Natural menopause happens gradually. The ovaries don’t abruptly stop working, they slow down. The transition to menopause is called perimenopause.

Menopause is a milestone — it’s the day that marks 12 months in a row since a woman’s last period. During perimenopause, it’s still possible to get pregnant — a woman’s childbearing years are winding down, and although her periods may become more unpredictable, her ovaries are still working and she still may ovulate, though not always monthly.

Menopause: What Is It?

Menopause is the permanent end of menstruation. It’s a turning point, not a disease, but it can have a big impact on a woman’s well-being. Although menopause can bring physical discomfort from hot flushes, night sweats, and other symptoms, it can also be the start of a new and rewarding phase of a woman’s life — and a golden opportunity to guard against major health risks like heart disease and osteoporosis.

What Causes Menopause?

Age is the leading cause of natural menopause. It’s the end of a woman’s childbearing years, brought on by the ovaries gradually slowing down.

BUT some surgeries and medical treatment can induce menopause. Those include surgical removal of the ovaries (bilateral oophorectomy), chemotherapy, and pelvic radiation therapy. Having a hysterectomy (surgical removal of the uterus) without removing the ovaries does not necessarily lead to menopause, although you will not have periods anymore.

When Does Menopause Start?

On average, women are 51 at natural menopause, notes the National Institute on Aging. But menopause can start earlier or later. A few women start menopause as young as 40, and a very small percentage as late as 60.

Women who smoke tend to go through menopause a few years earlier than nonsmokers. There is no proven way to predict menopause age. It’s only after a woman has missed her periods for 12 straight months, without other obvious causes, that menopause can be confirmed.

What to Expect

Menopause affects each woman differently. Some women reach natural menopause with little to no trouble. Others have severe symptoms.

And when menopause starts suddenly as a result of surgery, chemotherapy, or radiation, the adjustment can be tough.

Here is a look at menopausal symptoms that many women have, though the intensity can vary.

PeriMenopause Symptom: Period Changes

As menopause approaches, a woman’s menstrual periods will likely change. But those changes can vary from woman to woman — periods may get shorter or longer, heavier or lighter, with more or less time between periods.

Such changes are normal, but best to see a doctor if your periods come very close together, if you have heavy bleeding or spotting, or if they last more than a week.

PeriMenopause Symptom: Hot Flashes

Hot flushes are common around menopause. You can experience a feeling of heat that may make the face and neck flushed and cause temporary red blotches to appear on the chest, back, and arms. Sweating and chills may follow.

They vary in intensity and typically last between 30 seconds and 10 minutes. Dressing in light layers, using a fan, getting regular exercise, avoiding spicy foods and heat, and managing stress may all help you deal with hot them.

Hormonal surges are often to blame, so check your hormone balance to see if you need some progesterone, or a combined cream with oestrogens and progesterone.

PeriMenopause Symptoms: Sex Problems

Because of the hormonal changes, women can often experience mood swings and even depression. Neither of these are helpful for a good sex life, plus lower oestrogen levels can lead to vaginal dryness, which may make intercourse uncomfortable or painful.

Low libido is often one of the first sign things are changing, but many things besides menopause — including stress, medications, depression, poor sleep, and relationship problems — affect sex drive.

Managing Severe Symptoms

Conventionally women are likely to be offered HRT, the Pill or Coil and even antidepressants and blood pressure medication to cope with menopause symptoms.

Rebalancing hormones naturally with bioidentical hormones can help with all these symptoms plus herbal supplements and therapies such as acupuncture give relief for many women.

Menopause Health Risks

With menopause comes a greater chance of heart disease (which is the No. 1 cause of death for women), breast cancer and osteoporosis. Loss of oestrogen may play a role in heart disease after menopause, but hormone replacement therapy is not recommended to reduce the risk of heart disease or stroke.

Staying Healthy

Living a healthy lifestyle is important throughout a woman’s life and it is also a great time to upgrade your diet, physical activity, and stress management skills. Stress in particular has quite an impact on hormonal symptoms.

One ‘must’ at peri/menopause is to get regular physical activity. That includes aerobic exercise for the heart and weight-bearing exercise for the bones — both of which may help ward off the often inevitable weight gain and provide a mood boost.