The Menstrual Cycle

There are a lot of myths about menopause, the time in a woman' s life when she stops menstruating. It is a normal stage of life, as natural as pregnancy or menstruation. The average age at the last menstrual period is 51. Today, there are over 30 million women in the United States who are postmenopausal. Many of these women can enjoy a healthy life style for years to come. This section describes the physical changes that may occur during menopause and how you can help stay healthy during this time.

Menopause and the Menstrual Cycle

During childbearing years, one of the ovaries releases an egg each month. This is called ovulation. The ovaries produce hormones each month that prepare the uterus to nourish this egg if it is fertilized. Estrogen is produced in the ovaries during the entire menstrual cycle. It prompts the lining of the uterus, the endometrium, to grow a thick layer of tissue each month.

Progesterone is produced in the ovaries during the second half of the menstrual cycle. It further thickens the lining of the uterus. If the egg is not fertilized, it moves from the fallopian tube to the uterus and is absorbed. The levels of both of these hormones then drop. This signals the uterus to shed its lining. This shedding is your monthly period.

Estrogen and Menstrual Changes

As menopause nears, the ovaries produce less estrogen. A year or two before menopause, you may notice changes in your menstrual cycle. They may be caused by low estrogen levels. One of the earliest signs of approaching menopause is irregular periods. You may skip one or two periods. Your menstrual flow may change. It may become lighter or heavier. Bleeding may last a shorter or longer time than is usual for you. Abnormal bleeding can sometimes be a sign of a problem in the uterus or its lining. Even though periods tend to be irregular around the time of menopause, it is important to be aware of bleeding that is not normal for you. Call your doctor if you:

Early menopause sometimes occurs in women less than 40 years of age whose ovaries stop functioning or are removed by surgery. With surgery, there is a sudden loss of estrogen. This sudden loss may trigger severe symptoms. Women who have early menopause may need to take hormones to replace those made by the ovaries.

While the removal of the uterus alone (hysterectomy) ends periods, it will not cause early menopause.

If any part of one or both ovaries remains after surgery, most women will go through menopause around the normal age.

Body Changes During Menopause

Menopause is a natural part of aging. Its changes occur slowly, over time. For some women, the decrease in estrogen causes symptoms, many of which can be treated. Long and short-term treatments are available.

A woman is not completely without estrogen, even after menopause. It continues to be made by glands and body fat. In fact, women who are overweight sometimes don't have symptoms of menopause because their extra body fat allows them to make estrogen after the ovaries stop functioning.

Hot Flashes

Hot flashes, also called hot flushes, are the most frequent symptoms of menopause. A hot flash is a sudden feeling of heat that spreads over part or all of the upper body. The skin may blush red or break out in a sweat.

Flashes can come on at any time, day or night, but they don't last long. At night, they may disrupt sleep. Some women will have hot flashes for a few months, some for a few years, and some not at all.

Changes in the Vaginal Area

The loss of estrogen in menopause may cause changes in the vagina. Its lining may become thinner and less flexible. The vagina is drier, which can cause pain during sex. Some women have vaginal burning and itching. Others feel discomfort in the clitoris, part of the female genitals involved in sexual stimulation. The urethra - the tube that carries urine from the bladder - can become inflamed or irritated (look Uricalm). Some women may need to urinate more often. Painful urination, however, may be a sign of urinary tract infection.

Bone Changes and Other Body Changes

Bone loss is a normal part of aging. At menopause, the rate of bone loss increases. Such bone thinning, called osteoporosis, increases the risk of broken bones in older women. This is a major health problem. The hip, wrist, and spinal bones are most often affected. The most serious impact of hip fractures is the marked increase in death rates that can occur. Up to one in five patients dies within 6 months of hip fracture from problems caused by lack of activity, such as blood clots, stroke, heart attack, and pneumonia.

The estrogen that women produce before menopause gives them a natural protection from heart attacks. When less estrogen is made at menopause, women lose much of this protection. The risk of heart attack and stroke goes up after menopause.

Other changes are related to a decrease in hormones, but are hard to separate from the normal aging process. Skin becomes wrinkled. Hair thins and its texture changes. Some pubic hair is lost, and some facial hair may be gained. The breasts lose some of their fullness, and the nipples become less erect. There is less body fat in some places and more in others - Metaboltonics.

Emotional Changes

Some women go through menopause without any emotional changes. Some even feel a sense of freedom from unwanted pregnancy and monthly periods. Others may find themselves nervous, irritable, very tired, or mildly depressed. These feelings may be linked to changes in hormones; to other symptoms of menopause, such as lack of sleep from hot flashes; or to other factors, such as stress. If you find it hard to cope, don't deny your feelings. Talk them over with your partner, a close friend, a relative, or your doctor. Some women may want to seek professional counseling.


Sexual relations often become more enjoyable at this stage of life. An older woman and her partner may be more experienced sexually and know how to please each other. Also, couples who have more privacy and time for each other often have a deeper, more satisfying relationship.

Menopause need not affect a woman's ability to enjoy sex. Although the hormonal changes that cause vaginal dryness can make intercourse uncomfortable, this can be treated with estrogen creams or lubricating jellies. Regular intercourse helps the vagina keep its natural elasticity and lubrication. Longer foreplay will stimulate lubrication. If you have not been sexually active for a while, you may want to talk with your doctor about ways to make sex more comfortable.


Despite the signs of menopause, you still may be able to get pregnant. In fact, you are not completely free of this chance until a year after your last menstrual flow.

Birth control choices just before and during menopause include sterilization for women or men or barrier methods--such as a diaphragm for you, a condom for your partner, or both. Oral contraceptives (birth control pills) sometimes may be appropriate for healthy, non-smoking women over 40. Contraceptive implants or an intrauterine device (IUD) are good choices for some women. Not having sex at certain times in the menstrual cycle is a natural family planning method used by some women. It is not reliable during menopause, however, when cycles are irregular.

The Gynecologic Exam

Routine visits to your doctor for breast, pelvic, and rectal exams is recommended for all women, including menopausal and postmenopausal women (see box).

Your doctor will do a Pap test to screen for cancer of the cervix. A sample of cells is taken from your cervix (mouth of the uterus) and studied under a microscope.

A yearly mammogram, or breast X-ray, is recommended for women over age 50. You will also be asked about your general health and medical history. Based on this thorough exam, your doctor will know what, if any, treatment would be suitable and safe for you. If however, you have problems at any time, contact your doctor. Don't wait until your next checkup.

Hormone Replacement Therapy

After your exam, your doctor may recommend hormone replacement therapy, in which hormones are given to replace those your body made. The main goals of hormone replacement therapy are relieving symptoms, preventing osteoporosis, and protecting against heart disease, a major cause of death of women aged 55 and older. Hormone treatment works better to prevent osteoporosis if it is started at menopause (or when the ovaries are removed). Estrogen started at any time after menopause, though, can be effective. In addition, studies suggest that giving estrogen may help protect postmenopausal women from heart disease.

Most of the symptoms of menopause can be eased by taking estrogen. Estrogen usually will not get rid of the symptoms, but it can make them less frequent and intense. It is used to treat hot flashes. It also relieves itching and burning and reduces vaginal dryness. Estrogen can also relieve some emotional problems that stem from the loss of the natural hormone. It will not, however, solve problems that are a part of the natural aging process.

Along with estrogen, your doctor will often prescribe another hormone called progestin to reduce some risks of taking estrogen. Progestin is similar to the progesterone your body makes before menopause. When progestin is used, you may have vaginal bleeding once a month. This may bother some women. Ask your doctor what to expect, and contact him or her if unexpected bleeding occurs.

Women who choose not to take progestin should be monitored carefully for changes in the endometrium.

Your doctor may perform an endometrial biopsy, in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Whatever the recommended treatment, your doctor will explain how many days each month you should use it. Hormone treatment is most often prescribed in the form of pills. Sometimes, estrogen is given through a patch placed on the skin. Estrogen creams are made for use in the vagina. They can treat vaginal dryness, but are less effective for other symptoms. New ways to give hormones are being studied. They include vaginal suppositories, injections, and implants.

Risks from Hormone Use

There are both risks and benefits to hormone use.

Estrogen taken alone has been linked to cancer of the endometrium. However, this risk may be decreased by giving progestin with estrogen, as well as by reducing the dose of estrogen given. On the other hand, there is some question about the role of progestin in heart disease. While estrogens help reduce the risk, it is not known whether progestins may block some of the effect of the estrogen. Discuss these issues, as well as questions about dosage and hormone combinations, with your doctor.

Most studies suggest no link between hormone replacement therapy and breast cancer. Some studies, though, indicate that a woman's chances of developing breast cancer increase a small amount if she has been on hormones for more than 15 years. Like other women their age, women taking replacement hormones should have regular breast exams and mammograms.

Side Effects of Hormones

Although many women who take hormones don't notice any side effects, they do occur in some women. Side effects can include any or all of the following problems:

Although most women benefit from taking estrogens, not every woman can take them. If you have had breast cancer, endometrial cancer, or liver disease, estrogen usually is not recommended unless your symptoms are so severe that you feel the benefit from taking it is greater than the risk. If you have a blood clotting disorder, have abnormal vaginal bleeding, or think you might be pregnant, tell your doctor. Ask about other ways to treat the symptoms of menopause.

Diet and Exercise

A balanced diet and regular exercise will help you to stay fit and healthy before, during, and after menopause -

Be sure to include enough calcium in your diet. Most doctors recommend a total of 1,500 mg/day. If you cannot get enough calcium from eating dairy products and certain vegetables, you may want to use calcium supplements. Spending a little time in the sun helps, too.

It provides vitamin D, which is needed to absorb calcium. Use of alcohol and tobacco can decrease calcium absorption.

Follow a program of regular weight bearing exercise such as walking, aerobic dancing, or tennis. Weight bearing exercise slows down bone loss, keeps your weight down, controls your appetite, and improves your overall health.


The life expectancy of women has increased. Many good years lie ahead after menopause. The physical changes that occur during menopause should not prevent you from enjoying this time of your life. To function at your best, you should: