Menopause means that a woman is no longer having periods, ovulating (producing eggs) and can no longer become pregnant. The average age for natural menopause is 51, but like menstruation, menopause can vary from woman to woman. In some women, this can begin in their 40’s or even in their later 50’s. Some women experience early menopause because of surgery, illness or other health conditions. The process of cessation of periods is actually referred to as occurring in 3 stages, perimenopause, menopause and post-menopause..


This is sometimes called “the menopause transition” as it is the time leading up to a woman’s last period. During this time a woman will have changes in her levels of the hormones estrogen and progesterone. These changes can cause periods to be irregular- to stop and then start again. There may also be other physical symptoms possibly occurring- such as hot flashes, trouble sleeping, vaginal or urinary problems, mood changes, changes in libido, forgetfulness, trouble focusing, loosing muscle mass, gaining weight and feeling stiff or achy. These changes will vary from one woman to another, some women experience very few while others are troubled more intensely. These changes can possibly last long into post-menopause. If you suspect you may be experiencing some of these symptoms, and they are troublesome-your Certified Nurse Midwife can order hormone tests to determine if you are in the perimenopause.


The definition of menopause is given to a woman who has not had a menstrual period for 12 months. At that time, she is generally said to have experienced a natural menopause. Some of the physical changes she experienced during the later part of her perimenopause will linger into the menopause, and generally become less noticeable over time.

Post Menopause

After menopause, a woman is said to be postmenopause, which lasts the rest of her life. There are other conditions that contribute to menopause:

Surgical Menopause – Because the uterus is removed, there is no longer the possibility of having a period or becoming pregnant. If the ovaries are also removed at the time of surgery, the production of hormones is primarily stopped quickly, the menopausal symptoms can begin right away and may be more intense than those of natural menopause.

If the ovaries are not removed at the time of the hysterectomy, your ovaries might still make hormones and you may not have other signs of menopause. You may have hot flashes because the surgery may affect the blood supply to the ovaries. Later on, one may experience a natural perimenopause a year or two earlier than usually expected due to the surgery.

Cancer treatments – Chemotherapy or radiation to the pelvic area can damage ovaries and precipitate menopause. However, it has been shown that menopause does not always occur due to these treatments.

Immune System Disorders – There are conditions that causes a woman’s own body cells to attack her ovaries. There are other conditions that cause “premature menopause” or “premature ovarian failure”. These conditions are much less common, and require the care of a health care provider.

Managing Symptoms

Managing the symptoms of menopause for some women is as simple as a change in lifestyle routines: i.e. wearing lighter clothing, eating healthier and paying more attention to exercise. It is only necessary to seek the assistance of your certified nurse midwife if the management of these changes are complicating the activities of your everyday life. She can discuss with you the many treatment options available.

  • Hormone Replacement Therapy – This therapy can be very helpful. It can be prescribed for you only after testing the levels of your own hormones in order to prescribe an accurate dose. If you choose HRT, we recommend that one will use (a) the lowest dose that is needed to eliminate the symptoms for (b) the shortest amount of time needed.
  • Natural Treatments or Supplements – Some women try herbs or other products that come from plants. These include many Soy products, as well as a myriad of other plants containing phytoestrogens.
  • Bio-identical Hormones – This term means man-made hormones that are the same as the hormones the body makes. There are several prescription products that are well tested and approved by the US Food and Drug Administration. They have been proven to offer relief to many women dealing with menopausal symptoms.

There are other natural body processes that occur during this phase of a woman’s life. At menopause, the possibility of cardiovascular disease increases and risk factors for osteoporosis are evident. It is important to see your Certified Nurse Midwife for your annual exam – each year she will encourage you to have your mammogram and your lipid testing done. Your pelvic exam, blood pressure checks and weight checks should be done. Other health screenings will be advised at the appropriate times.