Menopause quiz

Natural menopause occurs most often during a woman's early 50s — on average around age 51 or 52. However, no two women experience menopause in exactly the same way, and that includes the age at which they enter menopause. One woman might experience early menopause — reaching menopause in her 30s — while another woman might not experience menopause until late into her 50s or even her 60s.

Several years before your last period, you may notice menopausal symptoms, even though you're still menstruating. This happens during a stage known as perimenopause, which literally means "around menopause" and refers to the years leading up to menopause and the first year after menopause.

During perimenopause, your hormone levels fluctuate, rising and falling unevenly. As a result, you may experience hot flashes and changes in your periods. Your menstrual flow may be heavier or lighter than usual, and you may have shorter or longer cycles, or start to skip some periods.

Although your fertility diminishes during perimenopause, it's still possible to become pregnant.

Although not every woman experiences hot flashes in the year or two before and after menopause, the majority do. By some estimates, as many as 80 percent to 85 percent of women have hot flashes at some point during perimenopause and the years after menopause (postmenopause).

The severity and frequency of hot flashes vary from woman to woman. Having a high body mass index and experiencing menopause at an earlier age both are linked to a greater incidence of hot flashes and night sweats (vasomotor symptoms).

Simple self-care measures, such as dressing in layers and avoiding alcohol and hot, spicy foods, may help relieve vasomotor symptoms. Some women swear by soy or black cohosh, although there's no scientific evidence that these supplements are effective. For many, estrogen therapy provides the best relief from vasomotor symptoms.

Although it's common to experience episodes of spotting or irregular bleeding during perimenopause, it's not normal to experience bleeding after menopause, unless you're on hormone therapy. Report any unexpected vaginal bleeding to your doctor so that you can be evaluated — if necessary — to determine the cause of the bleeding and to rule out a more serious condition, such as cancer of the uterine lining (endometrial cancer).

Bone mass drops most rapidly in the first few years after menopause, but bone loss persists throughout the postmenopausal years. When you lose bone faster than your body can replace it through normal bone remodeling, osteoporosis can result. Osteoporosis increases your risk of broken bones (fractures).

Regular exercise helps keep your bones and muscles strong. For the best bone protection, make regular exercise a lifelong habit, not just something you start when you're older. Try to do some type of weight-bearing exercise, such as walking, for 30 minutes a day on most days of the week.

To avoid osteoporosis, it's equally important to get enough calcium and vitamin D throughout your life. Your diet should include plenty of dairy products, calcium-fortified foods and beverages, and green leafy vegetables. If you have trouble getting enough calcium in your diet, take a calcium supplement — one that also includes vitamin D.

If you're at significant risk of osteoporosis, your doctor may recommend a prescription medicine, such as alendronate (Fosamax) or raloxifene (Evista), to keep your bones strong and reduce your risk of fractures.

Menopause, with its associated drop in estrogen levels, plays a role in the development of some urinary problems. Declining estrogen levels result in shortening and thinning of your urethra — the short tube that drains your bladder. You become more susceptible to urinary tract infections and certain other urinary problems as a result.

During perimenopause or after menopause, you could experience one of more of these urinary changes:

• A need to urinate more frequently
• Sudden urges to urinate even though your bladder may not be full
• Leaking urine when you have an urgent need to empty your bladder (urge incontinence)
• A need to get up to urinate during the night
• Leaking urine with coughing, laughing, sneezing or lifting (stress incontinence)
• Leaking urine during sexual intercourse or orgasm
• A burning sensation in the urethra with urination

If urinary changes interfere with your life — prompting you to avoid participating in activities or social gatherings — consider making an appointment with your doctor to discuss possible treatment options.

Over the menopausal transition, your sexual function may change. Although sexual desire tends to decrease in both men and women as they age, it's common for desire to decrease in women in their late 40s and 50s when estrogen levels are declining. It tends to take longer to become aroused during sex than it once did. The skin and tissues lining your vagina become thinner and drier, which can make sex uncomfortable or painful.

Some women become self-conscious about their aging bodies, which can affect enjoyment of sex and make sexual experiences less pleasurable than they once were. Other midlife women, however, enjoy a freedom and sexual awakening after menopause — with pregnancy and birth control no longer a concern — and feel more comfortable with their bodies and closer to their partners.

In general, women who enjoyed sex in their younger years continue to do so over the menopausal transition and beyond.

During perimenopause and after menopause, many women have difficulty getting a good night's sleep. Sleep disturbances tend to worsen as you progress through the menopausal stages.

You might have trouble falling asleep, staying asleep or falling back to sleep after waking during the night. Or you may awaken much earlier than usual. At night, you might experience hot flashes that trigger profuse sweating, leaving you drenched and uncomfortable — and awake.

Night after night of disturbed sleep can make you irritable and interfere with clear thinking and memory.

Doctors don't know exactly why, but abrupt transition into menopause — after surgical removal of your ovaries or cancer treatment, for example — is often linked to more severe menopausal symptoms. Usually, women who have medical or surgical menopause are more likely to need treatment to manage their menopause symptoms.

Menopause is a natural process. It may have little effect on you apart from making you slightly more sensitive to heat or less able to sleep soundly through the night. Most likely, you can handle these symptoms without medication.

Conversely, you don't have to put up with troublesome hot flashes, sleep disturbances and sexual problems if they interfere with your life. Effective treatments are available.