As menopause nears, the ovaries make less estrogen. One of the earliest signs that menopause may be approaching is a change in your menstrual periods. You may skip one or more periods. The amount of flow may become lighter or heavier. Bleeding may last a longer or shorter time than is usual for you.



Menopause is a natural part of aging. The lower amounts of estrogen that come with menopause will cause changes in your body. These changes occur slowly, over time unless the ovaries are surgically removed. Menopause, however, is different for everyone. Some women notice little difference in their bodies or moods. Others may find it difficult to cope with their symptoms.

  • Hot flashes: the most common symptom of menopause is hot flashes. A hot flash is a sudden feeling of heat that spreads over the body. Hot flashes can happen at any time, day or night. They can be mild or severe. Some women will have hot flashes for a few months, some for a few years and some not at all.
  • Sleep problems: A lack of sleep may be the biggest problems you face as you approach menopause. Too little sleep can affect your mood, health, and ability to cope with daily activities. Some may find it gets longer to get to sleep. Hot flashes, however, are the main cause of lack of sleep, often waking a woman from a deep sleep.
  • Vaginal and urinary track changes: loss of estrogen in the vagina may cause the lining to become thin and dry. These changes can cause pain during intercourse. They can also make the vagina more prone to infection, which can cause burning and itching. Tissues in the urinary track also change with age. The urethra- the tube that carries urine from the bladder- can become dry, inflamed, or irritated. Some women may need to urinate more often. Women may have an increased risk of bladder infection after menopause.
  • Emotional changes: Menopause does not cause sudden mood swings or depression. However, the changes in hormone levels may make you feel nervous, irritable or very tired. These feelings may be linked to other symptoms of menopause, such as lack of sleep. If you are under a lot of stress, the changes may be harder to manage. Most women in mid- life are going through many changes anyway. If you find it hard to cope, talk to your partner, a close friend, a counselor, or your doctor.
  • Sexual changes: Menopause does not have to affect your ability to enjoy sex. Although lack of estrogen may make the vagina dry, estrogen replacement and vaginal lubricants can help moisten the vagina and make intercourse more comfortable. Some women find that they have less interest in sex around and after menopause. Lower hormone levels may decrease sex drive.
  • Birth control: despite signs of menopause, you may still be able to get pregnant. You are not completely free of the risk of pregnancy until you have not had a period for one full year. There are many forms of birth control. Because birth control pills contain estrogen, they can be an excellent choice for many women. Natural family planning method is not reliable around menopause because ovulation is not regular.
  • Bone and other body changes: Bone loss is a normal part of aging. At menopause, the rate of bone loss increases, and unless estrogen is replaced this can eventually lead to osteoporosis. If a woman does not take estrogen, there are other options for preventing osteoporosis. The estrogen produced by womenís ovaries before menopause protects them from heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. The risk of heart attack and stroke then increases.

Yearly visits to your doctor for breast, pelvic, and rectal exams are recommended for all women. Your doctor will do a Pap test to screen for cancer of the cervix and vagina. Depending on your age your doctor may order a mammogram to screen for breast cancer. You should also do monthly self-breast exams.

After your gynecologic exam, your doctor may recommend hormone replacement therapy. More information is available on benefits and risks of hormone replacement therapy.