As my patients get into their 40s and start noticing changes in their menstrual cycles, they often start thinking about menopause. Their older sisters, coworkers and friends may be lamenting hot flashes and night sweats. They may hear stories about their mother’s transition to menopause. “What will happen to my body?” “How will I change?” “Will it be hard or easy?” “How long will it last and what do I need to do?” These are questions I hear frequently. Education about the process is what I have found to be most useful in helping women decide what is best for them.

What is menopause?

Menopause is a time of transition that all women experience when monthly cycling ceases, marking the end of reproductive life. The ovaries have served their function of providing eggs and hormones that make reproduction possible. Menopause is technically defined as the absence of spontaneous cycles for 12 months.

To understand why this occurs, it’s necessary to understand what happens during the monthly cycle. The ovaries have thousands of immature eggs at birth. A woman’s reproductive life begins with puberty. During each monthly cycle several eggs are recruited from both ovaries to go through the final development stages needed for fertilization. During this process, cells around the developing eggs produce estrogen in the early part of the cycle and progesterone after ovulation. These hormones have vital roles in communicating with the brain and preparing other organs, such as the uterus, to sustain a pregnancy.

When no pregnancy occurs, hormone levels fall, the endometrium is sloughed (as your monthly period) and the pituitary gland sends messages to the ovaries to start again. Over several decades, beginning with the onset of menstruation, a woman’s eggs age and ovarian function declines. The ability to reproduce is lost and menses ends at menopause. This may occur naturally or as a result of surgery or illness. In most women menopause occurs around age 50-51. The age range is generally 45-55 years old.

What is perimenopause?

Perimenopause occurs over the months and years proceeding and following menopause. With aging, the feedback loop between the ovaries and the brain is harder to maintain. Ovarian function declines, hormones levels swing more widely, periods change and energy levels can fluctuate from euphoric to depressed. Agitation, hot flashes, night sweats, difficulty concentrating and headaches are all possible symptoms. These changes can be mild or dramatic. The good news is that this stage does not last forever. It does, however, often last beyond the last menstrual period because the ovaries gradually cease to produce estrogen over a year or two, occasionally longer, after menopause. This gradual tapering off of hormones is good; it allows the body to adapt and the changes are less pronounced.

What are the most common symptoms?

Although the first years following cessation of menses are still considered perimenopause, they are more commonly referred to as postmenopause. There is now very little fluctuation in estrogen levels and progesterone is no longer secreted by the ovaries in the absence of ovulation. For some women, this is the beginning of a new phase of relative calmness and is often much better tolerated than the perimenopause. Some women find they feel better than they have for a long time. Other women will note mild symptoms, feeling warmer, for instance, but are not greatly affected. A healthy lifestyle, engagement with friends and family and involvement in work and the community can help make this a very positive and rewarding time in life.

For some women however, the classic symptoms—the ones everyone talks about, can be quite bothersome and disruptive, especially during the first two to three years after periods cease. The loss of estrogen is associated with numerous effects; the most well known are hot flashes and night sweats, also known as “vasomotor” symptoms. These are caused by changes in the temperature regulation system. They general fade with time, but can go on indefinitely in a small percentage of women. Other noticeable changes are in sleep patterns, fatigue, weight gain, joint aches, concentration, vaginal dryness, change in libido, hair loss, loss of bone density, fine wrinkles and involuntary loss of urine. Some are noticeable quite quickly and others take years to develop. These are the symptoms that frequently cause women to seek help.

Check back for more information on managing the symptoms of menopause. If you have started noticing changes and have questions about what perimenopause and menopause will bring, now is a great time to meet with one of our gynecologists, nurse practitioners or certified nurse midwives. Contact an office to schedule an appointment >

This article first appeared in the national publication Women magazine. Check it out online at