What is menopause? If you can't answer that question, you're in good company. A study published in the Journal of Local and Global Health Science found that fewer than 50 percent of women surveyed could correctly answer questions about menopause and its symptoms and complications.
But what you don't know can hurt you. Or, at the very least, produce unnecessary fear and anxiety.
So what, exactly, is menopause? Simply put, it's a time in a woman's life when menstruation stops. For good.
But menopause isn't simple. In fact, it's a pretty complicated hormonal process that can affect more than just your reproductive health. As we age, levels of the hormones estrogen and progesterone naturally decline. Without adequate amounts of these hormones, the ovaries stop releasing eggs and the uterine lining no longer thickens and sheds. Periods cease and pregnancy becomes impossible. A woman is considered to be in menopause when she has not had a period for 12 consecutive months. You can learn more about menopause symptoms here.
Before you go celebrating the end of cramps, PMS, and tampons spilling out of your purse at inopportune times, you should know that while menopause—also called "the change of life"—may mark the end of certain problems, it's also the beginning of others. While every woman's menopause is different, there are some pretty uncomfortable symptoms that plague many women. For example, 75 percent of menopausal women will experience hot flashes, which are brief-yet-intense increases in body temperature causing warmth and redness in your face, head, and chest. Some women have dozens of these disruptive hot flashes a day. Many will also have vaginal dryness (you'll notice it as pain during sex), mood swings, and even health problems you can't see, such as bone loss and heart issues.
So what can you expect during menopause—and after? From what menopause is to how long it lasts and everything in between, we've got you covered with this manual to menopause.
1. Does menopause happen gradually, or does it come on suddenly?
Women who have surgery to remove their ovaries (due to ovarian cancer, for example) and who are not treated with hormone therapy will have a sudden menopause. But for the majority of women, menopause is a long and gradual process. The time leading up to your last period is called perimenopause, and, according to the National Institute on Aging, this menopausal transition typically lasts seven years, although it can go on for (and we hope you're sitting down for this one) up to 14. You are not considered to be officially in menopause until 12 months have passed since your last period. The average age of menopause in this country is 51.
2. OK, so now that I know what menopause is, how do I know when I'm in perimenopause?
Perimenopause occurs for most women in their mid '40s to mid '50s. The hallmark symptom is irregular menstruation, which means your periods may be early or late, short or long, heavy or light. Other common perimenopause symptoms are hot flashes (which, according to Harvard Health, up to 50 percent of perimenopausal women experience), sleep disturbances (affecting about 40 percent of women in perimenopause) and mood swings (which up to 20 percent of perimenopausal women have).
3. Once I reach menopause, do these symptoms stop?
Many women find that their symptoms ease once their periods stop permanently, ushering them into what is called the postmenopausal phase. But, on average, typical menopausal symptoms like hot flashes and sleep disturbances don't fully resolve until about four years after menopause. For an unlucky few (about 10 percent), the symptoms will go on for up to 12 years.
4. Is there treatment for menopause symptoms?
Lots of women will have only mild—and thus—tolerable symptoms. If you're a woman who has more severe symptoms, however, your doctor may prescribe what is known as hormonal replacement therapy (HRT). This helps reduce symptoms by supplying your body with low levels of synthetic hormones—sometimes just estrogen, sometimes just progesterone, and sometimes a combination of both.
They come in the form of pills, patches, creams, and suppositories and are generally taken every day. Some women shouldn't use HRT (for example, those who have been previously diagnosed with cancer or who have blood clots) and it's important to note that HRT does carry some risks of its own, namely increasing a woman's chances of heart disease, blood clots, and breast cancer. Talk to your doctor about whether the benefits outweigh the risks for you.
5. How is menopause going to affect my health?
If you only know what menopause is in relation to your reproductive health, then you only know half the story. Menopause affects your body, inside and out. For example estrogen, or really the lack of it, can have a profound effect on your cardiovascular system. Estrogen helps keep blood vessels open and cholesterol from adhering to artery walls, thereby protecting you from heart disease. As estrogen dwindles, however, heart disease risk goes up. Estrogen also helps maintain bone mass, and without an adequate supply of it, bones thin and fractures become more common. You might also experience more problems holding your urine, as lower levels of estrogen can weaken the urethra, the tube that carries urine from the bladder to outside the body.
According to the Health and Human Services Office on Women's Health, the average woman gains around five pounds after menopause. But there is more to blame than just hormones. At least some of that weight gain is due to the natural decline of muscle mass as we age and to the normal slowing of metabolism. Experts advise consuming fewer calories (the Mayo Clinic says you need 200 fewer daily calories per day to just to maintain your weight when you're in your 50s versus what you needed in your 30s and 40s) and aiming for 30 minutes of moderate-intensity exercise (walking, biking, swimming at a brisk pace) most days of the week.
7. Is there a test I can take to see if I'm in menopause?
If you haven't had a period in over a year, testing for menopause is generally unnecessary. And testing while you're still having periods, however sporadically, is useless, as levels of estrogen and progesterone can fluctuate widely during perimenopause. That being said, if you absolutely want to confirm menopause, your doctor may order a test that measures your level of the follicle-stimulating hormone (FSH), which is a marker for estrogen production. You'll probably need more than one test, however, for a definitive answer.