John Sklavounos

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Menopause is defined as the phase of life that begins 12 months after your last menstrual period marking the end of your menstrual cycle. It essentially signals the permanent loss of ovarian function. Menopause can occur in your 40s or 50s, but the average age of onset is 51 in the United States.  
Menopause is a natural biological process. Although fertility is lost, you can stay healthy, lively and sexually active. Some women are relieved as they no longer have to worry about pregnancy or annoying periods with heavy bleeding.
Even so, physical and emotional symptoms, such as hot flashes, can disrupt your sleep, reduce your energy, or – for some women – cause anxiety or feelings of sadness and loss. Do not hesitate to seek treatment for annoying symptoms. Many effective treatments are available, ranging from lifestyle changes to hormone therapy.

Menopause can result from:

A decrease in reproductive hormones. As you approach your late thirties, your ovaries start producing less estrogen and progesterone-the hormones that regulate menstruation- so there is a decline in fertility.

In your 40s, your periods may become longer or shorter, heavier or lighter, and more or less frequent, until they eventually stop at the age of 51 on average.

Hysterectomy Hysterectomy that removes your uterus but not your ovaries does not usually cause immediate menopause. Although you no longer have periods, since there is no longer a uterus, your ovaries still release eggs and produce estrogen and progesterone.

Surgery that removes your uterus and ovaries, (total hysterectomy and bilateral oophorectomy) causes menopause without a transition phase. Your period will stop immediately, and you are likely to have hot flashes and other signs and symptoms, which can be severe, as hormonal changes occur abruptly rather than over several years.


Chemotherapy and radiotherapy. These are cancer treatments and can trigger menopause, causing symptoms like hot flashes during or shortly after treatment. Menopause (and the loss of fertility) is not always permanent after chemotherapy.

Primary Ovarian Insufficiency. About 1 percent of women experience menopause before the age of 40 (premature menopause).

Menopause can result from primary ovarian insufficiency-when your ovaries are unable to produce normal levels of reproductive hormones-stemming from genetic factors or an autoimmune disease.

Usually, no cause for the condition can be identified. For women with POI, hormone therapy is usually recommended at least until the natural age of menopause, to protect the brain, heart and bones.

In the months or years before menopause (perimenopause), you may experience the following symptoms:

– Irregular periods
– Vaginal dryness
Hot flashes
– Night sweats
– Sleep problems
– Mood swings
– Weight gain and slowing metabolism
– Thinning Hair and dry skin
– Loss of breast fullness


It is possible, but rare, to have a period every month until your last period. You are much more likely to experience menstrual irregularity.

Missing some periods during perimenopause is common and expected. Menstruation will often occur every two to four months during perimenopause, especially one to two years before menopause. Despite irregular periods, you can still get pregnant. If you have missed a period and it is not certain that the menopausal transition phase has begun, you may wish to determine if you are pregnant.

After menopause, the risk for certain medical conditions increases.

For example:

Cardiovascular disease. As your estrogen levels decrease, your risk of cardiovascular disease increases. Cardiological diseases are the leading cause of death in women, as well as in men. Therefore, it is important that you exercise regularly, eat healthily and maintain a normal weight. Ask your physician for advice on protecting your heart, and lowering cholesterol or blood pressure if it is too high.

Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. In the first few years after menopause, you may lose bone density at a faster rate, increasing your risk of osteoporosis. Post-menopausal women with osteoporosis are particularly susceptible to fractures of the hip bones, wrists and spine.

Urinary incontinence. As the vaginal and urethral tissues lose their elasticity, you may experience a frequent, sudden and intense urge to urinate, followed by the involuntary loss of urine (urge incontinence) or urine leakage when coughing, laughing or lifting weights (stress incontinence). You may also suffer from urinary tract infections or vaginitis more often.

Strengthening the pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen cream can help relieve the symptoms of urinary incontinence.

Sexual function. Vaginal dryness due to reduced moisture production as well as loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, a decrease in sensation may reduce your desire for sex (loss of libido).

Moisturizers and lubricants for the genital area can help. Choose products that do not contain glycerin, because women sensitive to this chemical substance may experience a burning sensation or irritation. If a vaginal lubricant is not enough, many women will benefit from using topical vaginal estrogen therapy, available as a vaginal cream, tablet, or vaginal ring.

Weight gain. Many women gain weight during perimenopause, and after menopause because their metabolism slows down. You may need to eat less and exercise more just to maintain your weight.