An Overview of Menopause

Menopause is your final menstrual period, which occurs when your ovaries have stopped producing the hormones that drive your menstrual cycle. It is diagnosed definitively when you have missed your period for 12 consecutive months. For most women, it is a natural process that occurs between the ages of 40 and 58, although some go into premature menopause or have induced menopause due to surgery or an injury to the ovaries. The hormonal fluctuations around menopause can cause symptoms including hot flashes and vaginal dryness, and you might seek relief from these with symptomatic treatments.

Symptoms

Every woman experiences menopause differently. Some women may have very severe menopausal symptoms, while other women will barely have any complaints. However, there are some predictable menopausal symptoms that are commonly noticed by most women.

During your menopausal transition, you might start to notice some changes in your period. Lighter and/or less frequent periods are a normal change and an expected response to your decreasing hormone levels. Heavier and/or more frequent periods need to be evaluated by your doctor.

Hot flashes or flushes are a very common—and unpleasant—symptom of menopause. The clinical term for a hot flash is a vasomotor symptom. Sometimes this may also be associated with anxiety or heart palpitations. A typical hot flash lasts anywhere from one to five minutes, and most women will have at least one per day.

Vaginal dryness in menopause is due to a lack of estrogen. Without adequate amounts of it, the walls of your vagina lose volume and moisture and become thin, dry, and easily irritated. This can lead to painful sex, an increase in vaginal infections, and chronic vaginal discomfort.

Sleep disturbances are common due hot flashes, insomnia, stress, or depression. Emotional symptoms such as mood swings, anxiety, and depression are also seen. Weight gain is a frequent problem in menopause, and the loss of estrogen shifts fat distribution to the waistline. This type of weight gain is particularly unhealthy and is associated with an increase in cardiovascular disease.

Causes

The signs and symptoms of menopause are caused by the changes in the function of your ovaries. There are three different ways your body can enter menopause:

  • Naturally Occurring Menopause: This is the most common progression to menopause. Every woman will eventually stop getting her period. This usually occurs around age 52. However, it is completely normal for menopause to occur between age 40 and 58.
  • Premature Menopause: This is menopause that happens before age 40. Unlike naturally occurring menopause, premature menopause is considered abnormal. It is often associated with other autoimmune disorders and puts you at increased risk of osteoporosis. If you are less than 40 years old and you think you are in menopause, it is very important that you discuss this with your doctor.
  • Induced Menopause: This type of menopause occurs when there is some injury to the ovaries, which is typically related to medical treatments like surgery, chemotherapy, or radiation. Unlike naturally occurring menopause, which happens gradually, induced menopause is usually abrupt, and menopausal symptoms are often sudden and intense.

Unless your ovaries have been removed surgically, menopause doesn't happen overnight. Instead, your ovaries gradually decrease the amount of hormones they produce. This winding down of your ovarian function typically takes several years and is called perimenopause or the menopausal transition.

Your ovaries don't slow their function in a predictable way. Some months your ovarian hormone production could be close to normal, while other months your hormone production could be way off from normal. Menopause is not reversible. Once your ovaries have stopped producing hormones, you will no longer get your period.

Diagnosis

If you are having menstrual irregularities and other symptoms of menopause, report them to your doctor. They might be signs of another condition or a need for adjustment to your medications or treatment for your existing medical conditions.

Your doctor will diagnose menopause when you report you have not had a menstrual period in 12 months. Because of the way your hormone levels change around menopause, there is no accurate and reliable blood test to diagnose it, although some may be done to rule out other conditions, such as thyroid disease.

Treatment

Despite all of the symptoms and changes in your body, menopause is not a disease that needs to be treated—it is a normal part of getting older. You can simply wait out the symptoms, but it can be helpful to discuss treatment options with your primary care doctor, gynecologist, or a menopause specialist.

There are many choices to help ease the menopausal transition and improve the symptoms of menopause. They range from mind/body practices such as yoga and meditation to hormone replacement and other prescription medications.

Menopause is the perfect time to take a look at your lifestyle. Follow the general principles of a healthy, well-balanced diet and regular physical activity. In addition to aerobic exercise, build muscle with strength training. You start to lose lean body mass (muscle) at the age of 40. Ask your doctor whether you should take vitamin D or calcium supplements to prevent osteoporosis.

Coping

The age at which you approach menopause often coincides with many social stressors. You may be seeing your kids off to college, dealing with the death of a parent, struggling with marital problems, or worrying about your finances. The added symptoms of menopause, including sleep deprivation and possible anxiety or depression, can certainly make things worse.

It is very important to take care of your mental health during menopause. Sometimes that can be accomplished by long walks, meditation, or yoga. But sometimes it takes more than that. Don't be afraid to talk to your doctor if you are having trouble coping with the demands of your daily life. Your mental health should be your number one priority.

A Word From Verywell

Menopause can be difficult to manage. It is not a disease, but it still affects your body physically and mentally. Understanding the changes in your body and learning about coping strategies and treatment options can help you to live very well during and after menopause.

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Article Sources

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  2. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531–539. doi:10.1001/jamainternmed.2014.8063. doi:10.1001/jamainternmed.2014.8063

  3. Kravitz HM, Zhao X, Bromberger JT, et al. Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep. 2008;31(7):979-90.

  4. Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga PL. Weight gain at the time of menopause. Arch Intern Med. 1991;151(1):97-102.

  5. The North American Menopause Society. Chapter 1: Menopause.


Additional Reading

  • American College of Obstetricians and Gynecologists (2014). ACOG practice bulletin no.141: Management of Menopausal Symptoms. Obstet Gynecol 2014;123:202-16.
  • North American Menopause Society. (2014). Menopause Practice A Clinician's Guide. Mayfield, Ohio.