Menopause is the time in a woman's life when she stops having menstrual periods. The years leading up to this point are called perimenopause. Menopause marks the end of the reproductive years.

The ovaries, two glands on either side of the uterus make estrogen from puberty until menopause. Estrogen cause the lining of the uterus to thicken each month.

On about the 14th day of your menstrual cycle, an egg is released from one of the ovaries. This is called ovulation. After ovulation, progesterone levels increase. If the egg is not fertilized, pregnancy does not occur. The levels of estrogen and progesterone decrease, which signals the uterus to shed its lining. This is your monthly period.

As menopause nears, the ovaries make less estrogen. A change in your menstrual periods is the most common sign that menopause is approaching. Even though periods tend to be irregular around the time of menopause, you should talk to your healthcare provider if you:

  • have a change in your monthly cycle
  • have very heavy bleeding with clots
  • have bleeding lasting longer than normal
  • bleed more often than every three weeks
  • bleed after sex or between periods

Eventually the ovaries stop making enough estrogen to thicken the lining of the uterus. This is when menstrual periods stop.

Menopause also can occur when a womans ovaries are surgically removed. This may trigger severe symptoms because the hormone levels decrease all at once. Removal of the uterus (a hysterectomy) ends menstrual periods, but it will not cause menopause unless the ovaries are also removed. If the ovaries remain, most women will go through menopause around the normal age (about 51 years).

Menopause is a natural part of aging. The lower amounts of estrogen will cause changes in your body over time. Menopause is different for everyone. Some women notice little difference in their bodies while others have difficulty coping with their symptoms.

Hot Flashes

The most common symptom of menopause is the hot flash. As many as 75% of menopausal women in the United States will experience a sudden feeling of heat that rushes to the upper body and face. The skin may redden, like a blush, and you may sweat.

Hot flashes last from a few seconds to several minutes and can happen day or night. They can range from mild to severe and may come a few times a month or several times a day. Even though hot flashes may be uncomfortable and embarrassing, they are not harmful.

Sleep Problems

Hot flashes can disturb sleep. A lack of sleep may affect your mood, health and ability to cope. Some women approaching menopause may find it takes longer to get to sleep.

Vaginal and Urinary Tract Changes

Loss of estrogen may cause the lining of the vagina to become thin and dry. These changes can cause pain during sex. They also can make the vagina more prone to infection, which can cause burning and itching.

The urinary tract also changes with age. The urethra (tube that carries urine from the bladder) can become dry, inflamed or irritated. Some women may need to urinate more often and have an increased risk of bladder infection.

Bone Loss, Stroke and Heart Attack

Bones are constantly changing throughout life. New bone is built in a process called formation. Old bone is removed in a process called resorption. As a person ages, more bone loss occurs than growth, the quality of the bone declines and the structure of the bone weakens. These conditions can lead to a condition known as osteoporosis. The bones of the wrist, hip and spine are affected most often. Osteoporosis can be diagnosed and treated to prevent damage.

The estrogen produced by women's ovaries before menopause protects them from heart attacks and stroke. When less estrogen is produced after menopause, the risk of heart attack and stroke increases.

Emotional Changes

Menopause does not cause depression. However the change in hormone levels may make you feel nervous, irritable or very tired. These feelings may be linked to other symptoms such as lack of sleep.

Many women in midlife are going through major life changes in addition to the physical changes of menopause. You may be experiencing stress at work or with finances. Some women are dealing with an empty nest and others are saddened that they can no longer have children. You may be responsible for children, grandchildren and aging parents. If you are finding it difficult to cope, talk to a close friend, your partner, a counselor or your doctor.


Menopause does not have to affect your ability to enjoy sex. Although lack of estrogen may make the vagina dry, many varieties of vaginal lubricants are available to make sex more comfortable. Regular sex may help the vagina keep its natural elasticity. If you have been having sex on a regular basis you may not notice any major changes during menopause.

Some women find that they have less interest in sex around and after menopause. Lower hormone levels may decrease the sex drive. It may affect your ability to have an orgasm or it may take longer for you to reach orgasm.

You are not completely fee of the risk of pregnancy until one year after your last period. Until this time, if you do not wish to become pregnant, it is important to use a method of birth control. You still need to prevent sexually transmitted diseases, if you are putting yourself at risk.

Health Evaluation

Routine health care can help detect problems early. During a routine exam your doctor will measure your weight and blood pressure. Your breasts will be checked for lumps or discharge and your abdomen checked to see if there are any problems with your ovaries, uterus, vulva and vagina. Your doctor may examine your rectum. Additional tests include a PAP smear (which detects changes in cells that could lead to cancer of the cervix), a mammogram (for the detection of breast cancer) and a colonoscopy (colon cancer screening).

You will also be asked about your health including:

  • Your medical history
  • Your diet
  • Your exercise habits
  • If you smoke, drink or use drugs
  • Medications you are taking

Hormone Therapy

Hormone therapy can help relieve symptoms of menopause by replacing female hormones no longer made by the ovaries.

For women with a uterus, estrogen is usually given along with progestin–a synthetic version of progesterone. This helps reduce the risk of cancer of the lining of the uterus that occurs when estrogen is used alone. Hormone treatment is most often prescribed in the form of pills, vaginal rings, or patches placed on the skin. Estrogen creams and tablets, used in the vagina, can treat dryness, but do not work as well for other symptoms.

Benefits of Hormone Therapy

  • Treats hot flashes
  • Relieves vaginal dryness
  • Relieves changes that can lead to problems in the urinary tract
  • Protects against bone loss
  • Prevents osteoporosis
  • Reduces the risk of colon cancer

Risks of Hormone Therapy

  • Prolonged use of hormones could increase the risk of heart attacks, strokes, blood clots and breast cancer for some women
  • In women with a uterus, estrogen can increase the risk of endometrial cancer and the addition progestin seems to increase the risk of breast cancer
  • Discuss risks and benefits thoroughly with your doctor, since risks vary from woman to woman.

Staying Healthy

Menopause is a natural event. Women can expect to live one third of their lives after menopause. The changes that occur should not prevent you from enjoying your life. To function at your best you should:

  • Exercise regularly to slow down bone loss and improve overall health
  • Eat a balanced diet that contains enough calcium and vitamin D
  • Visit your healthcare provider for routine checkups


dr jeffrey harris