“Doctor, when will this menopause thing stop? I’ve been having hot flashes for months now and it feels like they are getting worse. On top of this my husband is complaining because I have zero interest in sex. But tell me, who would want to have sex when it feels like pins and needles are attacking your vagina?”

Sofia is 53, and she walks into the visit with what many women feel during this stage: symptoms that can be confusing, frustrating, and intensely personal.

Menopause is a new stage of life. Some women celebrate the transition. Others mourn it. However a woman feels about it, the loss of ovarian function does contribute to some health challenges while other medical conditions develop as a result of aging.

This article breaks down what menopause is, what perimenopause is, and what’s happening inside the body during the transition—so the overall picture feels clearer.

What is menopause?

Menopause is defined as “the period of permanent cessation of menstruation.”

Culturally, however, the condition is most often discussed in the context of the perimenopausal phase. This is the transition phase when a woman’s periods are becoming irregular prior to the actual permanent cessation of menses. The troublesome symptoms that accompany this transition are responsible for the infamy of this change.

Menopause results once the ovaries have stopped producing eggs. The hormonal consequence is a significant reduction in the circulating levels of estrogen, progesterone, and testosterone. For the most part, these hormones are created in the ovaries. Estrogen and testosterone can be produced in smaller quantities from other sites within the body.

The average age of menopause is 51.3 years, but can range from 45 to 55 years of age.

What is perimenopause?

Perimenopause is the period prior to menopause during which ovarian function is slowing and ovulation is less frequent. The menstrual cycle lengthens. This tends to occur after age 40 and can continue for 2 to 8 years before the actual menopause.

Hormone levels reflect these changes. Follicle stimulating hormone (FSH) levels tend to be increased. This hormone is working harder and harder to get the ovary to make follicles and to ovulate. The remaining follicles tend to be less responsive, so higher levels of FSH are required to stimulate them. Sometimes ovulation doesn’t occur. This explains decreased fertility in this age group.

The estrogen levels are not significantly reduced but may fluctuate based on the ovarian activity. At the point when there are no follicles left to respond, menstruation ceases forever!

What changes once menopause is complete?

Once the transition to menopause is complete, there may be some health consequences that can be directly associated with hormonal deficiency. Historically, estrogen has been identified as the culprit. The role of progesterone is discussed in the lay literature but has largely been unstudied despite anecdotal evidence to support its function.

Menopause is the post-reproductive stage of a woman’s life. Because it coincides with aging there are many potential health risks that arise during this time. It is important to know your risks so you can eliminate them and develop good health habits that may counterbalance these risks.

Take our Menopause Stage Assessment to help discover where you may be in your menopause journey: /menopause-journey