Menopause is that time in a woman’s life when hormonal changes cause the menstrual cycle to stop. For most women, it happens between the ages of 45 and 55. The average age of onset in the United States is 51, according to the Mayo Clinic, which defines menopause as 12 months after your last period. At that point, you’re no longer fertile.

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Hormonal changes may begin years before, during what is known as perimenopause. It starts when your ovaries cut back on production of the female hormones, estrogen and progesterone, and your ovaries release eggs less often.

For most women, menstruation becomes irregular for some time before coming to a gradual stop. It’s rare, but for some women, periods stop suddenly. Even after your period has been absent for a few months, you may still be able to get pregnant. After a year without periods, you’ve entered postmenopause.

Find out nine things women should know about menopause »

A Growing Population

As our population ages, the number of postmenopausal women grows. It is estimated that in 1998, there were over 477 million postmenopausal women in the world. That number is projected to rise to rise to 1.1 billion by the year 2025.

Premature Menopause

Sometimes, menopause can happen earlier than usual. This can happen for a variety of reasons. Women who’ve received treatment for cancer may experience early menopause. That’s because chemotherapy, radiation, and hormone therapies can all interfere with hormone levels.

Another reason for early menopause is surgical removal of the ovaries. Surgical removal of the uterus does not cause menopause if your ovaries are still functioning.

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Another cause of early menopause is primary ovarian insufficiency. That’s when your ovaries simply don’t produce normal levels of female hormones. It can be an inherited condition or caused by autoimmune disease. According to the Mayo Clinic, about one percent of women reach menopause before their 40th birthday.

Smoking can also trigger early menopause. The cause of early menopause is not always clear. If you’re under age 45 and experience signs and symptoms of menopause, consult with your doctor so any problems can be detected and treated.

Quality of Life

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Menopause is a natural life occurrence. For most women, there’s no cause for alarm or medical intervention. A study of menopausal women revealed that 80 percent experienced no change in quality of life. Sixty-two percent felt positively about menopause. Ten percent of women said they were irritable, fatigued, and had feelings of despair during the menopausal phase of their lives.

Menopause and Sexuality

One study showed that 75 percent of women don’t feel less attractive because of menopause. Relieved that pregnancy is no longer an issue, many women find sex more enjoyable.

Some physical changes may have an affect on your sexuality. Lower levels of hormones can interfere with your sex drive. It can also affect the skin in and around your vagina, making it thinner and drier. If these changes are a problem for you, there are a few things you can do:

  • Tell your partner if intercourse is painful. Explain your likes and dislikes — what feels good and what doesn’t.
  • Try over-the-counter vaginal lubricants and moisturizers.
  • Consult with your doctor. A prescription strength medication may be able to treat vaginal dryness.
  • Use it or lose it. When you have sex, it increases blood flow to the vagina.

Symptoms

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Symptoms may begin years before your menstrual cycle is affected and include:

  • irregular menstruation: Periods become unpredictable in timing, length, and volume. You may miss several periods only to start again.
  • hot flashes: Hot flashes are like a sudden wave of heat flowing through your upper chest, neck, and face. Your skin may appear flushed or blotchy. Hot flashes (or hot flushes) can make you perspire, but when it’s over, you may feel a chill.
  • sleep disturbances: Hot flashes during the night (night sweats) can make it hard to stay asleep.
  • vaginal discomfort: Vaginal tissues may thin out and become drier, causing minor discomfort. Sexual intercourse may be uncomfortable.
  • incontinence: Without all that estrogen, your bladder may not be able to hold as much, causing urinary incontinence. You might lose a drop or two when you laugh, sneeze, or cough (stress incontinence).
  • mood changes: The hormonal changes of menopause can make you feel irritable and cause mood swings. You might also have a little trouble concentrating.
  • metabolism changes: As your metabolism changes, you may find yourself losing muscle and gaining a bit of weight.

A study published in Healthcare for Women International looked at ethnic differences in menopause symptoms. Asian women reported fewer physical and psychological symptoms than other ethnic groups. African-American women reported more symptoms than other groups.

Tests and Diagnosis

The symptoms are usually enough to diagnose menopause. If necessary, blood and urine tests can detect hormone level changes. Your gynecologist may be able to diagnose menopause by noting the changes to your vagina.

Complications and Risks

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Reaching menopause means things are changing and the risk of certain health conditions may be higher. There’s no need to worry, but you should be alert for signs and symptoms of:

  • cardiovascular disease: Estrogen provides some protection from heart and blood vessel diseases. Heart disease is the number one killer of women.
  • osteoporosis: Many women begin to lose bone density after menopause, making them more vulnerable to fractured or broken bones.
  • urinary tract infection: After menopause, you’re at greater risk of infection of the bladder or urethra.

It’s worth getting regular checkups and discussing all your symptoms with your doctor.

Treatment

Menopause is a normal stage of life, so it doesn’t require treatment. If your symptoms are interfering with your life, there are some steps you can take to find relief:

  • hot flashes: It’s a good idea to dress in layers, so you can quickly take off a layer, then put it back on when you cool off. Acupuncture and yoga may also help relieve hot flashes.
  • vaginal discomfort: Over-the-counter vaginal lubricants might be able to help. Perform some pelvic floor muscle exercises (Kegels). If the problem continues, prescription medications may be able to help.
  • sleep disturbances: Avoid caffeine and alcohol. Get a little exercise each day. Keep your bedroom at a cool temperature.

If symptoms are severe, medical intervention may be helpful. Treatment options include:

  • hormone therapy: Estrogen therapy may provide some relief from hot flashes. Other benefits of hormone therapy include improved heart health and bone loss prevention. Vaginal estrogen in the form of creams may help ease vaginal dryness.
  • low-dose antidepressants: If hot flashes are a continuing problem, low-dose antidepressants may be able to get them under control. It’s an alternative for women who are unable to take hormones.

To help prevent cardiovascular disease and osteoporosis, along with other potential health problems:

  • Visit your doctor regularly.
  • Monitor your blood pressure and cholesterol levels.
  • Don’t smoke.
  • Maintain a healthy diet.
  • Exercise regularly.

Some symptoms may be a sign that there’s a serious problem. If you experience spotting after a year without periods, have heavy bleeding, or bleeding after intercourse, see your doctor.

Male Menopause?

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Men don’t experience menopause, but they do go through something called “aging male syndrome,” or “andropause.”

Production of the male hormone testosterone ramps up during puberty. According to Harvard Health Publications, by the time a man reaches age 40, testosterone production begins to fall by about 1 percent per year. As they get older, lower levels of testosterone may affect sex drive. If it falls too low, it may cause erectile dysfunction (ED), loss of energy, and decreased muscle mass and bone density. Men don’t lose their ability to have children as they get older.

Costs

A study published in the Journal of Occupational and Environmental Medicine showed there’s a cost to being diagnosed with menopause. Medical expenses, medications, and absences from work can add 40 percent to a woman’s costs. Work productivity also suffers, with diagnosed women producing about 11 to 12 percent less than undiagnosed women.