Middle-aged menopausal White, Black, Hispanic, and Asian women looking confident with light reflecting on their perspiration.

Menopause: an overview

Image: Not actual patients.

The transition from the reproductive period to menopause begins with the perimenopause stage. During perimenopause, women experience marked fluctuations in levels of sex hormones, including a decline in oestrogen and persistent irregularity of the menstrual cycle. Menopause is defined as the cessation of menstrual periods for at least 12 months. The postmenopausal stage of life begins after menopause.1,2

Line graph of the stages of menopause: perimenopause, menopause, and postmenopause. Pre to Post menopause chart_outlines_v2
Line graph of the stages of menopause: perimenopause, menopause, and postmenopause.

During menopause, many women experience sleep disturbances, anxiety, depression, migraine, changes in cognitive performance, and Vasomotor Symptoms, as well as numerous physical changes.1

 

Physical changes can continue long into postmenopause1:

  • Changes in body shape related to cardiometabolic changes
  • Increased risk of cardiovascular events
  • Hair loss
  • Sexual dysfunction
  • Musculoskeletal alterations, including osteoporosis
  • Ageing of the skin
  • Vulvovaginal atrophy

 

Duration of menopausal symptoms

On average, women can expect to experience about 30 years of postmenopausal life. In other words, many will be postmenopausal for a third of their lives. For about 50% of women, some menopausal symptoms begin as early as 2 years before their final menstrual period. One study found that a third of women aged 65 to 79 years still reported at least 1 symptom.1,3,4

Impact on women’s lives

Although menopause is a natural transition, its symptoms occur when many women are handling a full-time job, actively raising a family, and caring for ageing parents.1 The unfortunate reality is that many women must deal with this distressing array of symptoms for a major portion of their adult lives.3

References:

  1. Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol 2018;14(4):199-215.
  2. Santoro NF. Menopause. In: Crandall CJ, Bachman GA, Faubion SS, et al., eds. Menopause Practice: A clinician’s guide. 6th ed. Pepper Pike, OH: The North American Menopause Society 2019:1-21.
  3. Biglia N, Cagnacci A, Gambacciani M, Lello S, Maffei S, Nappi RE. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric 2017;20(4):306-12.
  4. Zeleke BM, Bell RJ, Billah B, Davis SR. Vasomotor and sexual symptoms in older Australian women: a cross-sectional study. Fertil and Steril 2016;105(1):149-155.