Most women first begin developing menopause symptoms about four years before their last period. Symptoms often continue until about four years after a woman’s last period.
A small number of women experience menopause symptoms for up to a decade before menopause actually occurs, and 1 in 10 women experience menopausal symptoms for 12 years following their last period.
The median age for menopause is 51, though it may occur on average up to two years earlier for Black and Latina women. More studies are needed to understand the onset of menopause for women of color.
There are many factors that help determine when you’ll begin menopause, including genetics and ovary health. Perimenopause occurs before menopause. Perimenopause is a time when your hormones begin to change in preparation for menopause.
It can last anywhere from a few months to several years. Many women begin perimenopause some point after their mid-40s. Other women skip perimenopause and enter menopause suddenly.
About 1 percent of women begin menopause before the age of 40, which is called premature menopause or primary ovarian insufficiency. About 5 percent of women undergo menopause between the ages of 40 and 45. This is referred to as early menopause.
Perimenopause vs. menopause vs. postmenopause
During perimenopause, menstrual periods become irregular. Your periods may be late, or you may completely skip one or more periods. Menstrual flow may also become heavier or lighter.
Menopause is defined as a lack of menstruation for one full year.
Postmenopause refers to the years after menopause has occurred.
What are the symptoms of menopause?
Every woman’s menopause experience is unique. Symptoms are usually more severe when menopause occurs suddenly or over a shorter period of time.
Conditions that impact the health of the ovary, like cancer or hysterectomy, or certain lifestyle choices, like smoking, tend to increase the severity and duration of symptoms.
Aside from menstruation changes, the symptoms of perimenopause, menopause, and postmenopause are generally the same. The most common early signs of perimenopause are:
- less frequent menstruation
- heavier or lighter periods than you normally experience
- vasomotor symptoms, including hot flashes, night sweats, and flushing
An estimated 75 percent of women experience hot flashes with menopause.
Other common symptoms of menopause include:
- vaginal dryness
- weight gain
- difficulty concentrating
- memory problems
- reduced libido, or sex drive
- dry skin, mouth, and eyes
- increased urination
- sore or tender breasts
- racing heart
- urinary tract infections (UTIs)
- reduced muscle mass
- painful or stiff joints
- reduced bone mass
- less full breasts
- hair thinning or loss
- increased hair growth on other areas of the body, such as the face, neck, chest, and upper back
Common complications of menopause include:
- vulvovaginal atrophy
- dyspareunia, or painful intercourse
- slower metabolic function
- osteoporosis, or weaker bones with reduced mass and strength
- mood or sudden emotional changes
- periodontal disease
- urinary incontinence
- heart or blood vessel disease
Why does menopause occur?
Menopause is a natural process that occurs as the ovaries age and produce less reproductive hormones.
The body begins to undergo several changes in response to lower levels of:
- follicle-stimulating hormone (FSH)
- luteinizing hormone (LH)
One of the most notable changes is the loss of active ovarian follicles. Ovarian follicles are the structures that produce and release eggs from the ovary wall, allowing menstruation and fertility.
Most women first notice the frequency of their period becoming less consistent, as the flow becomes heavier and longer. This usually occurs at some point in the mid-to-late 40s. By the age of 52, most U.S. women have undergone menopause.
In some cases, menopause is induced, or caused by injury or surgical removal of the ovaries and related pelvic structures.
Common causes of induced menopause include:
- bilateral oophorectomy, or surgical removal of the ovaries
- ovarian ablation, or the shutdown of ovary function, which may be done by hormone therapy, surgery, or radiotherapy techniques in women with estrogen receptor-positive tumors
- pelvic radiation
- pelvic injuries that severely damage or destroy the ovaries
How is menopause diagnosed?
It’s worth talking with your healthcare provider if you’re experiencing troublesome or disabling menopause symptoms, or you’re experiencing menopause symptoms and are 45 years of age or younger.
A new blood test known as the PicoAMH Elisa diagnostic test was recently approved by the Food and Drug AdministrationTrusted Source. This test is used to help determine whether a woman has entered menopause or is getting close to entering menopause.
This new test may be helpful to women who show symptoms of perimenopause, which can also have adverse health impacts. Early menopause is associated with a higher risk of osteoporosis and fracture, heart disease, cognitive changes, vaginal changes and loss of libido, and mood changes.
Your doctor can also order a blood test that will measure the level of certain hormones in the blood, usually FSH and a form of estrogen called estradiol.
Consistently elevated FSH blood levels of 30 mIU/mL or higher, combined with a lack of menstruation for one consecutive year, is usually confirmation of menopause. Saliva tests and over-the-counter (OTC) urine tests are also available, but they’re unreliable and expensive.
During perimenopause, FSH and estrogen levels fluctuate daily, so most healthcare providers will diagnose this condition based on symptoms, medical history, and menstrual information.
Depending on your symptoms and health history, your healthcare provider may also order additional blood tests to help rule out other underlying conditions that may be responsible for your symptoms.
Additional blood tests commonly used to help confirm menopause include:
- thyroid function tests
- blood lipid profile
- liver function tests
- kidney function tests
- testosterone, progesterone, prolactin, estradiol, and chorionic gonadotropin (hCG) tests
You may need treatment if your symptoms are severe or affecting your quality of life. Hormone therapy may be an effective treatment in women under the age of 60, or within 10 years of menopause onset, for the reduction or management of:
- hot flashes
- night sweats
- vaginal atrophy
Other medications may be used to treat more specific menopause symptoms, like hair loss and vaginal dryness.
Additional medications sometimes used for menopause symptoms include:
- topical minoxidil 5 percent, used once daily for hair thinning and loss
- antidandruff shampoos, commonly ketoconazole 2 percent and zinc pyrithione 1 percent, used for hair loss
- eflornithine hydrochloride topical cream for unwanted hair growth
- selective serotonin reuptake inhibitors (SSRIs), commonly paroxetine 7.5 milligrams for hot flashes, anxiety, and depression
- nonhormonal vaginal moisturizers and lubricants
- low-dose estrogen-based vaginal lubricants in the form of a cream, ring, or tablet
- ospemifene for vaginal dryness and painful intercourse
- prophylactic antibiotics for recurrent UTIs
- sleep medications for insomnia
- denosumab, teriparatide, raloxifene, or calcitonin for postmenstrual osteoporosis
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