Menopause

You may think of menopause as the time when your menstrual periods stop permanently. But doctors define menopause as the time after 12 months have passed since your last period. Although your mother or grandmother may have called menopause the change, it isn't a single event. Instead, it's a series of changes that can start in your 30s or 40s and last into your 50s or even 60s.

Menopause is a natural biological process, not a medical illness. Although it's associated with hormonal, physical and psychosocial changes in your life, menopause isn't the end of your youth or your sexuality. Several generations ago, few women lived beyond menopause. Today, you may spend as much as half of your life after menopause.

Fortunately, much more is known about menopause now than was known when your mother and grandmother experienced it. You can do more to relieve bothersome symptoms, avoid complications and improve your health and vigor during this important phase of your life.

Signs and symptoms

Every woman experiences menopause differently. Even the age at which menopause begins may be unique to you. Some women reach menopause in their 30s or 40s, and some not until their 60s, but menopause most often occurs between the ages of 50 and 51.

Your signs and symptoms are also likely to be very individual. You may breeze through menopause with few signs and symptoms. Or you may experience a number of physical and emotional changes, including:

• Irregular menstruation. Your cycle may stop suddenly, or gradually get lighter or heavier and then stop. The unpredictability of your periods may be your first clue that menopause is approaching.
• Decreased fertility. When ovulation begins to fluctuate, you're less likely to become pregnant. Until you haven't had a period for a year, however, pregnancy is still possible.
• Vaginal changes. As your estrogen level declines, the tissues lining your vagina and urethra — the opening to your bladder — become drier, thinner and less elastic. With decreased lubrication you may experience burning or itching, along with increased risk of infections of your urinary tract or vagina. These changes may make sexual intercourse uncomfortable or even painful.
• Hot flashes. As your estrogen level drops, your blood vessels may expand rapidly, causing your skin temperature to rise. This can lead to a feeling of warmth that moves upward from your chest to your shoulders, neck and head. You may sweat, and as the sweat evaporates from your skin, you may feel chilled, weak and slightly faint. Your face might look flushed, and red blotches may appear on your chest, neck and arms. Most hot flashes last from 30 seconds to several minutes, although they can last much longer. The frequency, as well as the duration, of hot flashes varies from person to person. You may have them once every hour or only occasionally. They can occur any time during the day or night. They may be a part of your life for a year or more, or you may never have them.
• Sleep disturbances and night sweats. Night sweats are often a consequence of hot flashes. You may awaken from a sound sleep with soaking night sweats followed by chills. You may have difficulty falling back to sleep or achieving a deep, restful sleep. Lack of sleep may affect your mood and overall health.
• Changes in appearance. After menopause, the fat that once was concentrated in your hips and thighs may settle above your waist and in your abdomen. You may notice a loss of fullness in your breasts, thinning hair and wrinkles in your skin. If you previously experienced adult acne, it may become worse. Although your estrogen level drops, your body continues to produce small amounts of the male hormone testosterone. As a result, you may develop coarse hair on your chin, upper lip, chest and abdomen.
• Emotional changes. As you go through menopause, you may experience mood swings, be more irritable or be more prone to emotional upsets. In the past, these symptoms were attributed to hormonal fluctuations. Yet other factors may contribute to these changes in mood, including stress, insomnia and life events that can occur in this stage of adulthood — such as the illness or death of a parent, grown children leaving home and retirement.

Causes

Menopause begins naturally when your ovaries start making less estrogen and progesterone. During your reproductive years, these hormones regulate your monthly cycles of ovulation and menstruation. In your late 30s, the amount of progesterone your body produces diminishes, and the remaining eggs from your ovaries are less likely to be fertilized. Eventually your menstrual periods stop, and you can no longer become pregnant. 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're still ovulating. Your hormone levels rise and fall unevenly, and you may have hot flashes and variations in your periods. For instance, your flow may be irregular, or heavier or lighter than usual. This is a normal process leading up to menopause and may last four to five years or more.
• Postmenopause. Once 12 months have passed since your last period, you're considered postmenopausal. Your ovaries no longer produce estrogen or progesterone, and they don't release eggs.

Risk factors

Menopause is usually a natural process. But certain surgical or medical treatments 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. But an operation that removes both your uterus and ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause. There's no 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. But they usually do so gradually, and you may have months or years of perimenopausal symptoms before you actually reach menopause.