Menopause, Understanding the Basics

Menopause is the “change of life,” the time your period stops permanently. It is also a period of hormonal disruption. Menopause does not happen all at once. As your body transitions to menopause over several years, you may have menopause symptoms and irregular periods. The average age for menopause in the United States is 52

What is menopause?

We define menopause as when the menstrual cycle stops permanently. Ovulation has stopped and one can no longer get pregnant. You have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months.

After menopause, the ovaries make very low levels of the hormones estrogen and progesterone. The low hormone levels trigger menopausal symptoms and can raise your risk for certain health problems. 

What is perimenopause?

Perimenopause means “around menopause.” These years are the menopausal transition time leading up to your last period.

Perimenopause is a long transition to menopause. The ovaries begin working “part-time” before they retire. During this time, the ovarian hormonal production may fluctuate at random, causing menopause symptoms unexpectedly. 

The alterations in estrogen and progesterone disrupt ovulation and trigger irregular periods. Some have longer periods and others shorter. Some may skip a few months. When the cycle comes it may be lighter or heavier than before. Many women also have hot flashes and other menopause symptoms during this transition.

Hot flashes and night sweats are two of the most common and frustrating menopausal symptoms. A hot flash is a sudden sense of intense internal heat sometimes accompanied by sweating, a rapid heartbeat, and facial redness.

When does the transition to menopause usually start?

Perimenopause, the transition to menopause, usually starts in a woman’s mid- to late 40s. On average, women are in perimenopause for four years before their periods stop.

How will I know if I am starting the transition to menopause?

Sometimes it can be hard for you and your doctor to tell whether you are in perimenopause, the transition to menopause:

• Symptoms: Tell your doctor or nurse about any menopause symptoms, such as hot flashes or trouble sleeping.
• Irregular periods: Track your periods. Irregular periods may be your first sign of menopause.
• Hormone levels: One hormone called FSH may be tested to help determine menopausal status. Your doctor may test other hormones levels if your periods stopped at an early age. Most doctors do not routinely check estrogen and progesterone levels without a medical reason because the hormones fluctuate unpredictably making interpretation of the results challenging.

How will menopause affect me?

Each woman experiences menopause differently. Menopausal symptoms may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time or sporadically. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome (PMS). Others may be new to you. For example:

• Your menstrual periods may not come as regularly as before. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.
• Your periods might be heavier or lighter than before.
• You might have hot flashes and problems sleeping.
• You might experience mood swings or be irritable.
• You might experience vaginal dryness causing pain or discomfort during sex.
• You may have less interest in sex. It may take longer for you to get aroused.

Other possible changes are not as noticeable. For example, low estrogen levels cause a reduction in bone density. This can lead to osteoporosis, a condition that causes bones to become weak and break easily. Decreasing estrogen levels can also raise cholesterol levels increasing the risk of heart disease and stroke.

Many women choose to fight through menopausal symptoms while others choose hormonal supplementation to alleviate bothersome symptoms.

How long does the transition to menopause last?

Perimenopause can last between two and eight years before your menstrual cycles stop completely. For most women, this transition to menopause lasts about four years. Menopause has officially started when it has been twelve months from the last period.

Should I continue using birth control during the transition to menopause?

Yes. You can still get pregnant during perimenopause. While the ovaries are no longer working full-time ovulation can still occur. If the ovaries release an egg then pregnancy may be possible.

It is impossible to know for sure when you will ovulate during this transition. If you don’t want to get pregnant, you should continue to use birth control until one full year after your last period. Talk to your doctor about your contraceptive needs.

You can’t get pregnant after menopause, but anyone who has sex is at potential risk for sexually transmitted infections (STIs). If you are not in a monogamous relationship in which you and your partner have sex with each other and no one else, protect yourself by using a male condom or dental dam correctly every time you have vaginal, oral, or anal sex. After menopause, you may be more likely to get an STI from sex without a condom. Vaginal dryness can cause small cuts or tears during sex, exposing you to STIs.

When does menopause usually happen?

The average age of menopause in the United States is 52. The range for women is usually between 45 and 58. 

Menopause may happen earlier if you:

• Never had children. Pregnancy, especially more than one pregnancy, may delay menopause.
• Smoke. Studies show smoking can cause you to start menopause up to two years earlier than women who don’t smoke.

Certain health problems can also cause you to start menopause earlier.

Menopause usually happens on its own. However, you may enter menopause earlier than you normally would if you have had chemotherapy or surgery to remove both ovaries. Learn more about early menopause on our early or premature menopause page. 

What happens after menopause?

After menopause, you will no longer be able to get pregnant and you will no longer get a period. If you have any type of vaginal bleeding after menopause, you should see a doctor as soon as possible. Vaginal bleeding after menopause is not normal and can indicate a serious health problem.  

You may experience any of the following after menopause:

• Low hormone levels. With menopause, your ovaries make very little of the hormones estrogen and progesterone. Because of changing hormone levels, you may develop certain health risks, including osteoporosis, heart disease, and stroke.
• Menopausal symptoms instead of period problems. During menopause, most women trade period problems for menopause symptoms. As one passes through menopause, occasional hot flashes and sleep disturbances may persist.
• Vaginal dryness. Our bodies change as we grow older, but we do not have to age without a fight. Vaginal dryness is a common condition affecting 50–70% of women after menopause. A lack of lubrication is the most common cause of dyspareunia (dis-puh-ROO-nee-uh) or painful intercourse.