What is Menopause?

Menopause

What is menopause?

Menopause is when your periods stop for good. After you've gone through menopause, you can't get pregnant. These changes don't happen overnight. You can get symptoms of menopause for several years.

Menopause is not an illness. It's a normal part of every woman's life. But for some women, the symptoms of menopause can be distressing. Hot flashes can be uncomfortable and cause sleepless nights. A dry

vagina
This is the passage from a woman's womb (uterus) to the outside of her body.

vagina can make sex painful. You might get

urinary tract infection
A urinary tract infection (UTI) happens when bacteria invade the walls of your urinary tract, which includes your kidneys, bladder and urethra. An uncomplicated UTI is one that involves your bladder and urethra, but not your kidneys. A complicated UTI involves your kidneys and can be harder to treat. Another name for kidney infection is pyelonephritis.

urinary infections. And you might feel depressed.

Source:
Greendale GA, Lee NP, Arriola ER.
The menopause.
Lancet. 1999; 353: 571-580.

Source:
Gambrell RD Jr.
The menopause: benefits and risks of hormone replacement therapy.
Comprehensive Therapy. 1994; 20: 580-585.

Source:
Bachmann G.
Physiologic aspects of natural and surgical menopause.
Journal of Reproductive Medicine. 2001; 46 (supplement): S307-S315.

Source:
Carr BR, Bradshaw KD.
Disorders of the ovary and female reproductive tract.
In: Braunwald E, Fauci AS, et al (editors). Harrison's principles of internal medicine. 15th edition. Volume 2. McGraw-Hill, New York, U.S.A.; 2001.

⁴

Menopause is a normal part of every woman's life.

If your symptoms are making life miserable, you don't have to put up with them. There are treatments that can help, although some have side effects. You will need to weigh the pros and cons of treatment and decide with your doctor what's right for you.

Key points for women going through menopause

Menopause isn't an illness. It's a natural part of your life.
It happens when your body stops making certain

hormones
Hormones are chemicals that are made in certain parts of the body. They travel through the bloodstream and have an effect on other parts of the body. For example, the female sex hormone estrogen is made in a woman's ovaries. Estrogen has many different effects on a woman's body. It makes the breasts grow at puberty and helps control periods. It is also needed to get pregnant.

hormones.
The symptoms of menopause can be distressing, but you don't have to put up with them. You can get help.
The main treatment for menopause is hormone replacement therapy (HRT). But if you don't want to take this, there are other treatments that might also help.
There are things you can do yourself to help relieve symptoms of menopause. See Self-help for common menopausal symptoms.

Your periods

Your periods are part of your

menstrual cycle
A woman's periods are part of her menstrual cycle. This is the regular monthly pattern of events that causes an egg to be released from the ovaries so a woman can get pregnant and causes the bleeding that happens if she does not get pregnant.

menstrual cycle.

Source:
Guyton AC, and Hall JE.
Female physiology before pregnancy and the female hormones.
In: Textbook of medical physiology. WB Saunders, Philadelphia, U.S.A.; 2000.

⁵ This regular monthly set of events gets your body ready for pregnancy. It's controlled by many different hormones, including two made by your

ovaries
Women have two ovaries, one on each side of their womb. They are small glands that store eggs. Inside the ovaries are millions of pre-eggs, called follicles. Some of these grow into eggs.

ovaries:

estrogen
Estrogen is the name given to three female sex hormones: oestradiol, oestrone and oestriol. Estrogen causes women's sexual development during puberty: it is needed to develop breasts, have periods and get pregnant. Estrogen is also thought to affect women's health in other ways. It may influence their mood, cholesterol levels and how their bones grow. Men have very low levels of estrogen in their bodies, but doctors aren't completely sure what it does. Estrogen is an important ingredient in most types of contraceptive pill and hormone replacement therapy.

estrogen and

progesterone
Progesterone is a hormone that plays a part in a woman's menstrual cycle and in pregnancy. A form of this hormone made in the laboratory, called progestagen, is often added to contraceptive pills and hormone replacement therapy (HRT).

progesterone.

Estrogen is not one hormone but a group of hormones made by your body. But most people refer to all these hormones as estrogen.

Your hormones make an egg come out of one of your ovaries every month. They also make the lining of your womb (endometrium) get thicker and softer in case you get pregnant.

At the end of the monthly cycle, if you're not pregnant, your hormone levels drop and you have your period. A period is your body's way of getting rid of the thickened lining of your womb. After your period, your hormone levels start to rise and the whole cycle begins again.

Your menstrual cycle begins during

puberty
Puberty is the time when boys and girls develop secondary sexual characteristics. For boys, the major changes include pubic hair, a deeper voice, and growth of their penis and testicles. For girls, major changes include pubic hair, breasts and starting to have periods. After puberty, girls are able to become pregnant and boys are able to father children.

puberty. On average, each cycle lasts about 28 days, but it can be shorter or longer.

To learn more, see What happens every month.

It's also helpful to know something about the parts of your body involved in getting pregnant and having periods.

Your reproductive organs sit in the lower part of your abdomen.

Together, this is called your reproductive system. It includes your ovaries, your

fallopian tubes
Fallopian tubes are the two tubes that come out of the top of a woman's womb. They carry eggs from the ovaries to the womb.

fallopian tubes, your womb and your vagina.

To find out more about these parts of your body, see Your reproductive system.

What happens when you reach menopause

Strictly speaking, menopause begins at the end of your very last period.

⁴ Of course, you can't know when you're having your last period. So it's impossible to know at the time if you are going through menopause. You are said to be "menopausal" if you haven't had a period for 12 months and you have symptoms such as hot flashes.

Source:
Greendale GA, Lee NP, Arriola ER.
The menopause.
Lancet. 1999; 353: 571-580.

But menopause doesn't happen out of the blue. The changes in your body that lead to it start much earlier, even as early as 10 years before your last period.

Source:
Longscope C.
The endocrinology of the menopause.
In: Lobo RA. Treatment of the postmenopausal woman: basic and clinical aspects. Raven Press, New York, U.S.A.; 1994.

⁶

During the lead up to menopause, your ovaries start to make less of two important hormones: estrogen and progesterone. You make less of these hormones because, as you grow older, you start losing the eggs that are stored in your ovaries.

Source:
Andrews MC
Hormonal changes in the perimenopause and clinical consequences.
In: Eskin B. The menopause: comprehensive management. 4th edition. Informa Health Care, London, UK; 2000.

⁷

Source:
Al-Azzawi F.
The menopause and its treatment in perspective.
Postgraduate Medical Journal. 2001; 77: 292-304.

⁸ When you are born, there are hundreds of thousands of these young eggs stored in your ovaries. Only a few hundred ever get released during your lifetime. The rest begin to shrivel up and disappear as you get older.

It's these young eggs that stimulate your ovaries to produce the hormones estrogen and progesterone. So, as you lose these eggs, your ovaries make less of these hormones, too.

Researchers still don't completely understand why the ovaries stop working as part of the aging process.

Source:
Eskin BA.
The menopause and ageing.
In: The menopause: comprehensive management. 4th edition. Parthenon, New York, U.S.A.; 1999.

⁹ When and how quickly your ovaries stop working might be partly something you inherit from your mother.

The first signs of menopause

In the years before you reach menopause, you might notice that your periods aren't so regular, or there might be a change in your patterns of bleeding. This is often one of the first signs that your hormone levels are changing.

Doctors call this stage perimenopause. It usually begins in your 40s and it can last for several years.

Source:
Greendale GA, Lee NP, Arriola ER.
The menopause.
Lancet. 1999; 353: 571-580.

¹ Some of the most common symptoms of menopause, such as hot flashes and problems sleeping, can begin at this time.

Changes in your hormone levels can have lots of different effects on your menstrual cycle.

Source:
Andrews MC
Hormonal changes in the perimenopause and clinical consequences.
In: Eskin B. The menopause: comprehensive management. 4th edition. Informa Health Care, London, UK; 2000.

⁷ For example, when your ovaries start making less

progesterone, you might have heavier periods. The job of progesterone is to help prepare the womb for a fertilized egg. It also helps the womb to shed this lining if an egg is not fertilized. If the ovaries don't make enough progesterone, the lining of your womb might continue growing. This is why many women have such heavy periods during perimenopause.

Source:
Andrews MC
Hormonal changes in the perimenopause and clinical consequences.
In: Eskin B. The menopause: comprehensive management. 4th edition. Informa Health Care, London, UK; 2000.

⁷

Some of the things that might happen are listed below.

You might have lighter or heavier bleeding than normal.
You might bleed for fewer days or more days than usual.
Your menstrual cycle may get shorter or longer.
You might skip a period.

All of these changes in bleeding patterns are normal during perimenopause, and they're nothing to worry about. But you should talk to your doctor if you have any of the following changes in your bleeding, because you might have another condition that needs to be treated.

Source:
The North American Menopause Society.
Menopause Core Curriculum Study Guide.
The North American Menopause Society; Cleveland, Ohio, U.S.; 2000.

¹⁰

You should let your doctor know if:

Your periods are very heavy (you need to change a tampon or pad every hour or two)
Your periods last more than six days
The time between the start of one period and the start of the next is shorter than 21 days
You get bleeding or "spotting" between periods
You bleed after having sex.

Several things can cause this abnormal bleeding. The most common causes are:

polyp
A polyp is a growth that is found inside your body.

Polyps. These are growths in the lining of the womb or neck of the womb (

cervix
The cervix is a piece of tissue that sits between a woman's womb and her vagina. It has a small opening in it that gets much bigger when a woman is having a baby.

cervix). They aren't cancer
fibroid
A fibroid is a lump of extra tissue that can build up in the wall of your womb. Sometimes it can grow big enough to feel. It can cause pain and bleeding, and make it difficult for a fertilized egg to take hold in your womb. If these problems become too bad, you can have fibroids removed by surgery.

Fibroids. These aren't cancer. They're growths in the wall of the womb. To learn more, see our information on Fibroids
Endometrial hyperplasia. This is a thickening of the lining of the womb. It isn't cancer, but it could turn into cancer if it isn't treated.

All these things can be treated. However, some kinds of cancer can also cause abnormal bleeding, although this is less common. So it's important to see your doctor.

Reaching menopause

Eventually your ovaries make so little estrogen and progesterone that your menstrual cycle and your periods stop. This is when you have reached menopause.

But, your ovaries don't always stop producing estrogen completely, even after you've been through menopause. Although levels of one form of estrogen (called estradiol) drop, you will still make a weaker kind of estrogen (called estrone). And another part of your body, your

adrenal glands
You have two adrenal glands. They are on top of your kidneys. Your adrenal glands make hormones that help control your blood pressure, how fast your heart beats and the way your body uses food.

adrenal glands, will keep making estrone, too.

⁴

You can still get pregnant

It's worth remembering that, until you're sure you've reached menopause (that is, you haven't had a period for a year) you can still get pregnant. This is because your hormone levels go up and down, and your ovaries might still be releasing eggs (

ovulation
To get pregnant, a woman needs to release an egg from one of her ovaries. This is called ovulation. It normally happens once every month. The egg leaves the ovary and moves toward the womb.

ovulating), even if it's only once in a while. And if your periods are irregular, it might be more difficult to predict when you are likely to release an egg.

It's worth talking to your doctor about birth control if you are having sex and don't want to get pregnant.

Having an early menopause

Most women will go through menopause between the ages of 45 and 55, but some women have an early or premature menopause. Doctors say a woman has an early menopause when it happens before she is 40. Having surgery or other treatment for some diseases such as cancer are the most common reasons why women go through menopause early.

To find out more, see Early menopause.

Having a late menopause

Some women still have periods even when they're over 55. These women are said to have a delayed or late menopause. Having a late menopause usually runs in families, but it can also happen if you are overweight.

When will menopause happen to me?

In the United States, the average age that women go through menopause is 51.

Source:
Al-Azzawi F.
The menopause and its treatment in perspective.
Postgraduate Medical Journal. 2001; 77: 292-304.

⁸ But researchers don't know very much about the things that affect exactly when a woman will go through it.

Source:
Al-Azzawi F.
The menopause and its treatment in perspective.
Postgraduate Medical Journal. 2001; 77: 292-304.

⁸

This is what we know from studies.

Smokers are likely to go through menopause one to two years earlier than nonsmokers.

Source:
McKinlay SM, Bifano NL, McKinlay JB.
Smoking and age at menopause in women.
Annals of Internal Medicine. 1985; 103: 350-356.

¹¹

Source:
Gold EB, Bromberger J, Crawford S, et al.
Factors associated with age at natural menopause in a multiethnic sample of midlife women.
American Journal of Epidemiology. 2001; 153: 865-874.

¹²
If you've used the birth control pill or have had children, you might go through menopause a little later than other women.
The age at which you go through menopause might be linked to the age at which your mother and grandmother went through it.

Sources for the information on this page:

Greendale GA, Lee NP, Arriola ER.The menopause.Lancet. 1999; 353: 571-580.

Gambrell RD Jr.The menopause: benefits and risks of hormone replacement therapy.Comprehensive Therapy. 1994; 20: 580-585.

Bachmann G.Physiologic aspects of natural and surgical menopause.Journal of Reproductive Medicine. 2001; 46 (supplement): S307-S315.

Carr BR, Bradshaw KD.Disorders of the ovary and female reproductive tract.In: Braunwald E, Fauci AS, et al (editors). Harrison's principles of internal medicine. 15th edition. Volume 2. McGraw-Hill, New York, U.S.A.; 2001.

Guyton AC, and Hall JE.Female physiology before pregnancy and the female hormones.In: Textbook of medical physiology. WB Saunders, Philadelphia, U.S.A.; 2000.

Longscope C.The endocrinology of the menopause.In: Lobo RA. Treatment of the postmenopausal woman: basic and clinical aspects. Raven Press, New York, U.S.A.; 1994.

Andrews MCHormonal changes in the perimenopause and clinical consequences.In: Eskin B. The menopause: comprehensive management. 4th edition. Informa Health Care, London, UK; 2000.

Al-Azzawi F.The menopause and its treatment in perspective.Postgraduate Medical Journal. 2001; 77: 292-304.

Eskin BA.The menopause and ageing.In: The menopause: comprehensive management. 4th edition. Parthenon, New York, U.S.A.; 1999.

The North American Menopause Society.Menopause Core Curriculum Study Guide.The North American Menopause Society; Cleveland, Ohio, U.S.; 2000.

McKinlay SM, Bifano NL, McKinlay JB.Smoking and age at menopause in women.Annals of Internal Medicine. 1985; 103: 350-356.

Gold EB, Bromberger J, Crawford S, et al.Factors associated with age at natural menopause in a multiethnic sample of midlife women.American Journal of Epidemiology. 2001; 153: 865-874.

This information was last updated on Apr 09, 2009

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