What happens when a woman goes through menopause


It has been six months since my last period.Am I menopausal?

The answer isn’t so simple.You could be perimeno pausal (the time just before menopause), or you could be menopausal. “Classic” menopausal symptoms including hot flashes, night sweats or excessive sweating, palpitations, vaginal dryness, irregular or prolonged periods, and mood swings can suggest that you are beyond the perimeno- pausal stage. However, some perimenopausal women can have menopausal discomfort.

What happens during perimenopause?

The term perimenopause refers to the years imme- diately before menopause. Between two and six years before your last menstrual period, your ovaries have difficulty producing viable egg follicles. The common misconception is that women run out of eggs. This isn’t the case. Instead, ovarian function declines. The ovaries simply fail to respond to the command by FSH to “ripen an egg.” The ovaries release eggs irregularly instead of monthly. Eventually, no more egg follicles ripen, and the woman stops ovulating.

Most women enter perimenopause by their late 40s. Because natural menopause can occur by age 45, some women enter perimenopause by their late 30s.

Do the ovaries stop producing estrogen during perimenopause?

No. During this time, the ovaries continue to produce estrogen partly out of habit and partly in a final attempt to keep the reproductive process going. Also during this time, production of the second important female hormone, progesterone, becomes erratic. So while the estrogen in your body continues to build up the endometrium to accept a fertilized egg, menstruation occurs only if progesterone is present. When ovulation becomes irregular, your body does not have progesterone to cause regular menstrual periods.

So menstrual periods become unpredictable, right?

Yes. They usually become less frequent, although some women have more frequent periods just before menopause. Menstruation can disappear for several months and then reappear; the duration and flow can also change. For most women, changes in their menstrual cycles are the first flag that menopause is approaching.

Is pregnancy still possible in the perimenopausal years?

Yes. Technically, you are still in your reproductive years. Although menstrual periods may be irregular, your body is still releasing eggs, and pregnancy is possible.

How long do irregular periods last?

Irregular menstrual cycles can occur from a few months to several years before menstruation finally stops. A few women, though, experience no menstrual irregularities at all. And up to 20 percent of perimenopausal women experience the discomforts associated with menopause itself, particularly hot flashes and vaginal dryness.

How can I know for sure if I’m perimenopausal or menopausal?
If you are in your 30s or 40s and are having menstrual irregularities, your medical practitioner may suspect that you are entering your perimenopausal years. And suspect is the key word here. As we’ve said, the presence of menopausal symptoms can suggest that you are beyond the perimenopausal stage, but some perimenopausal women can have menopausal symptoms.

A doctor can confirm that you have entered menopause if (a) you are over age 40 and have gone 12 consecutive months without a menstrual period or (b) your follicle-stimulating hormone test shows FSH levels above 40 I.U./ml. (international units per milliliter of blood).

So there’s a test that measures FSH levels.Are there other tests as well?

Yes. A blood test can measure FSH levels, and other medical tests and procedures can confirm whether a woman is perimenopausal or menopausal. Let’s look at these now.

• FSH test. FSH test is a blood test that measures the amount of follicle-stimulating hormone, which, you’ll remember, is the hormone that tells dormant, or immature, egg cells in the ovaries to ripen. As you near menopause, your ovaries respond more slowly to FSH, so the pituitary gland in the brain works overtime to make more of this hormone. Levels of FSH in the bloodstream rise.

In a premenopausal woman, FSH levels are lower than 30 I.U./ml. Levels higher than 30 I.U./ml. indicate that you are perimenopausal and that menopause is imminent. Eventually, your levels pass the 40 I.U./ml. mark sometimes nearing 1,000. Once they reach 40 I.U./ml., FSH levels rarely fall below that measurement. Thus, exceeding the 40 I.U./ml. mark is one sign of the onset of menopause. Another, of course, is cessation of menstrual periods.

• Progesterone challenge test. Used alone or to confirm the results of an FSH test, the progesterone challenge test determines if irregular periods are caused by insufficient progesterone. In this test, you take progestin (a synthetic or natural form of progesterone) for one week a month for several months. If progestin makes menstrual periods regular and normal in flow, then you have probably entered perimenopause.

• Endometrial biopsy. In an endometrial biopsy (usually an in-office procedure), the physician takes a small sample of your endometrium. The sample is examined microscopically, measured for thickness and analyzed for the presence of abnormal cells. This biopsy is one way to check irregular bleeding and make sure that it is not due to hyperplasia (a proliferation of cells in the endometrium that can set the stage for cancer) or another health condition.

If my FSH levels are high, can I give up birth control without getting pregnant?

Most doctors recommend that you wait 12 months after your last period before giving up birth control.


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