Menopause – Symptoms and Causes

Overview

Menopause marks the permanent end of menstruation. Healthcare providers confirm this diagnosis after a person has gone 12 months without any periods or vaginal bleeding.

Most women experience menopause between their 40s and 50s, with 51 being the average age in the United States.

This natural biological transition can bring both physical and emotional changes.

Many women experience:

• Hot flashes
• Sleep disturbances
• Energy fluctuations
• Mood changes

The good news is that these symptoms can be managed through various approaches.

Treatment options range from simple lifestyle adjustments to hormone therapy, depending on symptom severity and individual health needs.

Signs and Changes

Menopause typically happens gradually over time. The period leading up to menopause is called perimenopause or the menopausal transition.

This phase can last between 2 to 8 years, with 4 years being the average duration. During this time, hormone levels fluctuate, causing various physical and emotional changes.

Common symptoms during perimenopause include:

• Irregular menstrual cycles
• Hot flashes (sudden feelings of warmth)
• Night sweats
• Sleep disturbances
• Mood shifts
• Vaginal dryness
• Memory issues and difficulty finding words (“brain fog”)

These symptoms vary from person to person. Menstrual periods often become irregular before stopping completely.

You might skip a month and then have normal periods for several months. Early in perimenopause, cycles may shorten (periods come closer together), while later they typically lengthen (periods become more spaced out).

It’s important to note that pregnancy is still possible during perimenopause. If you miss a period and aren’t sure if it’s related to menopause, consider taking a pregnancy test.

When to Get Medical Help

Continue regular checkups with your healthcare provider before, during, and after menopause. These visits help monitor your health and address any concerns.

Seek medical attention right away if you experience vaginal bleeding after your periods have completely stopped, as this requires prompt evaluation.

What Causes Menopause

Menopause occurs through several natural and medical pathways. Understanding these causes helps explain why this transition happens at different times for different people.

Natural Hormone Decline

The most common cause of menopause is the natural aging process. Around the late 30s, the ovaries begin producing less estrogen and progesterone—hormones that regulate the menstrual cycle. This gradual decline affects fertility and menstruation patterns.

During the 40s, periods often become irregular—they may be longer, shorter, heavier, lighter, more frequent, or less frequent. Eventually, the ovaries stop releasing eggs completely, ending menstruation. This natural process typically occurs around age 51.

Surgical Causes

Oophorectomy (surgical removal of ovaries) triggers immediate menopause. Since ovaries produce the hormones controlling menstruation, their removal causes hormone levels to drop suddenly rather than gradually. This results in:

• Immediate end of periods
• Often severe menopausal symptoms
• Abrupt hormonal changes

A hysterectomy (removal of the uterus only) doesn’t usually cause immediate menopause if the ovaries remain intact. While periods stop, the ovaries continue producing hormones for some time.

Medical Treatments

Cancer treatments can trigger menopause:

• Chemotherapy may cause temporary or permanent menopause
• Radiation therapy to the pelvic area, abdomen, or lower spine can affect ovarian function
• Whole-body radiation for stem cell transplants may impact hormone production

With chemotherapy, periods sometimes return after treatment ends, meaning fertility may be restored. Radiation directed at other body parts typically doesn’t affect menopause timing.

Primary Ovarian Insufficiency

About 1% of people experience menopause before age 40, known as premature menopause. This often results from primary ovarian insufficiency—when ovaries don’t produce normal hormone levels. Possible causes include:

• Genetic factors
• Autoimmune conditions
• Unknown causes (most common)

Risk Factors

The main risk factor for menopause is age, as it naturally occurs in people assigned female at birth. Most individuals experience menopause between ages 45-55.

Some factors can trigger early menopause:

• Surgical procedures that remove the ovaries
• Cancer treatments such as chemotherapy or radiation therapy to the pelvic area

These medical interventions can affect hormone production and may cause menopause symptoms to begin suddenly rather than gradually.

Health Complications

Menopause brings several health challenges that women should be aware of. These include:

Cardiovascular Issues

After menopause, the drop in estrogen levels increases the risk of heart and blood vessel disease. This is particularly concerning as cardiovascular disease remains the number one cause of death for both women and men.

Bone Health Problems

Women face a higher risk of osteoporosis (weakened bones) after menopause.

Bone density can decrease rapidly during the first few years, making bones more brittle and prone to fractures. The most common break sites include:

• Spine
• Hips
• Wrists

Urinary Changes

The tissues of the vagina and urethra undergo changes that can lead to:

• Urge incontinence (sudden, strong need to urinate with possible leakage)
• Stress incontinence (leaking when coughing, laughing or lifting)
• More frequent urinary tract infections

Sexual Health Concerns

Vaginal dryness and reduced elasticity can cause discomfort and slight bleeding during sex. Many women also experience decreased sensitivity and lower libido.

Weight Management

Weight gain is common during and after menopause.

This happens because metabolism (how quickly the body burns calories) naturally slows down with age.

These complications vary from person to person, and many effective treatments and management strategies exist to address them.