What Is Menopause, Exactly?

Menopause is a natural biological process that marks the end of your menstrual cycle and, thus, your reproductive years. In the US, the average age of menopause is 51; however, it can happen in your 40s and 50s. It is diagnosed after 12 consecutive months without a period (1). There are 3 phases during this life transition, and even though most people use the term “menopause” to describe all the phases associated, it’s important to note that menopause is just one day in your life.

The time leading up to menopause is called perimenopause, which means “around menopause.” It can also be termed the menopausal transition (2). During this time, those assigned female at birth begin transitioning to menopause and may start experiencing symptoms. While some symptoms, such as hot flashes, difficulty sleeping, weight changes, thinning hair, and emotional changes, are more well-known, some symptoms in the perimenopause stage aren’t as easily recognized (1,3). 

Results of a poll conducted by AARP of women aged 35 and up revealed that “most women aren’t aware that conditions they may be experiencing in this time could be linked to perimenopause.” Lesser known symptoms associated with declining hormones include: 

• Acne
• Heart palpitations
• Itchy skin
• Tingling extremities
• Burning tongue. 

Nearly half of the women surveyed said they had done nothing in response to the symptoms they were experiencing, and many figured it was just part of aging (4).

Similar to menopause happening at different ages, so does perimenopause. You may notice the progression towards menopause in your 40s, but for some, changes may begin as early as their mid-30s (2).

During perimenopause, estrogen (main female hormone) and progesterone levels will fluctuate unevenly. In turn, your menstrual cycle can become longer or shorter, and you may even have a menstrual cycle where you do not release an ovum (egg) from the ovaries. Once you have gone 12 consecutive months without a period, you have officially reached menopause, and perimenopause is over (2).

After menopause is reached, you then enter the postmenopause stage. During this time, the symptoms you experienced in perimenopause may become milder or completely go away. Although symptoms may begin to lessen in intensity after menopause, there are certain medical conditions where your risk could increase, such as:

• Cardiovascular disease
• Osteoporosis
• Urinary incontinence
• Sexual function
• Stroke
• Weight gain (1,6). 

Once you begin the postmenopause stage, your reproductive years are behind you, and you’ll no longer ovulate (5). 

Several factors can trigger menopause, including:

1. Natural aging and the decline in reproductive hormones. Around the time you reach your late 30s, your fertility declines due to your ovaries making less estrogen and progesterone (1). 
2. Surgeries that remove your ovaries (oophorectomy). Your ovaries produce estrogen and progesterone, which help regulate the menstrual cycle. If your ovaries are removed, this will cause immediate menopause, and you may experience symptoms. These symptoms can be more severe due to the abrupt change in hormones versus the gradual decline over several years (1).
3. Chemotherapy, radiation therapy, and medical conditions, such as primary ovarian insufficiency, could potentially put you into menopause (1).

Multiple options are available to help ease the symptoms associated with menopause. Treatments range from hormone therapy and dietary supplements to lifestyle changes and topical products like vaginal lubricants (7). Everyone’s experience is different, and it’s important to work with your healthcare provider to determine the best course of treatment for your individual needs. 

References:

1. Mayo Foundation for Medical Education and Research. (2022, December 17). Menopause. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 
2. Mayo Foundation for Medical Education and Research. (2023, May 10). Perimenopause. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666 
3. Menopause: What it is, age, stages, signs & side effects. Cleveland Clinic. (2021, October 5). https://my.clevelandclinic.org/health/diseases/21841-menopause 
4. Thayer, C., & Lampkin, C. (2021, May 1). Perimenopause is more than hot flashes: What women need to know. AARP. https://www.aarp.org/research/topics/health/info-2021/perimenopause-hormonal-changes-impact.html.
5. Postmenopause: Signs, symptoms & what to expect. Cleveland Clinic. (2021b, October 5). https://my.clevelandclinic.org/health/diseases/21837-postmenopause 
6. Menopause and your health. Menopause and your health | Office on Women’s Health. (2022, December 15). https://www.womenshealth.gov/menopause/menopause-and-your-health 
7. Endocrine Society. (2022, March 31). Menopause treatment. Endocrine Society. https://www.endocrine.org/patient-engagement/endocrine-library/menopause-treatment