Changing Hormonal Patterns
During this time, typically starting in the late 40's, the ovaries' response to the various stimulating hormones produced by the brain becomes unsynchronized, until eventually the aging ovaries fail to respond at all. They start to produce less progesterone, losing their ability to ovulate and develop the subsequent corpus luteum. When ovulation stops, estrogen levels decline and menstruation ceases.
As ovulatory cycles become more irregular throughout perimenopause, the body's sensitive hormonal rhythm is thrown off and menstruation may vary more from month to month. In addition, two hormones known as androgens begin to play a bigger role. Though referred to as male sex hormones, they are in fact produced in small amounts by the female body as well. As levels of the female hormones decline, the impact of these "male" hormones can increase.
The bottom line is that fluctuating blood levels of hormones during the transitional years can create a number of physiological changes. These may be less unsettling for women who have an understanding of what their bodies are going through.
Menopause at a Glance
The wide array of problems shown in this diagram may seem daunting; but fortunately, few women experience every one of them. Hot flashes are the most common complaint. However, these annoying sensations pass in due course, while other symptoms may pose a much greater long-term threat. Be particularly alert for lower back pain, which may signal the onset of osteoporosis, the bone-weakening disorder that leaves older women prey to fractures. Remember, too, that menopause robs you of estrogen's protective effect on the heart, and that heart disease is the Number One killer of women. (For more information, see "Heart Disease: The Greatest Threat of All.")
Changes in the Menstrual Cycle
Cyclical Changes occur for the vast majority of women whose periods do not just stop. The perimenopausal years may be marked by skipped menstrual periods, heavier or lighter than usual bleeding, and changes in the frequency of cycles. During some menstrual cycles, no egg may be produced; these are called anovulatory cycles.
Light, short, or skipped periods occur as the ovaries' hormonal response becomes unpredictable. Heavy and prolonged bleeding arise when a longer than normal release of estrogen overstimulates growth of the uterine lining. The lining may be irregular or thickened and may not slough off completely or evenly, causing menstruation to stop and start again. Clotting may be noticeable in menstrual bleeding.
The physical changes that accompany the menstrual cycle may also become less predictable and regular. Such signs as breast tenderness, fluid retention and headache may occur at unpredictable times.
Fertility declines as a woman enters her 40s, but it does not disappear entirely until menopause is complete. To avoid unplanned pregnancies, doctors recommend using birth control until a full year has passed since the last menstrual cycle.
Menopause: Myths and Realities
Myth: Menopausal women are unhappy and depressed.
Reality: Most women cope very well with the physical challenges of menopause. Serious mental health problems do not increase. While some women may experience emotional distress, this is often related to sleep disturbance and deprivation due to hot flashes.
Myth: All women going through menopause are plagued by hot flashes.
Reality: About 80 percent of American women experience only mild symptoms, or none at all, during menopause. When hot flashes do occur, in most cases they are mild and disappear after a few months, rarely persisting for more than 2 or 3 years.
Myth: Menopause is the end of your sex life.
Reality: Libido, or sexual desire, does decline with aging, but many women continue to enjoy a satisfying sex life deep into old age. Some women find sex more enjoyable after menopause when concerns about pregnancy are past.