Menopause is a normal, natural event—defined as the final menstrual period and usually confirmed when a woman has not had her period for 12 consecutive months (unless there are other obvious causes). Menopause is associated with reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other hormones. Occurring on average around age 51, it marks the end of a woman’s ability to bear children. Some women experience menopause at an earlier age for a variety of reasons.

Moving from the reproductive years through menopause and beyond, a woman experiences many physical changes caused by both menopause and aging. Some normal changes related to menopause include hot flashes, difficulty sleeping and vaginal dryness. Changes that can occur due to age include diabetes, thyroid disorders, sleep apnea (disordered breathing, high blood pressure, and an increased risk for heart disease and certain cancers). For women who also have an unhealthy lifestyle, high stress or unlucky genes, the changes due to menopause and aging can be particularly challenging.

Each woman experiences menopause differently. How she responds to the physical changes may be similar to or different from how her mother or sisters responded. A woman’s own expectations of this time of life are important, too. The menopause experience varies around the world and within ethnic groups, suggesting that both culture and genetics influence it. A woman may view the end of fertility as freedom from concerns about birth control, or she may regret the end of her childbearing ability. Some women will have troublesome symptoms, while others may have few or no symptoms at all.

Menopause is better understood and more openly discussed than ever before. Many women look back on menopause as a passage to a new part of life in which they feel confident, empowered, involved and energized. Menopause is an ideal time to begin or reinforce healthy changes in your life.

The Three Stages of Menopause
Let’s learn more about what you can expect in the transition through menopause. First, here are some essential terms.

Perimenopause
Physical clues that you are approaching menopause may start years before your final menstrual period. This time is called “perimenopause” (meaning “around menopause”). It is the result of changing levels of ovarian hormones in your body. Estrogen levels decline, but they do so unevenly. Sometimes they can even be higher than when you were younger. Irregular menstrual periods, hot flashes, vaginal dryness, sleep disturbances and mood swings are common, normal signs of perimenopause. At this time, women may still be able to get pregnant, although it does not happen often. Birth control is recommended until one year after the last period if pregnancy is not desired.

Natural Menopause
Natural menopause is a spontaneous, permanent ending of menstruation that is not caused by any medical treatment. In North America, most women experience natural menopause between ages 40 and 58, averaging around age 51. Some women reach natural menopause as early as their 30s and a few as late as their 60s. Today, most North American women spend at least one-third of their lives after menopause. Women often experience menopause around the same age as their mothers and sisters. Smokers may reach menopause about two years earlier than nonsmokers. No clear connection has been found between age at menopause and race, age at first period or use of birth control pills or fertility medications.

Postmenopause
Postmenopause is the time after menopause. Some menopause-related symptoms (such as vaginal dryness and hot flashes) may still occur because your body is only making a small amount of estrogen. In this time, your risk increases for diseases associated with low estrogen levels, including osteoporosis.

How Can I Confirm Menopause?
The most common symptoms women in their 40s notice are changes in periods and the onset of hot flashes. To date, there is no simple test to predict when menopause will occur but research continues.