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Menopause is a natural bodily process for women – understanding how and why it works can help keep you comfortable.

It seems that everyone is acquainted with the basics of menopause these days – your monthly menses, or periods, end for good, and for a time you have hot flashes that come seemingly out of nowhere and leave you feeling as hot as a summer’s afternoon. These and other symptoms are hallmarks of change in a woman’s body.

Understanding how and why these changes occur is the key to managing symptoms for comfort and discretion. The root cause of these symptoms is falling hormonal levels that regulate estrogen and progesterone.

Understanding the Menstrual Hormones

People largely think of menstruation as a physical process, however, the causative factors are actually a series of hormones produced in the pituitary gland and ovaries. The hormones wax and wane through an approximate 28-day cycle. In order of appearance, they are:

  1. Follicle-stimulating hormone (FSH): Produced by the pituitary gland, FSH causes the ovaries to produce several egg-containing sacs (follicles) each month. When FSH levels fall every month, only the strongest follicle will continue to develop.
  2. Estrogen: Triggered by the fall of FSH, estrogen ramps up in order to tell the uterus to build a blood-rich lining to prepare for possible egg-implantation and pregnancy.
  3. Luteinizing hormone (LH): When estrogen reaches a certain level, another pituitary hormone, LH, surges, stimulating the ovary to ovulate or release the egg.
  4. Progesterone: The LH surge stimulates production of progesterone. With estrogen, progesterone makes the lining of the uterus thicken even more, and conducive to nourishing a fertilized egg. If pregnancy does occur, estrogen and progesterone continue to rise, otherwise the levels drop which triggers the uterus to shed the ultra-rich lining (menstruation) and begin the process anew.


While the average age of menopause in the United States is 51, perimenopause, or the series of changes leading up to menopause, can begin as much as 10 – 15 years earlier. Research has found subtle changes in estrogen and progesterone production as early as a woman’s late 30s.

At this time, the number of follicles in the ovaries decline steeply and therefore less hormones are required to help the follicles mature. Fewer follicles also results in less progesterone. With less progesterone, estrogen is unchecked, which causes an irregular buildup of the uterine lining. Menses become irregular as a result; periods are longer or shorter, heavier or lighter than normal.

Estrogen levels also drop as a woman nears menopause. Symptoms caused by estrogen levels are thought to affect the entire body and last for a longer period of time. For example, estrogen affects the brain, breasts, heart and blood vessels, uterus, urinary tract, and skin, therefore its decline causes some of the more undesirable symptoms such as hot flashes and vaginal dryness, and potentially breast tenderness and fibroids if estrogen happens to spike.

Menopause: The Finish Line

Menopause is a finite process. The ovaries stop releasing eggs, and they produce much less estrogen and no progesterone. The new lows of these hormones no longer stimulate the uterus to build up and shed and therefore menstruation stops. Experts agree that 12 months after a woman’s last menstrual period, she has officially reached menopause.

Every woman does eventually reach menopause, though the process looks different for everyone. As each woman’s hormonal profile is different, so are their symptoms and timeline. Even though this is a natural and common process, please consult your health care team if anything seems amiss.

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