Menopause is a normal, natural event—defined as the final menstrual period and usually confirmed when a woman has missed her periods for 12 consecutive months (in the absence of other obvious causes). Menopause is associated with reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other hormones.
It marks the permanent end of fertility. Menopause occurs, on average, at age 51. The years between puberty (when periods start) and menopause are called premenopause.
Physical signs of menopause begin many years before the final menstrual period. This menopause transition phase is called perimenopause (literally meaning “around menopause”). It can last 6 years or more, and by definition, ends 1 year after the final menstrual period.
Perimenopausal changes are brought on by changing levels of ovarian hormones such as estrogen. During this transition time, estrogen levels gradually decline, but they do so in an erratic fashion. Sometimes they can even be higher than during the reproductive years.
Irregular menstrual periods, hot flashes, sleep disturbances, and mood swings are common, normal signs of perimenopause. Some women experience low libido (sex drive) and/or vaginal dryness. During perimenopause, a woman may be able to conceive, although fertility is very low. If pregnancy is not desired, contraception is necessary until menopause is reached.
When a woman suspects she is experiencing menopause, it is an excellent time to have a complete medical examination by a qualified health professional. The diagnosis of perimenopause can usually be made by reviewing a woman’s medical history, her menstrual history, and her signs and symptoms. Find out if there is a Menopause Practitioner near you.
In most cases, testing hormonal blood levels is not recommended because in menstruating women hormone levels are changing all the time. However, in younger women (below 40) menstrual irregularity is infrequently a sign of menopause, so hormone testing may be a useful tool to test whether menopause has occurred.
Testing blood hormone levels can also be helpful in assessing a woman’s fertility and potential for pregnancy. Results can help women make decisions about beginning or adjusting medications and help them understand their personal biological clock. For some women, it may make sense to test for other causes of symptoms that can mimic menopause, such as thyroid disease.
What about testing for follicle-stimulating hormone (FSH)? Sometimes, elevated FSH levels are used to confirm menopause. FSH is a hormone produced by the pituitary gland that triggers the ovaries to secrete estrogen. As the ovaries’ production of estrogen declines around menopause, the pituitary gland releases more FSH into the blood to try to stimulate estrogen production. So, when a woman’s FSH blood level is consistently elevated, and she is no longer having menstrual periods, it is generally accepted that she has reached menopause. However, a single FSH level can be misleading in perimenopause because estrogen production doesn’t fall at a steady rate from day to day. Instead, both estrogen and FSH levels fluctuate from fairly high to fairly low during menopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid.
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