MENOPAUSE

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Menopause

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Definition

Menopause is the transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether.

Alternative Names

Perimenopause; Postmenopause

Causes, incidence, and risk factors

Menopause is a natural event that normally occurs between the ages of 45 and 55.

Once menopause is complete (called postmenopause) and you have not had a period for 1 year, you can no longer become pregnant.

The symptoms of menopause are caused by changes in estrogen and progesterone levels. As the ovaries become less functional, they produce less of these hormones and the body responds accordingly. The specific symptoms you experience and how significant (mild, moderate, or severe) varies from woman to woman.

A gradual decrease of estrogen generally allows your body to slowly adjust to the hormonal changes. When estrogen drops suddenly, as is seen when the ovaries are removed surgically (called surgical menopause), symptoms can be more severe.

Because hormone levels fall, changes occur in the entire female reproductive system. The vaginal walls become less elastic and thinner. The vagina becomes shorter. Lubricating secretions from the vagina become watery. The outside genital tissue decreases. This is called atrophy of the labia.

Symptoms

In some women, menstrual flow comes to a sudden halt. More commonly, it slowly stops over time. During this time, the menstrual periods generally become either more closely or more widely spaced. This irregularity may last for 1 - 3 years before menstruation finally ends completely.

Common symptoms of menopause include:

• Heart pounding or racing
• Hot flashes
• Night sweats
• Skin flushing
• Sleeping problems (insomnia)

Other symptoms of menopause may include:

• Decreased interest in sex, possibly decreased response to sexual stimulation
• Forgetfulness (in some women)
• Irregular menstrual periods
• Mood swings including irritability, depression, and anxiety
• Spotting of blood in between periods
• Urine leakage
• Vaginal dryness and painful sexual intercourse
• Vaginal infections

Signs and tests

Blood and urine tests can be used to measure changes in hormone levels that may signal when a woman is close to menopause or has already gone through menopause. Examples of these tests include:

• Estradiol
• FSH
• LH

A pelvic exam may indicate changes in the vaginal lining caused by declining estrogen levels. The doctor may perform a bone density test to screen for low bone density levels that occur with osteoporosis.

Reviewer Info: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington ; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. , 12/31/2008