What is menopause?

Menopause¹ is a biological process that marks the end of a woman’s menstrual cycle (period). A woman is considered to have entered menopause after she has gone a full year (12 consecutive months) without having a period.

During menopause, the levels of circulating estrogen (the primary female sex hormone) in the body decrease significantly. This is what leads to the common symptoms of menopause, such as headaches, difficulty sleeping, and hot flashes. This decline in estrogen production also causes the ovaries² to stop releasing eggs, resulting in infertility (the inability to become pregnant).

What causes menopause?

Menopause is caused by a natural decrease in the reproductive (sex) hormones estrogen and progesterone. Both estrogen and progesterone are associated with egg production. Because of this, when a woman enters menopause, she stops releasing eggs (ovulating) and menstruating (having her period).

All women with reproductive potential will experience menopause at some point during their life. In most cases, the process occurs spontaneously. Some women, however, such as those who undergo surgical removal of their ovaries (oophorectomy), will experience a more abrupt form of the process known as surgical menopause³.

Additionally, women whose ovaries have been damaged by radiation therapy or chemotherapy may enter a premature menopausal state known as induced menopause⁴. Induced menopause may lead to additional health risks, such as bone density loss (osteoporosis), as the result of decreased circulating estrogen levels.

When does menopause start?

While the average age⁵ of menopause in the United States is 51, many women begin menopause in their 40s or 50s. The early stage of menopause (known as perimenopause) can begin as early as ten years before menopause fully occurs.

Some women who are going through menopause feel a sense of finality, or as if they are “closing a chapter⁶” in their lives. Others, however, find relief that they no longer have to deal with the challenges of contraception or menstrual cycles.

Menopause symptoms

The signs and symptoms⁷ of menopause may start months or years before a woman fully enters a menopausal state. Common signs and symptoms include⁸:

• Irregular menstrual periods (changes in duration, frequency, and intensity)
• Hot flashes (a sudden feeling of warmth that’s usually most intense on the face, neck and chest, often accompanied by sweating)
• Loss of vaginal lubrication (and, as a result, pain during intercourse)
• Heavy nighttime sweating
• Chills or shivers
• Difficulty sleeping
• Changes in mood
• Weight gain or noticeable changes in metabolism
• Hair thinning
• Difficulty focusing
• Dry skin
• Loss of fullness in breast tissue

If you start to experience any of the signs and symptoms of menopause, see your healthcare provider or a specialist, such as your OB-GYN. They will be able to determine whether you have entered menopause and recommend treatments to help alleviate your symptoms.

Pre-menopause symptoms

Pre-menopause, also known as perimenopause⁹, refers to the period of time during which a woman’s body is naturally transitioning to menopause. While women experience perimenopausal symptoms at varying ages, most start to feel symptoms in their late 30s and 40s.

During perimenopause, a woman’s estrogen levels fluctuate greatly, causing imbalances that result in irregular or non-ovulatory menstrual cycles.

Symptoms of perimenopause are much like those of menopause, including hot flashes, headaches, difficulty sleeping, and pain during intercourse due to vaginal dryness.

How long does menopause last?

The symptoms of menopause typically last for about 4.5 years¹⁰ after a woman has had her last menstrual period. Including perimenopause, however, these symptoms last, on average, for a total of 7.4 years.

Research has shown that women who experience early perimenopausal symptoms are likely to have a longer duration of menopausal symptoms. In addition, African American women are more likely than other racial and ethnic groups to experience a longer duration of menopausal symptoms, at an average of 10.1 years.

Complications from menopause

While menopause does not frequently lead to life-threatening coexisting conditions (known as comorbidities), it can cause symptoms that greatly affect a woman’s quality of life. These symptoms include¹¹:

• Changes in vaginal health: Some women begin to experience vaginal dryness at the start of menopause, which can cause pain during intercourse. This symptom can be helped by hormone replacement medications or lubricants.
• Cardiovascular disease: Low levels of estrogen have been linked to¹² an increased risk of cardiovascular (heart and blood vessel) disease. Heart disease is the primary cause of death in both males and females. Talk to your healthcare provider about how to reduce your risk of cardiovascular disease once you reach menopause.

• Decreased bladder control: Loss of bladder control, also known as incontinence, is a common symptom of menopause. A woman in menopause may experience difficulty holding her bladder for long periods of time or feel small amounts of leakage during exercise or while sneezing/coughing.
• Hot flashes: Hot flashes are one of the most common signs of menopause. These intermittent skin flushing episodes, which may only last for a few years after menopause begins, are thought to be related to fluctuating estrogen levels.
• Changes in body composition: As a woman ages, she may notice her body changing in certain ways. Women in menopause may experience weight gain or loss, changes in skin elasticity, and joint or muscle stiffness.
• Mood changes: Women in menopause may feel more easily frustrated, less patient, or simply “different.” These mood changes may result from a combination of menopausal hormone shifts, dealing with the symptoms of menopause, and external life stresses.
• Changes in sex drive: Some women experience differences in their sex drive (libido) after starting menopause. Changes in libido may present as both an increased and decreased interest in having sex. While a woman cannot become pregnant after menopause, she is still at risk for contracting sexually transmitted infections (STIs) during intercourse, so physical protection (like condoms) should still be used.
• Altered sleep patterns: A woman in menopause may experience disturbed sleep patterns due to headaches or hot flashes. You can improve your ability to get adequate, quality sleep by exercising and avoiding hot flash triggers.