What Happens During Menopause?

During perimenopause, changes in hormone levels in the body cause changes in menstrual periods.

Menopause is a normal occurrence in a woman's life when a woman stops ovulating (the ovaries stop producing eggs), menstrual periods end, and a woman can no longer get pregnant. 

Menopause usually occurs between the ages of 45 to 55 years, with an average age of 51 years.

Menopause is preceded by a transitional period of several years called perimenopause in which women may begin to experience menopausal symptoms.

Perimenopause is the menopausal transition that lasts an average of four years when periods change (usually becoming less frequent). Levels of the hormone estrogen fall and symptoms of menopause can occur. 

During perimenopause, changes in hormone levels in the body cause changes in menstrual periods:

• Menstrual periods occur more or less often than usual (for example, every five to six weeks instead of every four)
• Bleeding lasts fewer days than before
• Missed menstrual periods
• Symptoms of menopause begin, such as hot flashes 
• Abnormal bleeding -- see a doctor if the following occurs:
  • Vaginal bleeding more often than every three weeks
  • Excessive, heavy menstrual bleeding
  • Spotting between periods
  • Vaginal bleeding after menopause (even if it's just a spot of blood)

When your period ends, and it has been 12 months since the last period this is considered menopause. 

Post-menopause is the time after menopause.  

Some women have few or no menopausal symptoms, and other women have symptoms that interfere with their life. 

Symptoms of menopause include:

• Hot flashes (the most common symptom)
• Night sweats 
• Sleep problems such as insomnia
• Vaginal dryness that can cause discomfort, itching, or pain during sex
• Depression
• Anxiety
• Mood swings 
• Irritability
• Decreased interest in sex
• Problems with memory and concentration
• Urinary incontinence

Menopause is a normal part of aging in women and occurs as a result of a natural decline in the production of the hormones estrogen and progesterone. 

Once a woman has not had any periods for 12 full months, menopause has been reached. 

Menopause may also be caused by:

• Surgical removal the ovaries  
• Cancer treatments such as chemotherapy and radiation
• Hormone therapy treatment for breast cancer
• Premature ovarian failure (also called primary ovarian insufficiency) which may be caused by:
  • Chromosome abnormalities, such as in women with Turner syndrome
  • Autoimmune disease 
  • Certain infections, such as tuberculosis, malaria and mumps (rare)

Menopause is diagnosed when a woman has not had a menstrual period for 12 months. Most of the time a woman knows she is entering perimenopause when she starts experiencing menopausal symptoms.

Some women have no symptoms of menopause or only mild symptoms and do not need treatment. 

If symptoms are bothersome or severe enough to disrupt your life, treatments may include: 

• Menopausal hormone therapy 
  • Estrogen for hot flashes can be started before the age of 60 years may be given for up to five years
  • Hormone therapy involving a combination of estrogen and progestin (a progesterone-like medication), to relieve hot flashes and other symptoms of menopause, including vaginal dryness, depression, and other mood problems
  • Vaginal estrogen for vaginal dryness
  • Bioidentical hormone products and compounded preparations are not regulated by the Food and Drug Administration (FDA), and the dose of hormones can vary from batch to batch
• Antidepressants for depression
• Kegel exercises to strengthen pelvic floor muscles for urinary incontinence 
• Vaginal lubricants moisturizers for vaginal dryness and painful intercourse 
• Lifestyle changes
  • Stress-reduction techniques, including deep-breathing exercises and massage
  • Healthy, balanced diet
  • Regular exercise

Complications of menopause are related to the low levels of the hormones estrogen and progesterone, which can predispose women to health risks such as:

• Osteoporosis
• Heart disease
• Stroke