Menopause happens when changes in hormone levels mean that a woman can no longer become pregnant. It is a natural transition, not a health problem. However, it can cause noticeable effects.
When a female is in their 40s, levels of estrogen and progesterone start to fall. In time, they will stop menstruating.
When menstruation has not occurred for 12 months, menopause starts. The years leading up to this time are called perimenopause.
The hormonal changes of menopause can affect a person’s physical and mental well-being. For some, perimenopause is a time of anticipation, after which there is no need to worry about menstruation or pregnancy. For others, menopause can cause discomfort and distress.
The changes that occur around menopause vary widely, in terms of when they begin, how they affect a person, and how long they last.
It is not always clear when a missed period signals the start of menopause. It could indicate pregnancy or a health problem.
For this reason, a person may require confirmation that they are approaching or entering menopause.
Over time, the ovaries produce less of these hormones, giving rise to the symptoms of menopause. This usually happens slowly over several years. The average age at which menopause starts is 52 years in the United States.
However, menopause can begin earlier or suddenly if a person has:
- surgery on their reproductive organs, such as a hysterectomy
- some types of cancer or treatments for cancer
- other medical conditions
During perimenopause, a person may notice:
- lighter or irregular periods
- some symptoms of menopause
During menopause, a person may experience:
- hot flashes
- night sweats
- vaginal dryness
- difficulty sleeping
- a reduction in libido, or sex drive
- mood changes
Other health conditions, such as depression and low thyroid function, can cause similar symptoms.
If a person is experiencing these symptoms and is uncertain of the cause, they may wish to ask a doctor about testing.
Menopause usually starts 12 months after the last menstrual period.
However, periods can cease for various other reasons, and medical tests can help identify the cause.
Understanding whether perimenopause or menopause has begun can help a person make several decisions.
A person may wish to ask a doctor for a test if they:
- are considering fertility options
- want to know whether they can stop using birth control
- have a high risk of osteoporosis and want to start taking action to reduce the risk
- are experiencing symptoms such as hot flashes and wish to know the reason
Menopause involves changes in the production of hormones. However, it is not usually possible to confirm or predict menopause through hormone testing.
This is because hormone levels are constantly rising and falling, and measuring levels at any one point may not give an accurate indication. For this reason, a doctor may not recommend testing.
Other options include:
- testing for saliva for hormone levels
- testing for follicle stimulating hormone, which a person can do
The Food and Drug Administration (FDA) note that home tests can provide a reliable measure of follicle stimulating hormone 9 times out of 10. However, the results cannot confirm whether a person is in perimenopause or menopause.
Also, The North American Menopause Society point out that these tests are expensive and not reliable.
Usually, a doctor will only recommend a blood hormone test for menopause if a periods stop before the age of 40. In this case, the test results may help diagnose a health condition.
Testing can help a doctor confirm that a person has entered early menopause, which can pose specific challenges.
When menopause occurs before the age of 40, doctors call it early menopause.
Reasons for early menopause can include:
- Chemotherapy or other cancer treatments: These may damage the ovaries, affect hormone production, or both. The effects may be reversible, and menstruation may resume in the months after treatment.
- Surgical removal of the ovaries or uterus: Removing the ovaries (oophorectomy) or uterus (hysterectomy) will affect hormone levels and reproductive function. Menopause will start almost immediately after surgery.
- Chromosomal features: A person with certain genetic features may have ovaries that do not function in the usual way.
- Family history: Early menopause can result from genetic or hereditary factors.
- Medical conditions: People with thyroid disease or rheumatoid arthritis may experience early menopause.
Early menopause is not life threatening, but it can be a matter of concern. However, medical treatments can help manage some of the effects.
Fertility: A woman cannot become pregnant naturally after menopause, but assisted fertility treatments can make pregnancy possible for many women.
Osteoporosis: A decrease in estrogen is associated with thinning bones, which can contribute to osteoporosis. The risk is higher for people who have entered early menopause.
Symptoms of menopause: These can be more severe during early menopause. Treatments can help, and a doctor can provide specific guidance. One option is hormone therapy, though this can have adverse effects.
Sadness and depression: Experiencing menopause early can be distressing, and a person may not have the support of a peer group. Counseling can help a person cope with these and any other challenges.
Menopause is a transition to a new phase of life. It is not the end of youth, but a natural change that all females experience.
It affects everyone differently. Some people have no symptoms or very mild ones. For others, symptoms such as hot flashes continue for years. Vaginal dryness is a long-term change for most people.
If symptoms are troublesome, there are various ways of managing them, including:
- using hormone therapy, if a doctor advises it
- using vaginal lubricants to relieve dryness
- taking medications to reduce hot flashes
- using medications and other therapies for depression and anxiety
- getting regular physical activity to boost mental and physical well-being
- maintaining a healthful diet
- practicing stress-relieving activities, such as yoga and meditation
- maintaining a regular sleep pattern
- avoiding smoking
- limiting alcohol intake
- pursuing social engagements, for example, by joining an activity or club
Some people try herbs and other dietary supplements to manage menopause symptoms, such as black cohosh, red clover, wild yam, and kava.
However, there is no scientific evidence that these herbs reduce menopause symptoms.
In addition, the FDA do not regulate herbs and supplements. A person should speak to a doctor before trying any.
In the U.S., menopause starts, on average, at the age of 52. However, the timing can vary.
When a person’s periods have stopped for at least 12 months, menopause has likely begun. The 10 or so years leading up to this point are called perimenopause. Periods continue during this time, but they may be irregular, and a person may experience some menopause symptoms.
If periods stop suddenly or menopause symptoms begin unexpectedly, see a doctor, who will investigate and recommend any necessary treatment.