Because menopause is the time in a woman’s life when menstruation ceases, it is important to understand what occurs during the normal menstrual cycle.
The reproductive years consist of the time from menarche, or the start of normal menses, until menopause. The ovaries produce the hormones estrogen and progesterone.
Estrogen is produced throughout the menstrual cycle—for most women, a 28-day cycle. Estrogen stimulates the endometrium, or the lining of the uterus, to thicken and become more enriched with blood vessels. This is to provide a potential home for a fertilized egg, which implants in and gets its blood supply from the uterine wall.
The production of progesterone is increased in the latter half of the cycle and further stimulates and supports the endometrial lining. If the egg is not fertilized after ovulation, estrogen and progesterone levels fall, endometrial support declines, and menstruation results.
As women approach menopause, their ovaries begin to produce less estrogen and progesterone, and ovulation becomes less frequent. As a result, menstrual periods are more irregular. When periods occur, the menstrual flow is often different as well. Instead of four to seven days of normal flow, a woman may bleed one day, spot for two days, bleed a day and spot for three more, or menses may become very scant. If menses become extremely heavy, are prolonged beyond seven days, occur more frequently than every 21 days, or there is bleeding with intercourse, a healthcare provider should be notified.
Classic menopausal symptoms include: