Menopause Frequently Asked Questions
by Marshall Smith, MD,
OBGYN.net Editorial Advisor

Am I in menopause or not?

"Am I in menopause or not?" is a common question asked by women in their forties who are experiencing problems with perimenopausal symptoms. The word menopause is defined in the gynecological literature as "the absence of menses secondary to ovarian failure", but it certainly encompasses much more than just the cessation of menstruation. It was originally thought that female hormone production started to decline in women's late thirties and early forties, and gradually declined until after the menopause. Eventually, the production became so low that there was an insufficient hormone level to stimulate the lining (or endometrium) of the uterus to grow each month, and thus, women stopped having their menses. However, it is now known that a woman may not have measurably lower hormone levels until she is approaching 50 years of age, while all the menopausal symptoms may have progressed for several years and be full blown by this point.

In the United States the average age of "menopause", or stopping the menses, is 51 years of age. However, a woman can usually tell long before her menses cease that something is happening to her body. Often this begins sometime in her late thirties or early forties, and she begins to question if she is in "early menopause". She may start being somewhat more irregular with her periods, but generally still has one per month. On the other hand, she may still be having normal menses but begin to have intermittent hot flashes. She may notice such things as dryness of the vagina, or perhaps difficulty sleeping, finding herself feeling exhausted all the time. She, or perhaps her significant other, may note that she is not as easy-going as she once was. She starts to become more irritable and less tolerant of things that never bothered her before, and she begins to wonder what is happening to her body. She may have hormone levels drawn, only to be told that they are in the normal range. Nevertheless, she knows that something abnormal is happening to her body.

One concept which helps women to understand this transition period is to realize that this change is not an abrupt event, like turning off a light switch. The symptoms and changes begin insidiously in the early forties, and may come and go over the next decade. They may slowly become more severe and more persistent, even as the woman is continuing to have her menses. One way to conceptualize this transition is to liken it to "growing up". Obviously one cannot designate a single age or event that marks the transition of growing up; it is a gradual transition over many years. This perimenopausal period in a woman's life is similar, and she should remember that there is often no abrupt beginning or end to the transition. As with anything in life, understanding what is happening as well as what to expect often makes the journey a little easier.

Hopefully this section in OBGYN.net on the perimenopause and menopause will be able to provide some assistance to women in this transition period. It is hoped that it can provide reassurance and support to these women, and can assist them to become better informed for the health decisions and personal choices they will make during these years. This section will attempt to serve health care professionals as well, providing a forum where they can find an active interchange of experiences and philosophies in addition to medical information. Ultimately, the goal is the support and assistance of perimenopausal and menopausal women, helping them to continue to enjoy a healthy and productive life both during the transition period and for decades to come after the menopausal passage.