Puberty isn’t the only hormonal change that your body will undertake. If you are a woman between mid-40s and mid-50s, menopause—also known as the ‘change of life’—is a significant, and natural, part of aging. While you are only ‘officially’ menopausal when you haven’t had a period in 12 months, menopause itself is a process that takes years and can affect your body in a variety of ways.
In this Q &A, Elissa M. Gretz-Friedman, MD, Director of the Menopause Center at Mount Sinai and an Assistant Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, explains the basics of menopause and its symptoms.
What exactly happens during menopause?
Basically, your ovaries exhaust their supply of eggs. Women are born with all the eggs they will have for their lifetime. When this happens the ovaries will stop producing estrogen and progesterone. Estrogen affects almost every system in the body so this is a big change. While most women experience menopause as part of healthy aging, some women may reach it early due to chemotherapy or if their ovaries are surgically removed for various reasons. Some younger women who go into early menopause due to chemotherapy may regain their menses after treatment ends.
It’s important to remember that, generally, menopause is a process, not an “on-off” switch. Before you reach menopause, you’ve probably been in what we call the menopause transition, or perimenopause, for five to ten years.
What should I expect in the years leading up to menopause?
Every woman experiences perimenopause differently. Most go through two phases. In early perimenopause, the level of estrogen in your body may rise and fall unevenly, which could cause a variety of symptoms, the most common being irregular periods. Women may find that the length of time between periods varies from one month to the next. For instance, you could have a 21-day cycle followed by a 35-day cycle. When your estrogen level is higher, you may experience increased bleeding or breast tenderness.
During the last one to three years of this process, called late perimenopause, your period might become lighter. You might have spotting between periods and the time from one period to the next may grow longer. They will be 60 days or even six or nine months apart. Any one of these menses could be the last. You are post menopausal when you have not had a period for one year.
How will my body react to menopause?
Hot flashes are the best known and most common symptom of menopause with about three-quarters of menopausal women experiencing the symptom. These uncomfortable feelings of warmth can last for two to four minutes and are often followed by sweating. Hot flashes can happen at any time during the day or night, and you may have several or many during a 24-hour period. Nighttime hot flashes might awaken you from sleep.
Other possible symptoms include anxiety, heart palpitations, or vaginal dryness, which can cause pain during sexual intercourse. Some women experience cognitive changes, such as difficulty learning new tasks, forgetfulness, and brain fog. You may also find it difficult to sleep.
The cognitive issues usually resolve after menopause. The vaginal symptoms will continue to worsen the longer you get from your last menstrual period.
Once you reach menopause, your doctor will begin to monitor you for osteoporosis, a disease that can leave your bones more brittle and fragile, making them more likely to break from a fall. Menopause is a risk factor for osteoporosis as lowered sex hormones—like estrogen—affect the bone remodeling process. Menopause related-bone loss will accelerate significantly in the two years just before and the two years after your final menstrual period. Bone loss will continue even after that point, but your bone density will not change as quickly.
Will menopause affect my libido? And, can I stop using birth control once I am menopausal?
Many factors can affect your libido, including stress level, sleep, partner issues—and menopause. The vaginal dryness that some women experience due to menopause can lead to painful intercourse which, in turn, can affect your libido. Fortunately, lubricants, vaginal moisturizers, and vaginal estrogen—which is safe to use in most women and can help restore the vaginal tissues—are helpful. Lubricants and vaginal moisturizers are available over the counter, but you will need to talk to your primary care physician or gynecologist for a vaginal estrogen prescription.
Also, while it is rare to become pregnant in your late 40s, it is not unheard of. It is recommended that women continue to use birth control until officially menopausal.