Straight, No Chaser: Twenty Questions on Menopause (Plus One)

Menopause concept.

Menopause (aka “the change of life”) seems to be one of those things that everyone knows about but many don’t understand well. Let’s approach the topic by reviewing a series of frequently asked questions.

1. Why does it occur?
Menopause is the completion of menstruation. It can occur naturally due to the exhaustion of a woman’s supply of eggs or for other reasons such as having a hysterectomy combined with removal of the ovaries that store these eggs.
2. When does it occur?
The average age of menopause is 51. Symptoms may start much earlier, but it’s usually after age 45.
3. How do I know that menopause has started?
The first thing you may notice at the beginning of menopause is irregular periods. Other changes may include alterations in the flow or duration of periods. To actually know that the process has begun, you should discuss your symptoms with your gynecologist.
4. What’s going on with my hormones during menopause?
Many of the symptoms of menopause are related to changing levels of estrogen and progesterone, two prominent female hormones made in the ovaries.
5. What is perimenopause?
Perimenopause is the timeframe between when menopausal symptoms begin and your last menstrual period. You can still have periods and get pregnant during this time.


6. What are the common symptoms of menopause?

  • A change in periods (shorter or longer, lighter or heavier, with more or less time between)
  • A change in your sleep patterns, with trouble sleeping
  • Hot flashes and/or night sweats
  • Mood swings
  • Less hair on the head and more on the face
  • Trouble focusing
  • Vaginal dryness

7. What is a hot flash?
A hot flash is a sudden warming sensation in your body, usually in the upper portions. This can result in flushing of your upper skin with redness and sweating, followed by shivering. Hot flashes tend to last between 30 seconds and 10 minutes.
8. How do I best deal with hot flashes associated with menopause?
Here are some tips to help you address those hot flashes and night sweats.

  • Drink cold fluids when symptoms begin.
  • Don’t smoke.
  • Dress in layers so that if symptoms begin, you may comfortably take off some clothing.
  • Dress and sleep in fabrics that allow your skin to “breathe.”
  • Lower the room temperature, especially when you sleep

9. I’ve heard that hot flashes aren’t as bad if I’ve had a hysterectomy. Is that true?
In some cases, yes. Overall, that correlates with age. If you have a hysterectomy without affecting the ovaries, then the ovaries are still able to make estrogen and progesterone (two important female hormones), and hot flashes may not occur or be as prominent early on. Once the ovaries stop making these hormones, symptoms may occur.
10. Why do I have problems with my bladder?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequent can lead to imperfect control, resulting in leaking and urinary tract infections.

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11. Does sex change after menopause?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequently can lead to pain and other types of discomfort during intercourse. It is not uncommon to see a decreased level of interest after menopause. However, in some the feelings of freedom from possible pregnancy and other considerations lead many to feel sexually freer.
12. What causes early menopause?
Early (premature) menopause may be due to several factors, such as chemotherapy or pelvic radiation treatments for cancer, surgeries of the ovaries or uterus, genetics, chromosomal defects and certain autoimmune diseases (e.g., thyroid disease and rheumatoid arthritis–two conditions in which the body’s immune system may attack the ovaries).
13. Can I get pregnant after menopause?
By definition, no. Menopause represents the end of your menstrual periods, and as such you aren’t releasing any eggs that could be fertilized once this has happened. However, you can get pregnant during the perimenopausal period.
14. How is menopause medically managed?
Menopause is an occurrence, not a disease. However, some symptoms of menopause require treatment. More importantly (usually) considerations of and risks for breast cancer, heart disease and osteoporosis must be addressed. Your physician can be expected to have these conversations with you.
15. Can I still have periods after menopause?
By definition, no. “After menopause” is after you’ve had your last menstrual period. During the transition (i.e., the perimenopausal period), you may have a long gap between periods (i.e., irregular periods), but once menopause has occurred, you’re finished with menstruation.


16. Why do I seem to be more moody?
It is not clear that mood changes are directly related to menopause. Many other circumstances occurring simultaneously may be contributing to these feelings. Such considerations include stress, anxiety related to family changes (e.g., becoming an “empty nester” or having ill parents), depression or diminished physical fitness, all of which may independently cause emotional distress and mood changes.
17. Why do I develop problems with my bones?
Estrogen controls bone loss. The loss of estrogen occurring around the time of menopause contributes to women losing more bone than is being replaced. As this process progresses, bones become weaker or more likely to break.
18. Why do I develop problems with my heart?
This is likely multifactorial. Heart disease simply increases with age. So does obesity and high blood pressure, both of which are risk factors for heart attacks. Estrogen loss may also contribute.
19.  How can I best stay healthy after menopause?
Read the next Straight, No Chaser post, which specifically answers this question.
20. When is it safe to say I’ve reached menopause?
It’s safe to say a woman has reached menopause when she has not had a period for one year.


21. Why don’t men go through this?
Men actually do have a version of menopause called andropause. It is discussed in this Straight, No Chaser.
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