The Menopause Years

THE MENOPAUSE YEARS 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, or "around menopause." Menopause marks the end of the reproductive years that began in puberty. The average age that women go through menopause is 51 years. Most women enjoy a healthy lifestyle for years afterward.


What Is Menopause?

Estrogen and Menstrual Changes

As menopause nears, the ovaries make less estrogen.  One of the earliest and most common signs that menopause may be approaching is a change in your menstrual periods.  You may skip one or more periods.  The amount of flow may become lighter or heavier.  At some point, the ovaries stop making enough estrogen to thicken the lining of the uterus.  This is when the menstrual periods stop.

What to Expect

Menopause is a natural part of aging.  The lower amounts of estrogen that come with menopause will cause changes in your body.

Hot Flashes

The most common symptom of menopause is hot flushes (hot flashes).  As many as 75 percent of menopausal women in the United States will have them.  A hot flush is a sudden feeling of heat that rushes to the upper body and face.  The skin may redden like a blush.  You also may break out in a sweat.

Sleep Problems

Hot flushes can cause a lack of sleep, often waking a woman from a deep sleep.  A lack of sleep may be one of the biggest problems you face as you approach menopause.

Vaginal and Urinary Tract Changes

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

Bone and Other Body Changes

Bone loss is a normal part of aging.  At menopause, the rate of bone loss increases.  Osteoporosis, a result of this bone loss, increases the risk of breaking bones in older women.  The bones of the hip, wrist and spine are affected most often.

Emotional Changes

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


Menopause does not have to affect your ability to enjoy sex.  Although the lack of estrogen may make the vagina dry, vaginal lubricants can help moisten the vagina and make sex more comfortable.  Regular sex may help the vagina keep its natural elasticity.  Some women find that they have less interest in sex around and after menopause.  Lower hormone levels may decrease the sex drive.  You are not completely free of the risk of pregnancy until one year after your last period

The Gynecologic Visit

Routine visits to your doctor for breast, pelvic, and rectal exams are recommended for all women.  Your doctor will do a Pap test to check for cancer of the cervix.  Between visits you should perform a breast self-exam once a month.  Depending on your age, your doctor may recommend that you have a mammogram.  (Women older than 40 years should have a mammogram every one to two years, and then every year beginning at age 50 years.)

Hormone Therapy

Hormone therapy (HT) can help relieve the symptoms of menopause.  It replaces female hormones no longer made by the ovaries.  Depending on your situation, you may begin HT before menopause.  If you are taking birth control pills, they will be stopped when you begin treatment.


Many of the symptoms of menopause can be eased by taking estrogen.


Like any treatment, hormone therapy is not free of risk.  In women with a uterus, using estrogen alone can increase the risk of endometrial cancer because estrogen causes the lining of the uterus to grow.  Taking a progestin will help reduce the risk of uterine problems.  The drawback of using a progestin is that menopausal women may start bleeding again.  There is an increased risk of breast cancer in women who use combined hormone therapy.

Other Therapies

Women also can take selective estrogen receptor modulators (SERMs) to help prevent some of the bone problems that can occur during menopause.  SERMs are a type of medication that strengthen tissues of the bones.  If a woman does not take hormone therapy or SERMs, there are some other options for preventing bone loss.  A medication called calcitonin slows the breaking down of bone.  Other medications used to slow bone breakdown are bisphosphonates.

Staying Healthy

Good Nutrition

Eating a balanced diet will help you stay healthy before, during, and after menopause.  It's important to eat a variety of foods to make sure you get all the essential nutrients.  Choose a low-fat, low-cholesterol diet.  Also, be sure to include enough calcium in your diet to help maintain strong bones.


Exercise is very important, especially as you get older.  Regular exercise slows down bone loss and improves your overall health.  Follow a program of regular weight-bearing exercise, such as walking and aerobics.


Menopause is a natural event.  Today, women can expect to live one third of their lives after menopause.  The physical changes that occur around menopause should not prevent you from enjoying this time of your life.  This excerpt from ACOG's Patient Education Pamphlet is provided for your information.  It is not medical advice and should not be relied upon as a substitute for visiting your doctor.  If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.  To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.  Copyright © March 2003 The American College of Obstetricians and Gynecologists.