Menopause

Overview

Menopause is when periods stop for good. It's diagnosed after 12 months without a menstrual period, vaginal bleeding or spotting. Menopause can happen in the 40s or 50s. But the average age is 51 in the United States.

Menopause is natural. But the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt sleep, lower energy or affect mood. There are many treatments, from lifestyle changes to hormone therapy.

Symptoms

Most often, menopause happens over time. The months or years leading up to menopause are called perimenopause or the menopausal transition.

During the transition, the amount of hormones your ovaries make varies. Perimenopause can last 2 to 8 years. The average is about four years.

The hormone changes can cause symptoms such as:

• Irregular periods.
• Vaginal dryness.
• Hot flashes.
• Night sweats.
• Sleep problems.
• Mood changes.
• Trouble finding words and remembering, often called brain fog.

Different people have different menopause symptoms. Most often, periods are not regular before they end.

Skipped periods during perimenopause are common and expected. Often, menstrual periods skip a month and return. Or they skip a few months and then start monthly cycles again for a few months.

Period cycles tend to get shorter in early perimenopause, so periods are closer together. As menopause gets closer, periods get farther apart for months before they end.

You can still get pregnant during this time. If you've skipped a period but aren't sure it's due to menopause, think about taking a pregnancy test.

When to see a doctor

Keep seeing your healthcare professional for wellness visits and medical concerns before, during and after menopause. See your healthcare professional as soon as you can if you bleed from your vagina after menopause.

Causes

Menopause can result from:

• Natural decline of hormones. As you enter your late 30s, your ovaries start making less of the hormones that control your period. These are called estrogen and progesterone. With lower levels of them, it's harder to get pregnant.

  In your 40s, your menstrual periods may get longer or shorter, heavier or lighter, and happen more often or less often. In time, your ovaries stop releasing eggs. Then you have no more periods. This happens on average around age 51.

• Surgery that removes the ovaries, called oophorectomy. Ovaries make hormones, including estrogen and progesterone, that control the menstrual cycle. Surgery to remove the ovaries causes instant menopause.

  Your periods stop. You're likely to have hot flashes and other menopausal symptoms. Symptoms can be severe because the surgery causes hormones to drop all at once rather than slowly over several years.

  Surgery that removes the uterus but not the ovaries, called hysterectomy, most often doesn't cause instant menopause. You no longer have periods. But your ovaries still release eggs and make estrogen and progesterone for a time.

• Chemotherapy and radiation therapy. These cancer therapies can cause menopause. They can cause symptoms such as hot flashes during or shortly after treatment. Periods sometimes return after chemotherapy. Then you can still get pregnant. So you might want to keep using birth control.

  Radiation therapy aimed at the pelvis, belly and lower spine can cause menopause. Radiation to the whole body for stem cell transplant also can cause menopause. Radiation therapy to other parts of the body, such as breast tissue or the head and neck, likely won't affect menopause.

• Primary ovarian insufficiency. About 1% of people who have menopause get it before age 40. This is called premature menopause. Premature menopause may result from the ovaries not making the usual levels of hormones. This is called primary ovarian insufficiency. It can happen from gene changes or an autoimmune disease.

  Often no cause of premature menopause can be found. Then healthcare professionals most often suggest hormone therapy. Taken at least until the typical age of menopause, hormone therapy can protect the brain, heart and bones.

Risk factors

People assigned female at birth go through menopause. The main risk factor is reaching the age of menopause.

Other risk factors include:

• Surgery to remove the ovaries.
• Certain cancer treatments.

Complications

After menopause, your risk of certain medical conditions increases. Examples include:

• Heart and blood vessel disease. This also is called cardiovascular disease. When your estrogen levels fall, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in both women and men.
• Weakened bones, called osteoporosis. This condition causes bones to become brittle and weak, leading to a greater risk of breaking bones. During the first few years after menopause, you may lose bone density quickly. This ups your risk of osteoporosis. Bones often broken after menopause include the spine, hips and wrists.
• Loss of bladder control, called urinary incontinence. As the tissues of your vagina and urethra change, you may have sudden, strong urges to urinate often. Then you might lose urine, called urge incontinence. Or you might lose urine with coughing, laughing or lifting, called stress incontinence. You may have urinary tract infections more often.
• Sex problems. Menopause causes the vagina to get drier and lose its stretch. This can cause discomfort and slight bleeding during sexual intercourse. Also, less feeling in the area may lessen your desire for sex, called libido.
• Weight gain. Many women gain weight during and after menopause because calorie burning, called metabolism, slows.