Overview of menopause

Menopause is a normal stage in a woman’s life when her menstrual period stops. Natural menopause usually starts with a period of transition called perimenopause. The physical changes associated with menopause begin during perimenopause, a phase which can last up to eight years.

Some women experience menopause due to medical treatment or surgery. This induced menopause can be more intense but has many of the same symptoms as natural menopause.

Once a woman has gone one year without having periods, she has gone through menopause and is considered postmenopausal. The average age for this is 51.

Our experienced gynecologists at Dignity Health provide personal care and relief for menopause symptoms. Find a Doctor near you today.


Menopausal symptoms can start in perimenopause and continue after menopause.

Menopause involves changes in multiple hormones, including estrogen and progesterone.

Because these hormones are involved in many processes throughout your body, the signs and symptoms of menopause vary widely from person to person. They may include:

  • Hot flashes
  • Having an irregular period or skipping one or more periods
  • Mood swings
  • Anxiety
  • Night sweats
  • Chills
  • Sleep problems
  • Thinning hair
  • Fatigue
  • Dry skin
  • Vaginal dryness and painful sex
  • Decreased sexual desire or response
  • Osteoporosis (thinning bones)


A woman’s two main sex hormones are estrogen and progesterone. Levels of these hormones rise and fall each month, triggering ovulation and menstruation.

As a woman ages, the monthly rise and fall of hormones become less regular and predictable. Eventually, hormones settle at low levels, and fertility drops. Ovulation and menstruation stop, and menopause occurs.


While menopause is a natural process, some types of menopause may warrant medical attention. For example:

  • Premature menopause is menopause that starts in women who are younger than 40 years old. If you are younger than 40 and miss more than three periods or have other symptoms of menopause, you should see a doctor to rule out other conditions. For example, Turner syndrome, some autoimmune diseases, and thyroid issues can all lead to premature menopause.
  • Early menopause is menopause beginning between the ages of 40 and 45. As with premature menopause, if you believe you are entering menopause and are under the age of 45, consult with your doctor. If menopause does start before the age of 45, it can also increase your risk for heart disease and osteoporosis.
  • Induced menopause is menopause brought about by an underlying condition or a medical intervention. For example, some cancer therapies such as chemotherapy and radiation can cause menopause, as can hormonal therapies and surgeries to remove the uterus or ovaries.
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Symptoms of menopause

Symptoms of menopause can start in perimenopause and continue postmenopause. The symptoms of menopause are related to changing hormone levels, so symptoms can vary widely.

You may have:

  • Anxiety, fatigue, and difficulty thinking: Some women feel more anxious, tired, or forgetful. Experts do not yet know if these symptoms are related to declining hormone levels.
  • Loss of bladder control: Urinary incontinence — leaking when coughing or sneezing or experiencing a sudden, nearly uncontrollable urge to urinate — is more common after menopause. The walls of the urethra (the tube that carries urine from the bladder to the outside of the body) become thin when estrogen levels drop.
  • Osteoporosis: Estrogen promotes bone health and protects against osteoporosis (thinning bones). In the first four to eight years after menopause, women lose bone tissue rapidly.
  • Hot flashes: A sudden, unexpected feeling of warmth is a hot flash. Hot flashes typically begin during perimenopause and go away after menopause.
  • Night sweats: Some women in perimenopause wake up drenched in sweat. Night sweats may be caused by hot flashes in the middle of the night.
  • Sleep problems: Difficulty falling asleep and staying asleep may be a symptom of menopause. Night sweats can also interfere with sleep.
  • Mood swings: Changing hormone levels cause the mood swings of women in perimenopause.
  • Decreased sexual desire: Estrogen and progesterone levels have been linked to sex drive. Some women are less interested in sex after menopause. Others remain very sexually interested.
  • Vaginal dryness: As estrogen levels decline, so does vaginal lubrication.
  • Painful sex: Vaginal dryness combined with thinning vaginal walls (another effect of menopause) can make sex uncomfortable.
  • Decreased sexual response: It may take you longer to become aroused or to achieve orgasm.

If you experience troublesome symptoms, talk with your doctor. Treatment can ease many uncomfortable symptoms.

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