Although it also ends fertility, you can stay healthy, vital and sexual. Some women
feel relieved because they no longer need to worry about pregnancy. Even so, the physical symptoms, such as hot flashes, and emotional symptoms
of menopause may disrupt your sleep, lower your energy or — for some women — trigger anxiety or feelings of sadness and loss. Don't hesitate to
seek treatment for symptoms that bother you. Many effective treatments are available, from lifestyle adjustments to hormone therapy.
In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Sleep problems
- Mood changes
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Loss of breast fullness
It's possible, but very unusual, to menstruate every month right up to your last period. More likely, you'll experience some irregularity in your periods. Skipping periods during perimenopause is common and expected. Often, menstrual periods will occur every two to four months during perimenopause, especially one to two years before menopause. Despite irregular periods, pregnancy is possible. If you've skipped a period but aren't sure you've started the menopausal transition, you may want to determine whether you're pregnant.
When to see a doctor
Starting at perimenopause, schedule regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause. Preventive health care can include recommended screenings at menopause, such as a colonoscopy, mammography, lipid screening, thyroid testing if suggested by your history, and breast and pelvic exams. Always seek medical advice if you have bleeding from your vagina after menopause.
Natural decline of reproductive hormones : As you approach your late 30s, your ovaries start making less estrogen and progesterone — the hormones that regulate menstruation — and your fertility declines. In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually — on average, by age 51 — you have no more periods.
Hysterectomy : A hysterectomy that removes your uterus but not your ovaries (partial hysterectomy) usually doesn't cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone. But surgery that removes both your uterus and your ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause, without any transitional phase. Your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptoms, which can be severe, as these hormonal changes occur abruptly rather than over several years.
Chemotherapy and radiation therapy These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures may still be desired.
Primary ovarian insufficiency : About 1 percent of women experience menopause before age 40 (premature menopause). Menopause may result from primary ovarian insufficiency — when your ovaries fail to produce normal levels of reproductive hormones — stemming from genetic factors or autoimmune disease. But often no cause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones.
- Adolescence (during which cycles may not be associated with ovulation)
- Polycystic ovary syndrome (PCOS) (bleeding irregular but heavy)
- Uterine fibroids (benign growths of uterine muscle)
- Endometrial polyps (benign overgrowth of the lining of the uterus)
- Adenomyosis (the presence of uterine lining in the wall of the uterus)
- Nonhormonal IUDs
- Bleeding disorders, such as leukemia, platelet disorders, clotting factor deficiencies, or (less common) von Willebrand disease
- Pregnancy complications (miscarriage)