) are all part of your body’s adjustment to these changes.
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 you’ll have your 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 may 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 menstrual period for 12 consecutive months.
- Postmenopause: This is the name given to the period of time after a woman has not bled for an entire year (the rest of your life after going through menopause). During this stage, menopausal symptoms, such as hot flashes, may ease for many women. However, some women continue to experience menopausal symptoms for a decade or longer after the menopause transition. 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 (the menopause transition) last?
The length of each stage of the menopause transition can vary for each individual. The average length of perimenopause is about four years. Some women may only be in this stage for a few months, while others will be in this transition phase for more than four years. If you have gone more than 12 months without having a period, you are no longer perimenopausal. However, if there are medications or medical conditions that may affect periods, it can be more difficult to know the specific stage of the menopause transition.
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, or a sign of increased fluctuation (ups and downs) in hormone levels. 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.
What are hot flashes and how long will I have them?
Hot flashes are one of the most frequent symptoms of menopause. It is a brief sensation of heat. Hot flashes aren’t the same for everyone and there’s no definitive reason that they happen. Aside from the heat, hot flashes can also come with:
- A red, flushed face.
- A chilled feeling after the heat.
Hot flashes not only feel different for each person—they also can last for various amounts of time. Some women only have hot flashes for a short period of time during menopause. Others can have some kind of hot flash for the rest of their life. Typically, hot flashes are less severe as time goes on.
What triggers a hot flash?
There are quite a few normal things in your daily life that could set off a hot flash. Some things to look out for include:
- Spicy foods.
- Tight clothing.
- Stress and anxiety.
Heat, including hot weather, can also trigger a hot flash. Be careful when working out in hot weather—this could cause a hot flash.
Can menopause cause facial hair growth?
Yes, increased facial hair growth can be a change related to menopause. The hormonal change your body goes through during menopause can result in several physical changes to your body, including more facial hair than you may have had in the past. If facial hair becomes a problem for you, waxing or using other hair removers may be options. Talk to your healthcare provider about your options to make sure you don’t pick a product that could harm your skin.
Is having a hard time concentrating and being forgetful a normal part of menopause?
Unfortunately, concentration and minor memory problems can be a normal part of menopause. Though this doesn’t happen to everyone, it can happen. Doctors aren’t sure why this happens. If you’re having memory problems during menopause, call your healthcare provider. There are several activities that have been shown to stimulate the brain and help rejuvenate your memory. These activities can include:
- Doing crossword puzzles and other mentally stimulating activities like reading and doing math problems.
- Cutting back on passive activities like watching TV.
- Getting plenty of exercise.
Keep in mind that depression and anxiety can also impact your memory. These conditions can be linked to menopause.
Can menopause cause depression?
Your body goes through a lot of changes during menopause. There are extreme shifts in your hormone levels, you may not be sleeping well because of hot flashes and you may be experiencing mood swings. Anxiety and fear could also be at play during this time. All of these factors can lead to depression.
If you are experiencing any of the symptoms of depression, talk to your healthcare provider. During your conversation, your provider will tell you about different types of treatment and check to make sure there isn’t another medical condition causing your depression. Thyroid problems can sometimes be the cause of depression.
Are there any other emotional changes that can happen during menopause?
Menopause can cause a variety of emotional changes, including:
- A loss of energy and insomnia.
- A lack of motivation and difficulty concentrating.
- Anxiety, depression, mood changes and tension.
- Aggressiveness and irritability.
All of these emotional changes can happen outside of menopause. You have probably experienced some of them throughout your life. Managing emotional changes during menopause can be difficult, but it is possible. Your healthcare provider may be able to prescribe a medication to help you (hormone therapy or an antidepressant). It may also help to just know that there is a name to the feeling you are experiencing. Support groups and counseling are useful tools when dealing with these emotional changes during menopause.
How does menopause affect my bladder control?
Unfortunately, bladder control issues (also called urinary incontinence) are common for women going through menopause. There are several reasons why this happens, including:
- Estrogen. This hormone plays several roles in your body. It not only controls your period and promotes changes in your body during pregnancy, estrogen also keeps the lining of your bladder and urethra healthy.
- Pelvic floor muscles. Supporting the organs in your pelvis—your bladder and uterus—are called the pelvic floor muscles. Throughout your life, these muscles can weaken. This can happen during pregnancy, childbirth and from weight gain. When the muscles weaken, you can experience urinary incontinence (leakage).
Specific bladder control problems that you might have can include:
- Stress incontinence (leakage when you cough, sneeze or lift something heavy).
- Urge incontinence (leakage because your bladder squeezes at the wrong time).
- Painful urination (discomfort each time you urinate).
- Nocturia (feeling the need to get up in the night to urinate).
Will I start menopause if I have a hysterectomy?
During a hysterectomy, your uterus is removed. You won’t have a period after this procedure. However, if you kept your ovaries—removal of your ovaries is called an oophorectomy—you may not have symptoms of menopause right away. If your ovaries are also removed, you will have symptoms of menopause immediately.