What is Menopause

What is Menopause?

*Please note: for the purpose of this article, “woman/women” refers to individuals who have a body with a uterus, which could include trans and gender non-binary individuals that do not identify as a “woman”.

Menopause refers to the time when a woman ceases menstruating. This process marks the end of a woman’s reproductive cycle similar to the way menarche (i.e. the first menstrual cycle), marks marks its beginning.

During the reproductive years, a woman’s ovaries are responsible for 90% of overall estrogen production as well as approximately 50% of daily testosterone (Devprabu & Carpenter, 1997). The overall fluctuation and eventual decrease in hormonal production correlates with an increase in age, and stems from changes in the hypothalamus, the neural center of the brain. This decrease is responsible for the many physical changes experienced by peri and post-menopausal women (Shifrin & Schiff, 2000). Menopause is typically confirmed through a blood test that confirms the decline in hormone levels.

What does it look like?

Beginning around the age of thirty-five, many women begin to experience changes to their reproductive cycles, a decline in ovulation, and an increased frequency of menstruation, which lasts for fewer days. These changes are part of the natural aging cycle. However, some women experience none of these changes until their menstruation ends altogether (Gold et al., 2001), and the average length from beginning to end of menopause transition is between one to three years (Harlow et al., 2012).

Overall, the process of menopause can be rapid or gradual. Rapid, premature menopause is usually related to ovarian damage or bilateral oophorectomy: removal of both ovaries (Devprabu & Carpenter, 1997). For some women who experience gradual or peri-menopause, an interesting but often overlooked phenomenon is found in endogenous ovarian hyperstimulation, in which some researchers hypothesize that hormonal fluctuations may lead to the release of more eggs (CEMCOR, 2014; Prior, 2005). For women who experience gradual or peri-menopause, the exact onset of menstrual discontinuation varies from person to person, though it often begins between the ages of 35-45. Interestingly, there was once a commonly-held belief that the age of onset of menarche predicted the age of menopause, but this has been refuted (Bjelland, Hofvind, Bybgerg, & Eskild, 2018): in fact, the onset of menopause is determined by a number of variables. However, for all women,  the exact beginning date of menopause is typically determined by calculating one year from the date of the woman’s last menstruation.

What are the Physical Symptoms?

Hot flashes are sudden, uncontrollable fluctuations of body temperatures, similar to generalized flushes. They often begin with a tingling sensation, which rises to the mid-body, causing reddened skin, dizziness, rapid heartbeat, chills, and sweating. Hot flashes can occur at any time of day and in any location. However, they most often occur during sleep. Hot flashes, on average, last somewhere between 30 seconds to five minutes. This affects 75-80% of per-menopausal women in the United States (Avis et al., 2015), although the degree of impact varies. Only a small percentage of women report that hot flashes impair normal functioning. However, hot flashes can lead to frequent sleep disturbances, causing exhausting, chills and discomfort, all of which can make women feel less comfortable or embarrassed about their bodies.

Hot flashes seem to be the body’s way of re-signaling the pituitary gland to respond to the decrease in estrogen. While frequent hot flashes can last anywhere from three to seven years, African American women are most likely to experience them for a longer duration (Avis et al., 2015). Other factors contributing to the duration of hot flashes include smoking, obesity, stress, and anxiety (Avis et al., 2015).

The good news is there are several methods to reduce discomfort that women may experience as a result of hot flashes. Primarily, increasing daily exercise is helpful, as well as an adequate intake of fluids, eating a healthy diet with sufficient calcium (NAMS) Vitamins B and C, and decreasing the intake of spicy foods, hot beverages, tea, and alcohol. Thirdly, taking cold showers, keeping the room cool, and avoiding tension may lower the frequency of hot flashes. Some women swear by moisture-wicking, breathable pajamas and nightgowns to keep them comfortable at night.

Vaginal Atrophy occurs when the prolonged drop in estrogen causes the vaginal mucosa to shrink, thin, and lose lubrication.  A decrease in lubrication may cause the vaginal walls to more readily become irritated, tear and/or become infected. One common manner in which women deal with these changes is to ignore the pain, while continuing to engage in the very sexual behaviors which lead to discomfort. Over time, this strategy may lead women to associate pain with penile-vaginal intercourse and thus become avoidant of these behaviors. This avoidance behavior may result in either the woman viewing herself as asexual or in others viewing her this way. In reality, the change in female lubrication is more indicative that her sexual partner may need to adjust. She may benefit from prolonged stimulation and/or the use of lubrication. In this regard, there are several options. Women may want to use an estrogen replacement cream, which helps women to self-lubricate. Second, women may purchase over-the-counter lubrications, such as Astroglide or K-Y Jelly or Replens, a nonprescription, non-hormonal lubricant that may work as well as estrogen cream (Mitchell et al., 2018) .

Lastly, one of the best ways to increase lubrication is by engagement in frequent sexual pleasuring (link to article 4). Moreover, because lack of sexual activity may actually contribute to vaginal atrophy, it is important to keep all the pelvic and perineal muscle groups in active use. In addition to engaging in sexual pleasuring, women may benefit from strengthening her PC muscle which plays an important role in orgasm. This can be done through the use Kegel exercises.

What’s the bottom line?

Menopause emotionally or physically disables only a small percentage of the female population (10-15%). Similarly, 10-15% of all women exhibit no symptomology at all. However, most women experience mild symptoms due to fluctuations in hormonal levels (Burger, Dudley, Robertson, & Dennerstein, 2002). Of these, only a small amount have consulted a healthcare provider (AARP, 2018). Not every woman, therefore, feels the need to address menopause from more than an anecdotal or even home-remedy approach. However, for those who would like to seek treatment from medical professionals, the next article, Treating Menopause, explores the most common options of care.



 Written by Dr. Erica Hyatt-Goldblatt and Alex Robooy, CAS, MSW, LCSW