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Some women mourn it as the end of youth and fertility. Others welcome it as a time of freedom and new opportunities. Either way, menopause is a universal rite of passage for women, marking significant physical and emotional changes which can require some adjustment. Technically speaking, menopause refers to the time when a woman ceases menstruating (considered permanent after 12 months), but typically the term to refers to the ongoing and gradual process of reproductive aging, which also includes both perimenopause and postmenopause.
For most women, the process of menopause begins silently somewhere around age 40, when declining levels of estrogen and progesterone may cause menstruation to be less regular. The process also leads to other physical changes, such as reduced likelihood of pregnancy, onset of those proverbial “hot flashes,” and possible thinning of bones which could lead to osteoporosis. As with adolescence, menopause involves yo-yoing hormones and is different for every woman. For most it occurs between the ages of 40 and 58 (51.4 on average). A few women reach menopause in their thirties (before 40 it’s called premature menopause; it can be induced surgically or by drug treatment), and a smaller number don't reach menopause until they’re 60. The most likely predictor of how you’ll experience menopause is how your mother or grandmother fared.
Perimenopause, the period preceding menopause, is often more dramatic than menopause itself. During this preliminary phase, hormone levels fluctuate widely, causing a variety of symptoms, including:
Hot flashes: Experienced by 75-80 percent of all women, these can range from a strong blush to profuse sweating with intense heat, usually starting at the head and the neck.
Menstrual cycle changes: Menses can become heavier or lighter; occur more or less frequently; last longer or shorten in duration.
Mood changes:You may find yourself feeling more irritable, teary, emotionally-detached or worried than usual, or you may feel a vague sense of anxiety without a particular cause. Many women experience poor motivation and a general sense of fatigue.
Changes in appetite: You may experience food cravings (especially during the second half of your menstrual cycle), an increased appetite, or suffer from nausea.
Sleep disturbances: Disrupted sleep patterns are quite common, including difficulty falling asleep, or waking in the middle of the night (or early in the morning) and not being able to go back to sleep. Sleep problems can lead to feelings of depression, though many women may typically feel depressed at this time even without sleeping disturbances.
Memory changes: You may feel as if you forget things more easily. This may be due to lack of sleep or the fact that decreased estrogen levels are reducing the hundreds of estrogen receptors on the brain, thus affecting brain function.
Urinary symptoms: You may find that you have to urinate more frequently, can’t get to the bathroom fast enough or sometimes sustain slight leakage when you sneeze, cough, or laugh. It’s also common to have increased incidence of urinary tract infections (UTIs), because of changes in the normal bacteria in your vagina.
Sexual changes: Because of lowered estrogen levels, your libido (sex drive) may decrease. Due to vaginal dryness you might feel pain or discomfort during intercourse or even experience light spotting after sex (because the cervix’s lining is more fragile and thin). In addition, thinning of the vaginal lining—once maintained by higher estrogen levels—can cause uncomfortable vaginal dryness and itching, as well as decreased lubrication that can make intercourse painful and uncomfortable.
Skin sensitivity: Some women experience "crawling" skin—a tingling, dry, or even burning sensation.
Joint & muscle aches and pains
Digestive disturbances: Heartburn is a common complaint.
Heart jitters: The feeling of a pounding or racing heart can be very scary. In perimenopause, this pounding—harmless to your body—may be accompanied by shortness of breath and hot flashes. *It’s important to make sure this is due to perimenopause—if in doubt, talk with your doctor.
Ovarian growths: You may suffer from the growth of benign ovarian cysts. *Always consult your doctor to make sure it’s not something more serious.
Becky is a registered and licensed dietitian with almost 20 years of experience. A certified health coach through the Cooper Institute with a master's degree in health education, she makes nutrition principles practical, easy-to-apply and fun. See all of Becky's articles.
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