When a woman’s reproductive system shuts down, she enters menopause, usually because of normal aging, and it sometimes occurs after a hysterectomy.
You’re officially in menopause when you have gone 12 months in a row without any bleeding, including spotting.
This can happen as early as age 45 or as late as 58; the age of 52 is average. You’ll often enter menopause around the age your mother did. Menopause comes up to two years earlier for women who smoke and arrives sooner if you don’t have children. More than one pregnancy may push menopause later.
Most women see changes for about four years leading up to that point. During the transition, called perimenopause, you may have longer or shorter periods or skip some months. You might have heavy or light bleeding some months and skip some months entirely. The number of days you bleed may change. You might have hot flashes or trouble sleeping. You may find that you’re moodier. Some women get chills, night sweats, thinning hair, and dryer skin. You might find you put on weight more easily.
You can still become pregnant during perimenopause. Once you’re in menopause, you can’t. At this point, any vaginal bleeding is a reason to see a doctor. Many women find it a relief that they don’t have to worry about pregnancy. However, condoms are still recommended if your partner may be carrying an infection. A menopausal woman is at greater risk of sexually transmitted infections because the vagina walls may become drier and thinner and may tear during sex, allowing an infection to enter.
In menopause, you are no longer ovulating, and your ovaries will only produce small amounts of estrogen and progesterone. Women often experience fewer symptoms than they did in perimenopause but not necessarily. In one large study, significant numbers of women had hot flashes even 13 years after menopause. You may have less interest in sex, or you may feel dry and sex may become uncomfortable or even painful. Low estrogren can cause bones to become less dense and prone to break. Low estrogen can also lead to higher cholesterol levels, which makes your diet and exercise patterns even more important in order to avoid heart disease and stroke. Some women find that they get sudden strong urges to urinate and may have accidents. Other women get urinary tract infections or lose urine when they cough or laugh. You can strengthen the pelvic floor muscles with special exercises and use a topical cream.
Besides aging, women can go into menopause because of an illness. A total hysterectomy that removes your ovaries along with your uterus will put you into menopause immediately, and you’re likely to have immediate, sometimes severe, symptoms. In some hysterectomies you keep your ovaries, which still release eggs and make estrogen and progesterone. Women have hysterectomies because of uterine cancer, endometriosis, fibroids, or pelvic inflamatory disease if they are severe, and other reasons.
Chemotherapy and radiation therapy for cancer can bring on menopause, though not necessarily permanently.
About 1 percent of women experience menopause before the age of 40 because their ovaries do not make the normal amount of hormones. They may have an autoimmune disease, or a genetic factor, though in many cases the reason isn’t clear.
May 24, 2021
Janet O’Dell, RN