What is Menopause? All of Your Menopause Questions Answered


Every woman experiences menopause differently, so it’s good to understand the basics.

We tend to get left in the dark about menopause. Nearly one-third of women over age 40 don’t get any information about it, according to a 2018 AARP report (1). And when we do, less than half of us are talking to a physician or health care provider.

Midlife can be an amazing time in your life, and menopause isn’t something you have to hide away or be quiet about. It’s a natural part of it that every woman goes through— and experiences in her own way.

What is menopause?

Let’s start with the basics. Menopause is defined as the permanent end of a woman’s menstrual cycle and is reached 12 months after her last period. Women usually experience a variety of symptoms before their period finally ends. This lead-up time to menopause is referred to as perimenopause. After a woman has not had a period for 12 months, she is then postmenopausal. Women will spend the rest of their lives in postmenopause.

The changes start when your ovaries produce less of the reproductive hormones estrogen and progesterone, which leads to the symptoms of perimenopause including changes in your menstrual cycle. These are the main hormones that regulate your fertility and reproduction, along with luteinizing hormone (LH) and follicle-stimulating hormone (FSH) .

Why is estrogen so important?

Estrogen is what ushered your body through puberty and all the (fun?) physical changes that it came with. It keeps your vaginal lining elastic, lubricated, and well-supplied with blood. Estrogen also affects a laundry list of other body parts and systems (urinary tract, the heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles, and your brain).

Starting in perimenopause (the transition to menopause), your estrogen levels naturally fluctuate and eventually decline. If you’ve experienced any of these symptoms, you may be in perimenopause:

  • Hot flashes that break you out into a sweat during a big meeting
  • Brain fog that steal your focus when you’re checking your kid’s homework
  • Nights spent staring at the ceiling because you can’t stay asleep
  • Uncomfortable sex because you aren’t naturally lubricating

These symptoms are typically associated with perimenopause, and can start up to 10 years before menopause.

The other important hormone: progesterone

Progesterone is the hormone that prepares the uterus to receive a fertilized egg after ovulation. If there is no pregnancy (fertilized egg) that cycle, progesterone levels drop, and this starts menstrual bleeding. During perimenopause, because your body is making less progesterone of the hormone, you could have heavier, or longer periods. After your last period, your body stops needing to make progesterone.

A quick reminder on the internal anatomy of our reproductive systems: We each have a pair of ovaries, almond-sized glands on either side of the uterus. Inside the ovaries are follicles, which house your eggs. Your ovaries produce hormones, protect your eggs, and release your eggs during your menstrual cycles (ovulation).

What causes declines in estrogen & progesterone levels?

Two other reproductive hormones that factor into perimenopause changes are luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These two work together to stimulate ovulation and regulate estrogen and progesterone levels. But during perimenopause, the ovaries become less responsive to the duo.

This leads to a decline in estrogen and progesterone and that’s when you start noticing health changes like the ones outlined below.

What are common signs & symptoms of perimenopause?

With perimenopause, signs and symptoms can vary greatly from woman to woman, so it can be a bit tricky to pinpoint at first. Here are some are common signs and symptoms to be aware of:

  • Irregular periods
  • Hot flashes
  • Difficulty sleeping
  • Memory problems
  • Mood swings
  • Vaginal dryness
  • Less interest in sex
  • Weight gain
  • Dry skin
  • Hair loss
  • Increased facial hair
  • Chin acne

What is the average age for menopause?

Menopause happens, on average, at age 51, according to The North American Menopause Society (2). It occurs most often between ages 45 and 55 and is different for every woman.

Perimenopause, the transition to menopause, usually starts in the mid- to late-40s. It lasts an average of four years, but can start up to 10 years before menopause. During perimenopause, estrogen and progesterone levels fluctuate as they start to drop, which can result in symptoms including:

  • Hot flashes
  • Night sweats (hot flashes at night)
  • Irregular periods
  • Mood swings
  • Sleep disturbances
  • Vaginal discomfort
  • Urinary issues

Keep in mind that you can still get pregnant during perimenopause because you’re still ovulating — even if it’s irregular. If expanding your family isn’t part of your plan, continue to use contraceptives. The National Institutes of Health (3) recommends using contraception for at least 12 months after your last period.

You might know someone who reached menopause before she turned 40. This is known as premature menopause. When menopause happens before age 45, it’s called early menopause. Some causes of premature or early menopause include smoking (4), never being pregnant, and medical intervention, including chemotherapy, radiation, oophorectomy (removal of ovaries), and hysterectomy (removal of the uterus)

How long does menopause last?

One important thing to know is that menopause is technically defined as the end of your menstrual cycle, which makes it sounds like a one-time deal, but the whole process really goes in three phases: perimenopause, menopause, and postmenopause.

On average, perimenopause lasts 4 years. Some women may enter perimenopause up to 10 years before they reach menopause, and some women even experience hot flashes while they have regular periods, according to the Cleveland Clinic (5).

Every woman experiences the menopause journey differently, so think of this as a general timeline, not your personal one.

Will my cholesterol levels change after menopause?

Your cholesterol levels can rise around the time of menopause. 

Estrogen is believed to have the following positive effect on cholesterol levels: (6)

  • Increases HDL cholesterol
  • Decreases LDL cholesterol
  • Relaxes, smoothes, and widens blood vessels so blood flow increases

This explains why before menopause, many women have lower total cholesterol, and LDL cholesterol, levels than men of the same age.

However, when estrogen levels decline in menopause, levels of LDL cholesterol increase while HDL cholesterol levels decrease. This contributes to the buildup of plaque in the arteries, increasing the risk of heart attack and stroke.  

The American Heart Association recommends all adults age 20 or older have their cholesterol and other traditional risk factors (such as your age, family history, smoking status, blood pressure, diabetes status) checked every four to six years, to determine your risk for cardiovascular disease and stroke. (7)

A cholesterol test can shed light on your cholesterol levels and allow you to make informed decisions about your health.

When should I talk to my doctor about menopause?

For most women, perimenopause or the transition to menopause comes with hot flashes, sleep problems, memory problems, vaginal dryness, and more. Talking to a doctor about your symptoms can help you find the path through the menopausal years that’s right for you.


Anderson GO, Gelfeld V. Menopause Experiences: Providers Can Do Better in Educating, Starting the Conversation. AARP. Published July 1, 2018. Accessed February 18, 2019.

Menopause FAQs: Understanding the Symptoms. Menopause Frequently Asked Questions | The North American Menopause Society, NAMS. Accessed February 18, 2019.

What Is Menopause? National Institute on Aging. Accessed February 18, 2019.

Whitcomb B, Purdue-Smithe A, Szegda K. Cigarette smoking and risk of early natural menopause. Am J Epidemiol. 2018;87(4):696-704.

Menopause, Perimenopause and Postmenopause. Cleveland Clinic. Accessed February 18, 2019.

Reslan OM, Khalil RA. Vascular effects of estrogenic menopausal hormone therapy. Rev Recent Clin Trials. 2012;7(1):47-70.

What Your Cholesterol Levels Mean. http://www.heart.org/HEARTORG/Conditions/AboutCholesterol/What-Your-Cholesterol-Levels-Mean_UCM_305562_Article.jsp. Accessed May 16, 2019.