There can be several reasons for not having a menstrual period including pregnancy, failure to ovulate, and ovarian failure. Menopause means the permanent end to menstrual periods due to ovarian failure, and occurs when the ovaries stop producing estrogen and progesterone.  Menopause is a natural aging process that normally occurs when a woman is between 48 and 52 years of age.  Menopause can also be due to the surgical removal of both ovaries. Menopause is an unavoidable, normal process that affects everyone differently.  It can be a challenging time in a women’s life due to the physical and emotional changes that accompany the lack of hormone production by the ovaries.

Although menopause means the end to having menstrual periods, cycles leading up to the last menstrual period may be very irregular.  Missing several menstrual periods in a row, only to have them resume, is not unusual.  As you near menopause, it is impossible to predict if any given bleeding episode is “the last” menstrual period.  A blood test (FSH level) to determine if the ovaries have stopped producing hormone is available, but usually unnecessary.

Some women have no symptoms other than missing menstrual periods; other women may experience severe symptoms.  There are basically three symptoms due to the loss of hormone production.

  1. “Hot Flashes”
  2. Vaginal Dryness
  3. Loss of Bone Density

The most common symptom of menopause is hot flashes.  This is an overwhelming “hot” sensation in the upper body and face.  They can last from a few seconds to several minutes and can cause redness and sweating.  These hot flashes tend to interfere with normal sleep patterns, specifically REM sleep.  Menopause does not cause depression, but interference in sleep patterns may cause one to feel tired, irritable, and unable to concentrate.  Hot flashes tend to get better with time, although several years of severe symptoms are not unusual.  Hormone replacement therapy can ease the discomfort of hot flashes, but comes with some risks.  Over-the-counter medication is available.  These medications have no known risks, but benefits are controversial and limited.   “Bioidentical hormones” are compounded by pharmacists and are not FDA approved for the treatment of menopause symptoms.  The FDA has no evidence that “bioidentical hormones” are safer or more effective.

The lack of estrogen in menopause can cause vaginal dryness due to decreased lubrication and thinning of the lining cells.  Unlike hot flashes, vaginal dryness tends to get worse over time instead of better.  Hormone replacement therapy can be used to treat the symptoms of vaginal dryness, or risk-free vaginal lubricants can be tried.

Bone loss increases after menopause and can lead to osteoporosis, a condition that increases the tendency to fracture bones in the wrist, hip and spine.  Hormone replacement therapy can help prevent the loss of bone density.   As an alternative to hormones, there are numerous prescription medications that contain no hormone and are FDA approved for the prevention of osteoporosis.