Menopause is the stage in a woman’s life when her regular menstrual periods have ceased for 12 months, at least, and she cannot become pregnant any longer. This is a natural part of a woman’s aging process. Menopause can take place at any time after 35 years old, but typically it takes place when a woman is in her late 40s to her early 50s. For American women, the average age for the onset of menopause is 51 years old.
Throughout a woman’s child-bearing years, the hormones progesterone, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) work together on a monthly basis to grow and release an egg from the woman’s ovaries (ovulate) and to either support the beginning stages of pregnancy or regulate the monthly menstrual cycle. As menopause nears, the cyclical production of progesterone and estradiol are less consistent and occur less frequently.
The start of the menopausal process is referred to as perimenopause or menopausal transition. It can start at some point when a woman is in her 40s but could take place in her late thirties. This process is a gradual one and normally takes between two to five years for it to complete.
Through the perimenopause stage, hormone levels may fluctuate on a month to month basis from high to low, and ovulation and periods can become irregular. A woman might have her period one month and then not have another one for several months. During perimenopause, some women might discover that the intensity and frequency of their periods increase. Although it is expected that there will be irregularities throughout the menopause transition period, all changes should be discussed with the woman’s healthcare provider so that she can make sure that her symptoms are not being caused by some other condition other than fluctuations in hormones. Perimenopausal women also need to be aware that although it is not as likely, women who are in transition may still become pregnant.
Associated Health Issues
After a menopausal woman has not had a period for twelve months, the transition is usually considered to be complete. At that point, she enters the post-menopause stage. At this point, her ovaries have stopped producing progesterone and estradiol, and she is not ovulating any longer and cannot become pregnant. Although this is part of the natural aging process, there are certain health issues associated with post-menopausal and menopause stage of life:
- Decreased estrogen levels might result in an increased risk of developing osteoporosis. Changing estrogen levels might also contribute to a woman developing heart disease.
- Vaginal tissues tend to thin (atrophy), which can cause susceptibility to infection, vaginal dryness, and chronic irritation.
- Reduced levels of estrogen are also accompanied by reduced production of elastin and collagen, which are the two proteins that are responsible for maintaining the integrity of the skin. As those levels are reduced, the skin becomes more susceptible to being injured, dryer, and thinner.
As a woman continues to age, menopause occurs naturally. However, it also may happen for various other reasons as well. Surgical menopause takes place when a woman’s ovaries are removed, as with a hysterectomy or with ovarian cancer. Since that removal stops hormone production by the ovaries (since they are no longer there), it can result in certain menopausal symptoms developing shortly after surgery. Menopause may also take place in women who are in very poor health, with pituitary gland disorders, or with excessive exposure to chemotherapy or radiation.
Women who experience hormonal irregularities and menopausal symptoms before they are 40 years old were referred to in the past as having “premature menopause.” They are now said to have “primary ovarian insufficiency” or “premature ovarian failure. Some of those women might still become pregnant despite having these conditions.
Symptoms and Signs
During menopause, a woman’s body will undergo several changes. Some of the most common symptoms and signs of menopause happen when estrogen levels begin to drop. A woman might experience the following:
- Changes in the frequency of menstruation and flow intensity (including more frequent or heavier periods for some women)
- Hot flashes
- Night sweats
- Decreased sex drive (libido)
- Rapid mood swings that range from euphoria to depression
- Sudden urge to or increased frequency to urinate
- An increase in bone loss which can result in osteoporosis
- Vaginal dryness that might lead to pain during intercourse
- Increased risk of heart disease (due to potential increases in LDL “bad” cholesterol levels in the blood)
Not every woman who has gone through or is going through menopause will need to have laboratory tests performed. However, women who might have premature ovarian failure with menopausal symptoms or who might be at risk for other health issues, like osteoporosis, might have one or more of these tests done:
Follicle-stimulating hormone (FSH): to determine whether a woman is nearing, transitioning, or undergone menopause. The FSH level, in general, increases during the transition phase.
Estradiol: to measure estrogen production by the ovaries and to evaluate whether the woman has a normal menstrual cycle.
Thyroid function testing (TSH and free T4): to test the thyroid gland’s functioning, which may slow as women age, affect menstruation, or cause certain symptom that are similar to those that are found with menopause
Anti-Mullerian hormone (AMH): for predicting when menopause will begin and/or when a woman is worried about fertility loss
Other tests that might be ordered include the following:
Lipid profile: for testing increased LDL (“bad”) cholesterol and triglycerides and decreased HDL (“good”) cholesterol for assessing risks for developing cardiovascular disease.
Comprehensive metabolic panel (CMP): for testing kidney and liver function, particularly when hormone replacement therapy (HRT) is being considered.
Complete blood count (CBC): for determining whether there is an adequate number of white and red blood cells in the blood.