Menopause — Who? What? When? and Why It Matters!

Menopause — Who? What? When? and Why It Matters!

Menopause: three syllables, nine letters, and a whole lot of confusion. Let’s clear up the basic facts – some may surprise you!




Who goes through menopause? Every person with ovaries who lives long enough. That means half the population will go through menopause at some time. It’s as normal and certain as puberty.




What is menopause is a little bit of a trick question. That’s because menopause can occur in at least three different ways.


  • Natural menopause – this is by far the most common way. It happens gradually over as many as ten years. Estrogen and progesterone, the two main hormones produced by the ovaries, are in balance during most of the reproductive years. But towards the end of that time, those hormones get increasingly unbalanced. And unbalanced hormones cause menopause symptoms.


That window of time when hormones are unbalanced is called perimenopause. When a person goes one full year without a period, that is defined as menopause. Menopause symptoms actually begin in perimenopause, get worse within 2-3 years of menopause, and continue for another several years after menopause. About five to seven percent of people with menopause symptoms will continue to have them until their 60s and occasionally, their 70s.


Most common menopause symptoms:

  • Difficulty getting pregnant or staying pregnant
  • Irregular and sometimes heavy vaginal bleeding
  • Hot flashes
  • Weight changes, particularly in the belly
  • Sensitive bladder
  • Vaginal dryness
  • Loss of libido
  • Brain fog
  • Anxiety or depression
  • Sleep problems
  • Dry skin


Most people don’t get all of these, and about one in seven don’t get any menopause symptoms. But 85+ percent get at least some of these and possibly some other symptoms too.


  • Surgical Menopause – This type of menopause happens if both of a person’s ovaries are removed before natural menopause occurs. As soon as that surgery happens, the person is in surgical menopause. Because it happens so abruptly, the menopause symptoms are often more severe unless they are treated at the time of surgery. Estrogen is the most effective treatment for surgical menopause.
    • If one ovary is removed and the other is not, the person won’t go into menopause immediately, but menopause may come a little sooner.
    • If the uterus is removed but the ovaries are not, the person won’t have periods, because menstrual blood comes when the lining of the uterus is shed. However, even though the person isn’t having periods, they will not be in menopause because they still have at least one of their hormone-producing ovaries, but they may enter menopause sooner due to disrupted pelvic blood flow.


  • Iatrogenic Menopause – This type of menopause is caused by a medical procedure. It might be chemotherapy or radiation or other treatments that are toxic to the ovaries. Doctors can often shield the ovaries, or prescribe medications that shut down the ovaries to try and prevent the treatment from causing menopause.




What if I asked, “When does puberty start?” That’s the age when the ovaries start to get active. You might say age 11. And you’d be right a lot of the time.


But it’s perfectly normal for ovaries to start producing hormones from ages 8 to 13 years. For a small percentage, it’s even older. So, it shouldn’t be surprising to find that the age when ovaries start to slow down their hormone production also isn’t just one age. When that slow-down does begin, it’s the beginning of perimenopause. It could begin in the late 30s or early 40s. It could also begin in the early or late 50s.


Same is true of menopause when the ovaries finally do become inactive, which is one year after the last menstrual period. For most people, menopause occurs at about age 50, plus or minus five years. But not for everyone. People who enter menopause between the ages of 40 – 44 are defined as being in early menopause. People who enter menopause before age 40 are in premature menopause.


Here’s another way to look at When Menopause Occurs:


Onset of Menopause


Before age 20

1 out of 10,000

Before age 30

1 out of 1,000

Before age 40

1 out of 100

Before age 45

1 out of 10–20

From: Seibel, MM. The Estrogen Window p 23

Why it Matters?


No one should have to suffer with menopause symptoms. There are treatments for just about everything; and for most menopause symptoms, there are lots of treatment options.


Early and premature menopause are important because they shorten the number of years a person has to complete a family. With people waiting longer to begin their families, or who want a child with a new partner, or just want to have another kid, waiting can lead to infertility. In fact, if you are having difficulty getting pregnant, ask your doctor if you could be in perimenopause. Pregnancy is still possible in perimenopause; it just happens a little slower and likelihood a little lower.


The second reason menopause matters, particularly, early or premature menopause, is because entering menopause early without any treatment puts the person at greater risk for heart disease, emotional changes, bone loss and some other medical conditions. Those issues can be greatly reduced or prevented by treatment with estrogen from the beginning of menopause till at least age 51, which is the mean age of natural menopause. There are many other treatments as well.


The third reason treating menopause matters is that reducing or eliminating menopause symptoms will improve your performance at work, your enjoyment of work, and your success at work. Studies show those who treat their menopause symptom of hot flashes have six less doctor’s visits yearly and are much more productive and enjoy work much more than those who don’t.


While there are other reasons, the one additional one to share with you is that nearly seventy percent of women don’t get their menopause symptoms treated.  A lot of that is due to the fact most doctors only get 2 hours of training per year on menopause. That includes treating loss of libido, sensitive bladder, hot flashes, and a whole lot more.  Surveys show that many believe there are no treatments. Others believe their doctors aren’t interested in treating them. Still others are embarrassed to ask about sensitive topics. These are the types of things I explain at


Don’t tough it out; figure it out. Menopause happens. And once you figure it out with your healthcare provider, not only will you feel better, you will also likely identify potential problems that could be prevented and start feeling better at the same time.


Stay tuned for the next article on menopause treatments.

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