By Eve Harris
Menopause is a natural, inevitable part of aging. Still, for many women, the looming “change of life” can be daunting as they prepare to navigate the hormonal changes that trigger irregular menstrual cycles, hot flashes and mood swings. Here’s what you need to know about the transition into menopause — and life after the change takes place.
Two hormones help to regulate a woman’s menstrual cycle: estrogen and progesterone. During the first part of the cycle, a woman’s ovaries release estrogen, causing the lining of the uterus to thicken in preparation for pregnancy. The ovaries release one mature egg each month, usually around the middle of a woman’s cycle. After ovulation occurs, a woman’s progesterone levels increase in anticipation of the egg being fertilized. However, if the egg is not fertilized, her estrogen and progesterone levels decrease, causing the uterine walls to shed their lining which results in the menstural period.
As a woman reaches her late 30’s, her reproductive system begins to undergo certain changes. Her ovaries get smaller, thereby producing less estrogen and progesterone each month. These changes continue to accelerate into the next decade, causing distinct changes to a woman’s menstrual period — it may vary in length, heaviness of flow or frequency (some months, a woman may not produce enough estrogen to thicken the uterine lining and trigger ovulation, resulting in a missed period).
This is the transition into menopause, and is known as perimenopause. Perimenopause can last anywhere from two to eight years. When a woman has gone 12 consecutive months without a menstrual cycle, she has officially reached menopause. Once a woman hits menopause, she is no longer able to get pregnant.
There is no way to predict a woman’s menopause age. The average age of natural menopause is 51. For some women, the transition into menopause begins in their 40s; for a small percentage, it may occur in their late 50’s.
Several factors are thought to affect how soon you start perimenopause, including the age you had your first period, the number of pregnancies you’ve had, the type of birth control you use or whether or not you breastfed any of your children — but most research supports a strong link between family history (the age your mother underwent menopause) and your menopause age. Although the majority of women enter menopause naturally, surgical removal of the ovaries, as well as certain cancer treatments and hormonal medications, can cause menopause by suppressing ovarian function.
Aside from changes to a woman’s menstrual cycle, a variety of physical and psychological symptoms coincide with a woman’s transition to menopause.
Most symptoms are related to the change in the level of sex hormones (estrogen, progesterone and testosterone) circulating in a woman’s body. Skin, gut and brain cells are all sensitive to those hormones. However, doctors also suspect that some of the side affects are just natural consequences of aging.
Every woman experiences menopause differently, but common signs of menopause include:
Women who have induced menopause, for instance because they had their ovaries removed surgically or have had menopause triggered by a medical treatment (like chemotherapy), may experience a more sudden and intense onset of symptoms and usually have a greater need for treatment to control their menopause-related symptoms. Also, because these women are often younger, they sometimes need ongoing monitoring and treatment to lower the risk later in life of menopause-associated conditions like osteoporosis.
Hot flashes are the classic signal that "the change" is underway. As many as 60 to 85 percent of women experience hot flashes, sporadic sensations of warmth growing and spreading across their upper bodies. The body reacts as it does any time it’s overheated: it perspires. Each flash usually lasts from three to five minutes.
It’s unclear exactly why hot flashes occur during the years leading up to menopause. It may be that the changes in hormone levels during menopause lead to a change in the body’s temperature control center. Flushes and sweats are called vasomotor symptoms and they vary immensely in both severity and duration. For the majority of women, hot flashes do not cause any serious disruptions to daily activities; but for 20 percent of women, they may cause significant interference with work, sleep and quality of life. On average, women are affected by hot flashes for about two years. But for about 10 percent of women the symptoms linger — sometimes for more than 15 years.