Key facts
- Menopause is one of the series of stages in a woman's life* and marks the end of the childbearing years. After menopause, a woman cannot become pregnant except in rare cases when specialized fertility treatments are used.
- Most women [1] reach menopause between the ages of 45 and 55, a natural stage of biological aging.
- Menopause occurs as a result of the cessation of ovarian follicular function and a decline in estrogen levels in the blood.
- The menopausal transition may be gradual, and usually begins with changes in the menstrual cycle. The term "premenopausal period" refers to the period in which these signs begin to be noticed, and ends one year after the last menstrual cycle.
- The perimenopausal period may last for several years and may affect a woman's physical, emotional, psychological and social well-being.
- A variety of non-hormonal and hormonal interventions may help relieve perimenopausal symptoms. [2]
- Menopause may occur as a result of surgical or medical procedures.
How does menopause happen?
Most women reach menopause when the menstrual cycle (also known as menstruation or “the cycle”) stops due to the cessation of ovarian follicular function. This means that the ovaries stop producing eggs for fertilization.
The menstrual cycle varies in terms of its regularity and length during the reproductive period of a woman's life, but the age at which natural menopause occurs generally ranges between 45 and 55 years in women around the world.
Natural menopause is considered to have occurred after 12 consecutive months have passed without the woman menstruating, without any other physiological or pathological cause becoming clear and in the absence of clinical intervention.
Some women reach menopause at an early age (before 40 years of age). This "early menopause" may result from some chromosomal abnormalities, autoimmune disorders, or other unknown causes.
It is not possible to predict when a woman will reach menopause, although there is a connection between menopause and some demographic, health, and genetic factors.
Menopause may also occur as a result of surgeries that involve the removal of the ovaries or medical interventions that cause ovarian function to stop (such as radiation therapy or chemotherapy).
Menstruation stops in many women before menopause, such as women who undergo certain surgeries (hysterectomies or surgical removal of the lining of the uterus) and women who use some hormonal contraceptives and other medications that cause their menstrual cycles to become distant or stop. However, these women may experience other changes related to the menopausal transition.
Changes associated with menopause
The hormonal changes associated with menopause may affect a woman's physical, emotional, psychological and social well-being. The symptoms that occur during or after menopause vary greatly from one woman to another. In some women, symptoms may be reduced or absent. For others, symptoms may be severe, affecting daily activities and quality of life. Symptoms may persist for some people for several years.
Symptoms associated with menopause include:
- Hot flashes and night sweats. Hot flashes refer to a sudden feeling of heat in the face, neck, and chest, often accompanied by flushing (reddening of the skin), sweating, palpitations, and a sharp feeling of physical discomfort that may last several minutes;
- Changes in the regularity and flow of the menstrual cycle, ending with the cessation of menstruation.
- Vaginal dryness, pain during intercourse, and urinary incontinence;
- Difficulty sleeping/insomnia;
- Mood changes, depression, and/or anxiety.
Body composition ratios and cardiovascular risk may also be affected. Women's advantage over men with regard to the likelihood of developing cardiovascular diseases gradually disappears, with the significant decline in estrogen levels after menopause. Menopause may also weaken the supporting pelvic structures, increasing the risk of pelvic organ prolapse. The decline in bone density during menopause contributes significantly to high rates of osteoporosis and fractures.
There are a variety of non-hormonal and hormonal interventions that may help relieve menopause symptoms. Symptoms that affect health and well-being should be discussed with a health care provider to determine options for management, taking into account past medical history, values and preferences.
Pregnancy remains possible during the period before menopause. It is recommended to use contraceptives for 12 consecutive months after menopause, to avoid unintended pregnancy. Pregnancy after menopause is unlikely without undergoing fertility treatment that involves the use of donor eggs or previously frozen embryos.
In the premenopausal and postmenopausal period, the possibility of contracting sexually transmitted diseases, including HIV, through unprotected sexual intercourse, including oral, anal or vaginal intercourse, continues. Thinning of the vaginal wall after menopause increases the chances of lesions and tears, which increases the risk of HIV transmission during vaginal sex.
The importance of understanding menopause
It is crucial to view menopause as one link in a continuum of life stages. The health status of a woman who begins the period before menopause depends to a large extent on her previous health and reproductive history, her lifestyle, and the environmental factors surrounding her. Premenopausal and postmenopausal symptoms may disrupt personal and professional lives, and menopause-related changes may affect a woman's health as she gets older. Therefore, premenopausal care plays an important role in promoting healthy aging and quality of life.
Menopause may constitute an important transitional stage from a social perspective as well as a biological perspective. Women's experiences of menopause may be socially influenced by gender norms and family, social and cultural factors, including the way women's aging and menopause are viewed in their culture.
The world's population of postmenopausal women is increasing. In 2021, women aged 50 or over accounted for 26% of all women and girls in the world. This percentage represents an increase of 22% compared to their percentage ten years earlier. [i] In addition, women are living longer. Globally, a woman who was 60 years old in 2019 can expect to live, on average, another 21 years. [ii]
Menopause may provide an important opportunity for a woman to re-evaluate her health, lifestyle, and goals.
Public health challenges related to menopause
Premenopausal women need access to quality health services and to communities and systems that can support them. Unfortunately, awareness and availability of menopause-related information and services remain a major challenge in most countries. Menopause is often not discussed within families, communities, workplaces or health care settings.
Women may not know that the symptoms they are experiencing are related to menopause or that there are counseling and treatment options that can help alleviate the discomfort. Women in menopause may feel embarrassed or ashamed to draw attention to what they are experiencing and seek support.
Health care providers may not be trained to recognize perimenopausal and postmenopausal symptoms and to advise patients about treatment options and to maintain their health after the menopausal transition. Menopause currently receives only limited attention in the training curricula of many health care professionals.
Many countries ignore the sexual well-being of postmenopausal women. This means that common gynecological effects of menopause, including vaginal dryness and pain during intercourse, may remain untreated. Likewise, older women may not consider themselves at risk for sexually transmitted infections, including HIV, [iii] or their caregivers may not advise them to practice safe sex or get tested.
Many governments do not have health policies or funding allocated to include menopause diagnosis, counseling and treatment in their available routine services. Menopause-related services pose a particular challenge in settings where there are often other urgent priorities competing for health funding.