by Nicole Evans M.D.

Created on: April 23, 2008   Last Updated: December 15, 2010

Menopause occurs when a woman naturally stops menstruating due to an alteration in the levels of hormones that control the menstrual cycle.  The drop in hormone levels is directly related to the inevitable decline in viable eggs within the ovaries that occurs as women age.

Women are born with an amazing 2 million egg-containing follicles in their ovaries.  Each follicle can either be chosen to release an egg during ovulation or atrophy and dissolve away. Thus, the number of follicles slowly declines over the years.  By the time a woman enters peri-menopause, usually occurring two to eight years before menopause, there are only 25,000 follicles left.

At the magic number of 1,000 remaining follicles a woman's ovaries can no longer secrete high amounts of hormones and she stops menstruating. A woman officially moves from perimenopause into menopause only after 12 months without a period.

For most women, perimenopause begins in their 40's. The hallmark of perimenopause for most women is the onset of very irregular periods.  Most women in perimenopause first have a shortening of their menstrual cycle that is then followed by a lengthening of their menstrual cycle (in other words more time between periods). 

The quality of the periods also often changes, with heavier flow and clot formation becoming more common when the menstrual cycle begins to lengthen.  Many women may also experience perimenopausal symptoms such as:

-Hot flashes

-Sleep disturbances

-Headaches

-Breast tenderness

The average age women enter menopause is at 51 years old. Menopause occurs earlier in women who are smokers and in women whose mother's started menopause early. Unfortunately, hot flashes continue occurring for the first 1 to 2 years of menopause.

The post-menopausal years are also associated with a new set of health concerns for women to be aware of.  Key changes in health that occur after menopause inclue:

-Accelerated bone loss

-Coronary artery disease

-Increased LDL "bad" cholesterol

-Vaginal dryness and pain during intercourse

-Decreased libido

Fortunately, there are many options available to help relieve the uncomfortable symptoms of perimenopause and menopause.  Finding relief from menopausal symptoms is a very individual endeavor and often requires some trial and error.  Woman seeking relief for perimenopause and menopause symptoms should be willing try several different approaches. And of course, focusing on the negative, worrying over how frequent, irritating, persistent or fluctuating your symptoms are won’t do much but increase your stress level and promote fatigue.  Rather, by attempting to maintain a strong focus on sustaining and improving one’s overall health, in body, mind, emotion and spirit, you can  reap the benefits that come from loving one’s self through all the changes of life.

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