Menopause, or the permanent end of menstruation and fertility, is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss.
Hormonal changes cause the physical symptoms of menopause, but mistaken beliefs about the menopausal transition are partly to blame for the emotional ones. First, menopause doesn't mean the end is near — you've still got as much as half your life to go. Second, menopause will not snuff out your femininity and sexuality. In fact, you may be one of the many women who find it liberating to stop worrying about pregnancy and periods.
Most important, even though menopause is not an illness, you shouldn't hesitate to get treatment if you're having severe symptoms. Many treatments are available, from lifestyle adjustments to hormone therapy.
Technically, you don't actually "hit" menopause until it's been one year since your final menstrual period. In the United States, that happens about age 51, on average.
The signs and symptoms of menopause, however, often appear long before the one-year anniversary of your final period. They include:
- Irregular periods
- Decreased fertility
- Vaginal dryness
- Hot flashes
- Sleep disturbances
- Mood swings
- Increased abdominal fat
- Thinning hair
- Loss of breast fullness
Menopause begins naturally when your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation. The process gets under way in your late 30s. By that time, fewer potential eggs are ripening in your ovaries each month, and ovulation is less predictable. Also, the post-ovulation surge in progesterone — the hormone that prepares your body for pregnancy — becomes less dramatic. Your fertility declines, perhaps partially due to these hormonal effects.
These changes are more pronounced in your 40s, as are changes in your menstrual pattern. Your periods may become longer or shorter, heavier or lighter, and more or less frequent. Eventually, your ovaries shut down and you have no more periods. It's possible, but very unusual, to menstruate every month right up to your last period. You're much more likely, though, to have a gradual tapering off.
Unfortunately, there's no way to know exactly which period will be your last. You have to wait until well after the fact — 12 months after, by official definition. In your final months before reaching menopause, it's still possible to get pregnant, but it's quite unlikely.
Because this process takes place over years, menopause is commonly divided into the following two stages:
- Perimenopause. This is the time you begin experiencing menopausal signs and symptoms, even though you still menstruate. Your hormone levels rise and fall unevenly, and you may have hot flashes and other symptoms. Perimenopause may last four to five years or longer.
- Postmenopause. Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and no progesterone, and they don't release eggs. The years that follow are called postmenopause.
Menopause is usually a natural process. But certain surgical or medical treatments or medical conditions can bring on menopause earlier than expected. These include:
- Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone. But an operation that removes both your uterus and your ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause, without any perimenopausal phase. Instead, your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptoms
- Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during the course of treatment or within three to six months.
- Premature ovarian failure. Approximately 1 percent of women experience menopause before age 40. Menopause may result from premature ovarian failure — when your ovaries stop working before age 40 — stemming from genetic factors or autoimmune disease, but often no cause can be found.