Menopause is defined as the absence of menstrual periods for 12 months. It is the time in a woman’s life when the function of the ovaries stops. It does not occur overnight, but rather is a gradual process.
This so-called perimenopause transition period is a different experience for each woman. The average age of menopause is 50 years old, but menopause may occur as early as the 30s or as late as the 60s.
There is no reliable lab test to predict when a woman will experience menopause. Contrary to popular belief, the age at which a woman starts having menstrual periods is not related to the age of menopause onset. Although it also ends fertility, you can stay healthy, vital and sexual.
Some women feel relieved because they no longer need to worry about pregnancy. The physical symptoms, such as hot flushes and feeling emotional, may disrupt your sleep, lower your energy or for some women trigger anxiety or feelings of sadness and loss.
Many effective treatments are available, from lifestyle adjustments to hormone therapy. Starting at perimenopause, schedule regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause.
Preventive health care can include recommended screenings at menopause, such as a colonoscopy, mammography, lipid screening, thyroid testing if suggested by your history, and breast and pelvic exams. Always seek medical advice if you have bleeding from your vagina after menopause.
In the months or years leading up to menopause (or perimenopause), you might experience these signs and symptoms:
- Irregular periods
- Vaginal dryness
- Hot flushes
- Night sweats
- Sleep problems
- Mood changes
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Loss of breast fullness.
It’s possible, but very unusual, to menstruate every month right up to your last period. More likely, you’ll experience some irregularity in your periods.
Often, menstrual periods will occur every two to four months during perimenopause, especially one to two years before menopause. Pregnancy is still possible, though during perimenopause it must always be ruled out.
Natural decline of reproductive hormones
As you approach your late 30s, your ovaries start making less oestrogen and progesterone, and your fertility declines. In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent; until eventually on average by age 51 you have no more periods.
A hysterectomy that removes your uterus but not your ovaries (partial hysterectomy) usually doesn’t cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce oestrogen and progesterone.
But surgery that removes both your uterus and your ovaries does cause menopause, without any transitional phase. Your periods stop immediately, and you’re likely to have all the menopausal signs and symptoms.
Chemotherapy and radiation therapy
These cancer therapies can induce menopause, causing symptoms such as hot flushes during or shortly after the course of treatment. The stopping of menstruation after chemotherapy is not always permanent so birth control measures may still be needed.
Primary ovarian insufficiency
About 1% of women experience menopause before age 40 (premature menopause). Menopause may result from primary ovarian insufficiency — when your ovaries fail to produce normal levels of reproductive hormones — stemming from genetic factors or autoimmune disease.
But often no cause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones.
After menopause, your risk of certain medical conditions increases. Examples include:
Heart and blood vessel (cardiovascular) disease
When your oestrogen levels decline, your risk of cardiovascular disease increases.
This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Postmenopausal women with osteoporosis are especially susceptible to fractures of their hips, wrists and spine.
As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal oestrogen may help.