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. 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 8 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 1-2 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 most 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 the first year after menopause (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 hysterectomy) 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. How will I know when I am postmenopausal? A woman is considered to be postmenopausal when she has not had her period for an entire year. Measuring through a blood test called the follicle stimulating hormone (FSH) level is another way to determine if you are postmenopausal. FSH is a hormone produced by the pituitary gland (located at the base of the brain). However, the routine use of the FSH test is not needed to help the vast majority of women. Sometimes, the levels can be misleading since the levels go up and down during the transition into menopause. Can I get pregnant if I am postmenopausal? The possibility of pregnancy disappears once you have been without your period for an entire year. However, during the menopause transition (perimenopause) you can still become pregnant. If you do not want to become pregnant, you should continue to use some form of birth control until you reach menopause (you have gone 12 months without having your period). For some women, getting pregnant can be difficult once they are in their late 30s to 40s due to a decline in fertility. However, if becoming pregnant is the goal, there are fertility-enhancing treatments and techniques that can help you get pregnant. Make sure to speak with your doctor about when it is appropriate to stop using contraception. 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 slowly begin to run out of eggs. Eventually, the ovaries no longer release eggs into the fallopian tubes and the woman has her last menstrual cycle. 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 upper 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, eyes or mouth Women who are still in the menopause transition (perimenopause) may experience the above as well as: 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 Headaches 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. How do I know if changes in my periods are normal perimenopausal symptoms or something to be concerned about? Irregular periods are common and normal during perimenopause. But other conditions can cause abnormalities in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes. Your periods are changing to become very heavy, or accompanied by blood clots Your periods last several days longer than usual You spot or bleed after your period You experience spotting after sex Your periods occur closer together Potential causes of abnormal bleeding include hormonal imbalances, birth control pills, pregnancy, fibroids, blood clotting problems or, rarely, cancer. What are the long-term health risks associated with menopause? Osteoporosis Osteoporosis, a “brittle-bone” disease, occurs when the inside of bones become less dense, making them more fragile and likely to fracture. Estrogen plays an important role in preserving bone mass. Estrogen signals cells in the bones to stop breaking down. Women lose an average of 25 percent of their bone mass from the time of menopause to age 60, due in large part to the loss of estrogen. Over time, this loss of bone can lead to bone fractures. There are many options, including estrogen therapy, to treat brittle bones. Coronary artery disease Coronary artery disease is the narrowing or blockage of arteries that surround the heart muscle. It results when fatty plaque builds up in the artery walls (known as atherosclerosis). This buildup is associated with high levels of cholesterol in the blood. After menopause, a woman’s risk for coronary artery disease increases. A healthy diet, not smoking, and getting regular exercise are your best options to prevent heart disease. Treating elevated blood pressure and diabetes as well as maintaining cholesterol levels with “statin” medications and aspirin therapy for selected at-risk persons are the standards of care. The benefits and risks of hormone therapy vary depending on a woman’s age and her individual history. In general, younger women in their 50s tend to get more benefits from hormone therapy as compared to postmenopausal women in their 60s. Women who undergo premature menopause are often treated with hormone therapy until age 50 to avoid the increased risk that comes from the extra years of estrogen loss. Can menopause be a positive time of life? Most certainly, menopause can be a positive time of life. Too often, myths foster misconceptions about this normal process of aging. Although menopause can cause some noticeable and uncomfortable changes, these can be effectively managed.