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Causes
By Mayo Clinic staffCauses of menopause include:
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Natural decline of reproductive hormones. As you approach your late 30s, your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation. During this time, fewer potential eggs are ripening in your ovaries each month, and ovulation is less predictable. Also, the post-ovulation surge in progesterone — the hormone that prepares your body for pregnancy — becomes less dramatic. Your fertility declines, partially due to these hormonal effects.
These changes become more pronounced in your 40s. Your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually, your ovaries stop producing eggs, and you have no more periods. It's possible, but very unusual, to menstruate every month right up to your last period. More likely, you'll experience some irregularity in your periods.
- Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone. But an operation that removes both your uterus and your ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause, without any transitional phase. Your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptoms.
- Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during the course of treatment or within three to six months.
- Primary ovarian insufficiency. Approximately 1 percent of women experience menopause before age 40. Menopause may result from primary ovarian insufficiency — when your ovaries fail to produce normal levels of reproductive hormones — stemming from genetic factors or autoimmune disease, but often no cause for primary ovarian insufficiency can be found.
Stages of menopause
Because the menopausal transition occurs over months and years, menopause is commonly divided into these stages:
- Perimenopause. This is the time you begin experiencing menopausal signs and symptoms, even though you still menstruate. Your hormone levels rise and fall unevenly, and you may have hot flashes and other symptoms. Perimenopause may last four to five years or longer. During this time, it's still possible to get pregnant, but it's quite unlikely.
- Postmenopause. Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and no progesterone, and they don't release eggs. The years that follow are called postmenopause.
- Bradshaw KD. Menopausal transition. In: Schorge JO, et al. Williams Gynecology. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aid=3158526. Accessed June 5, 2009.
- Manson JE, et al. The menopausal transition and postmenopausal hormone therapy. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aid=2881945. Accessed June 5, 2009.
- Menopause. National Institute on Aging. http://www.nia.nih.gov/HealthInformation/Publications/menopause.htm. Accessed June 3, 2009.
- Cedars MI, et al. Menopause. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:725.
- Col NF, et al. In the clinic: Menopause. Annals of Internal Medicine. 2009;150:ITC4.
- Gass MLS. Menopause. In: Hillard PJA. The 5-Minute Obstetrics and Gynecology Consult. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:292.
- National Institutes of Health state-of-the-science conference statement: Management of menopause-related symptoms. Annals of Internal Medicine. 2005;142:1003.
- Cohen BE, et al. Feasibility and acceptability of restorative yoga for treatment of hot flushes: A pilot trial. Maturitas: The Europena Menopause Journal. 2007;56:198.
- Chattha R, et al. Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy: A randomized control study. Menopause: The Journal of the North American Menopause Society. 2008;15:862.
