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Menopause is a process of change and transition as a woman's body sheds its child-bearing potential and adjusts to lower levels of hormones. Menopause usually starts around the late forties, when periods start to get more irregular and finally stop altogether. The average age at which periods stop is around fifty, but it can occur earlier, particularly in black and non-European women.

Like childbirth, menopause is a complex topic that women only recently have begun to explore in depth. And like childbirth, the truths about menopause have been obscured by myths and fallacies. Unlike childbirth, every woman will experience menopause either naturally, or surgically induced through the removal of the uterus, with or without the ovaries being left in place. Some women may experience an earlier menopause following a tubal ligation. Earlier menopause may also be induced by chemotherapy or radiation therapy.

In the past, medical descriptions of menopause have been intimidating. Phrases that referred to the menopause as "deterioration," "deficiency disease," "estrogen starvation," "living decay" or "partial death" projected to women an image of irreversible and inevitable physical and mental decline.

In addition, our culture has created a negative stereotype of the menopausal woman. Added to this is the fact that a lot has been attributed to menopause that has nothing to do with it. Although sometimes difficult, it is worth trying to distinguish the normal healthy changes of menopause from the normal healthy changes of aging.

In spite of the negative press, studies show that women feel positive or neutral about menopause and that most are relieved by the end of their fertility. The post-menopausal years can be energetic ones. As Margaret Mead once said, "the most creative force in the world is the post-menopausal woman with zest."

While the physical and emotional changes of the menopausal period may be numerous, only three physical symptoms are said to be directly attributed to the hormonal shifts that occur during menopause. They are menstrual changes, hot flashes and vaginal changes. However, the medical profession's understanding of menopause is still growing.

Menstrual Changes

The first symptoms that a woman notices, usually in her mid-forties, is that her periods start to change. Some women menstruate more frequently, others skip periods altogether, and others find their periods are more widely spaced. The amount of bleeding varies from the same to lighter or heavier. Her periods may last for a longer or shorter time. The timing of her periods may become unpredictable. Occasionally there is only spotting at the time of the expected period. Eventually, around the average age of 50, the periods stop altogether. There are no hard and fast rules about the age at which periods become irregular or the age at which the periods stop.

Normally, a woman's ovary releases one egg every month and secretes into the bloodstream the female hormones estrogen and progesterone. In the first half of the cycle estrogen predominates; and then after the egg is released at ovulation, progesterone predominates with estrogen still present. Later in the cycle, barring pregnancy, both estrogen and progesterone reach their low points and the period begins.

Around the time of menopause, ovulation becomes irregular and some cycles don't occur at all. With no ovulation, estrogen remains high and progesterone low. Since progesterone is necessary to shed the uterine lining, there is no period or only scant spotting. Sometimes the weight of the menstrual material causes it to slough off in late and very heavy flow.

Eventually at menopause the ovaries stop producing eggs altogether, and the levels of estrogen and progesterone go way down. But long before the ovaries slow down, the body develops other sources of estrogen. These are located in the fatty tissues of the body and in the adrenal glands. The ovaries themselves continue to secrete small amounts of estrogen for ten years or longer after the periods stop. In addition, the ovaries and the adrenal glands continue to produce androgens.