Menopause is considered the point in a woman's life when menstruation stops permanently, signifying the end of fertility. At least 36 million American women will live about one-third of their lives beyond menopause. It is a natural biological event that is associated with the reduction of ovarian function and declines in ovarian production of hormones -estrogen, progesterone, and androgen. The term "menopause" is derived from the Greek words "menses," meaning months, and "pausis" meaning pause.

The physiological process of menopause is called the climacteric, which lasts six to thirteen years. It is during this process where ovulation (egg production) ceases and menstruation becomes less frequent and eventually stops. The majority of women experience menopause naturally at the average age of 51. Technically, menopause is confirmed when a woman has not had her period for 12 consecutive months (1 year).

Genetics play a key factor, and women, oftentimes, experience menopause around the same age as their mothers. Although most women experience natural menopause, some medical treatments induce menopause, such as surgical procedures (e.g. hysterectomy with the removal of ovaries referred to as an oopherectomy), chemotherapy or radiation treatment. Menopause is considered premature if it occurs naturally before the age of 40. Women may experience an earlier menopause as a result of other factors such as smoking, a traumatic experience, and low body weight.

Many options are available for managing menopause symptoms. Hormone Therapy (HT) is by far the most effective way to treat women for the relief of menopausal symptoms and the prevention of osteoporosis. Non-hormonal therapies are also available to ameliorate symptoms. Lifestyle choices for relief of menopausal symptoms includes exercise, diet, nutrition, botanical therapies, vitamins and nutritional supplements. Your healthcare professional should provide you with understandable and high-quality information about menopause; ways to promote good healthy lifestyle changes (diet, nutrition, exercise programs); and information regarding the pros and cons of HT, non-hormonal and nondrug treatments.

0.1. Phases of Menopause

Women who experience natural menopause usually do so in phases: perimenopause, menopause and postmenopause. Approximately 36 million American women will live more than one-third of their lives beyond the onset of menopause.

0.2. Menopause Symptoms

Seventy-five percent of women report some symptoms during menopause, which can include hot flashes, night sweats, insomnia, breast changes, hair and skin changes, psychological and mood changes and sexual health changes. Hot flashes are the most common symptom of menopause, and 80 percent of all women with hot flashes have them for two years or less, while 20-25 percent have them for more than five years.

The continued decline of estrogen levels at menopause affects physical and emotional health. As estrogen levels decline, changes occur to the uterus, vulva, vagina, bones, heart, central nervous system and other organs and tissues. About 75% of women report some troublesome symptoms during menopause, but the severity of symptoms varies from woman to woman. The most common menopausal disturbances are:

• Hot flashes
• Changes in menstrual periods
• Palpitations
• Insomnia
• Loss of vaginal lubrication
• Numbness, tingling, pins and needles
• Formication
• Fatigue
• Headaches
• Mood swings, anxiety, irritability
• Increase in urinary conditions (frequent urination, urine leakage problems)
• Changes in sexual functioning (discomfort during sexual activity and loss of interest in sex)
• Changes in skin, digestive tract and hair
• Other symptoms may include memory loss, weight gain, strange joint and muscle pains and dry eyes and mouth.

Menopause can also bring about other long term effects as well. The continued decline in hormone levels may also cause:

• Increased risk for osteoporosis
• Increased risk for heart disease

0.3. Lab Tests to Confirm Menopause

Always check with your clinician to exclude any other medical causes that may have caused you to skip your menses. Your clinician will discuss with you your symptoms, your medical history, give you physical exam and may suggest you have laboratory tests to determine whether you are actually in menopause.

Tests are available, including some which you can take yourself, in the comfort of your own home. Scores of over them are available over the counter at your local pharmacy. They are inexpensive and (like pregnancy tests) promise a definitive answer in a matter of minutes. These tests may not necessarily be telling the entire story.

0.3.1. Follicle Stimulating Hormone (FSH)

FSH is a hormone produced by the pituitary gland that kicks off ovulation by stimulating the ovaries to develop follicles. An FSH test measures the amount of follicle stimulating hormone in a blood sample. This analysis is given to women to help evaluate menstrual problems and it is also helpful to determine whether a woman has gone through menopause. The test is available as a blood test or a urine test.You can purchase the urine tests without a prescription on websites although their reliability is questionable.

During the normal menstrual cycle, FSH levels rise slowly a few days before your period begins in order to develop a follicle. The follicle then works with another hormone (lutenizing hormone, or LH) to release an egg. Afterwards, FSH levels fall and progesterone kicks in, preparing for your next period (or pregnancy).

During perimenopause, when the ovary can’t make estrogen in response to the FSH, the brain says “keep on going!” So, the pituitary gland produces more FSH in hopes of stimulating the ovary to its former function. Therefore, the theory behind the FSH tests is that high levels can indicate menopause… during a particular day within your cycle. Levels measuring greater than 30IU/L are elevated and are often used to indicate menopause.

It sounds straight forward enough, right? Sure, FSH levels will tell you when your ovaries are getting close to shutting down follicle production. But, how do you know they’re not just in a wild state of confusion and fluctuation (typical of the years leading up to menopause, perimenopause)? Or, if you are not in menopause, the FSH test will only tell you where in your cycle you are. Higher levels could just indicate your body’s getting ready to ovulate.

I’m sorry to say that just because you haven’t had your period for 3 months and are continuing to feel the fiery inferno of hot flashes on a regular basis, it may just be a peak at the top of the perimenopause roller coaster. Elevated levels can occur even as long as ten years before menopause. In the Massachusetts Women’s Health Study, 20% of midlife women who experienced 3 months without their period, began menstruating again. See how a single measurement of FSH greater than 30IU/L may not be enough to determine menopause?

If you’re still set on getting an FSH test to determine where exactly you are in the menopause transition, ask your doctor about getting one, do not use the home tests which are commonly advertised on websites. The FSH tests that clinicians give are blood tests. Since FSH fluctuates, it's best to have this test within the first three days of your period when FSH levels are at lower levels. What clinicians are looking for with this test is a confirmation of menopause that substantiates a high level of FSH. Menopausal women typically have FSH levels higher than 30, and sometimes in the 100s.

0.3.2. The Estradiol Test

The estradiol test is another blood test clinicians use to diagnose menopause. This test will tell you exactly how much estrogen your ovaries are producing.

One of the many types of estrogen circulating the body is estradiol. This test looks for an estradiol level lower than 50 pg/ml (picograms per milliliter). Clinicians usually agree that an estradiol of 20 or 30 confirms menopause.

During perimenopause, one or two years before menopause, the number of follicles producing estrogen decreases. Ovulation slows down and estradiol levels drop, (although FSH continues to rise). This is when the temperature feels like it starts to rise and the hot flashes come into play.

When menopause occurs and estrogen production decreases, you can easily measure levels in the bloodstream. Levels lower than 50pg/ml usually indicate menopause. During perimenopause and the normal menstrual cycle, levels can range between 50 and 400pg/ml.

When measuring estrogen levels, it is important for your clinician to know exactly where you are in your cycle. This raises a problem for reading levels during perimenopause, as a woman’s cycle are usually irregular (remember the roller coaster earlier). Low estradiol levels may just indicate a woman is very early or very late in her cycle.

0.3.3. Saliva Testing

Another test that is often used to diagnose menopause is the saliva test. This test is a waste of money, so stay clear. It uses saliva, instead of blood to determine hormone levels. It sounds appealing and less invasive but unfortunately, the results have not proven accurate or reliable.

Many compounding pharmacies recommend using the saliva test to determine the combination of custom-compounded hormones they should mix. But, what is the “right” amount of hormones a woman needs to prevent symptoms? Unfortunately, a true standard has not truly been established. Your comfort level may not even be related to your hormone levels.

The North American Menopause Society (NAMS) does not recommend custom compounded products over well-tested, government-approved products for the majority of women – and does not recommend saliva testing to determine hormones.

Things to Keep in Mind When Choosing a Test to Diagnose Menopause

First remember, it's unfortunate, that these lab tests don't always give definitive answers as to the question of where you are in the menopausal process. These tests may also be quite expensive and can add up in costs, especially, if you have to have them taken often. So, to keep your medical costs under control, please discuss whether your clinician feels any of these tests are worthwhile.

Perimenopause is not a static state. Your hormones, your body, your stresses are all in a state of flux. You can feel a little more menopausal at some times than other s (remember when the sheets were sticking like saran wrap to your legs that one night)? Blood tests, urine tests and saliva tests are all available but keep in mind, the hormone levels they measure are all greatly variable.

Menopause is a natural change in life. It is not a disease or a sickness. The surefire way to find out if you’re in menopause is keep a calendar of your cycles. When you haven’t experienced a menstrual cycle for 12 consecutive months, welcome to The Club!

If you’re really struggling with symptoms and still having your cycle, you are most likely in perimenopause. If symptoms are getting in the way of your life and you are experiencing great discomfort, you have many options. Talk to your clinician about the many routes you can take to prevent and relieve symptoms and manage menopause.