Understanding menopause
Dr. Lisa Kramer, initiator, gynecologist, and menopause specialist, explains what menopause is, the phases of the menopausal transition, what to expect in each phase (including onset, duration, and symptoms), and the treatment options.
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Menopause explained
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Surgical &
Medical Menopause
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Premature menopause
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Menopause and contraception
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Menopause and hysterectomy
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Menopause and Fertility
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Blood tests
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Thriving in Menopause
What is menopause?
Menopause is a completely normal and natural part of a woman's life. It's a time when our hormones change and our bodies adjust to the end of fertility. It's a phase in our lives where we should pause and take care of ourselves, so that we can live our best lives and thrive in the future.
The word 'Menopause' literally means 'the end of monthly cycles' (the end of monthly periods or menstruation), derived from the Greek words pausis ('pause') and mēn ('month').
What is menopause?
Menopause is a completely normal and natural part of a woman's life. It's a time when our hormones change and our bodies adjust to the end of fertility. It's a phase in our lives where we should pause and take care of ourselves, so that we can live our best lives and thrive in the future.
The word 'Menopause' literally means 'the end of monthly cycles' (the end of monthly periods or menstruation), derived from the Greek words pausis ('pause') and mēn ('month').
What is menopause?
What is menopause?
Menopause is a completely normal and natural part of a woman's life. It's a time when our hormones change and our bodies adjust to the end of fertility. It's a phase in our lives where we should pause and take care of ourselves, so that we can live our best lives and thrive in the future.
The word 'Menopause' literally means 'the end of monthly cycles' (the end of monthly periods or menstruation), derived from the Greek words pausis ('pause') and mēn ('month').
What is menopause?
Menopause is a completely normal and natural part of a woman's life. It's a time when our hormones change and our bodies adjust to the end of fertility. It's a phase in our lives where we should pause and take care of ourselves, so that we can live our best lives and thrive in the future.
The word 'Menopause' literally means 'the end of monthly cycles' (the end of monthly periods or menstruation), derived from the Greek words pausis ('pause') and mēn ('month').
What do the terms 'surgical' and 'medical' menopause mean?
Some women experience menopause due to reasons other than natural hormonal changes.
The two most common forms are surgical and medical menopause.
Surgical Menopause This occurs when a woman's ovaries are surgically removed. Hormone levels drop abruptly, and she experiences menopause immediately.
Medical Menopause This occurs when a woman's ovaries stop functioning due to chemotherapy, other medications, or radiation.
Statistics on the Transition to Menopause Today, there are an estimated 9 million women in Germany who are in some phase of the menopausal transition (perimenopause, menopause, and postmenopause).
Each of these phases is explained in detail below.
What is premature menopause or premature ovarian insufficiency (POI)?
Premature menopause or premature ovarian insufficiency (POI) occurs when a woman experiences menopause before the age of 40. This affects 1% of women and can be a devastating diagnosis.
If you are concerned about experiencing menopause before the age of 40, it is important to discuss this with your doctor. Your doctor can arrange tests and provide you with the necessary support.
It is crucial to receive proper guidance on hormone replacement therapy (HRT) to replace the estrogen your body no longer produces. This can help alleviate symptoms and significantly reduce long-term health risks. Your primary care physician can refer you to a fertility clinic for evaluation and discuss options if you wish to have children.
Early menopause occurs between the ages of 40 and 45 and affects an estimated 5% of women.
How long does menopause last?
The duration of menopause varies for each woman.
Perimenopause Perimenopause, the transition phase to menopause, varies in duration. Typically, this phase lasts about five years, but it can extend to eight to ten years.
Menopause Menopause itself lasts only one day because once you have gone twelve consecutive months without menstruation, you are considered postmenopausal and will remain so for the rest of your life.
Postmenopause Symptoms can persist in postmenopause, on average for about five to seven years. For instance, women typically experience hot flashes for about seven years on average, but over 40% of women aged 60-65 still have hot flashes and night sweats. Some women experience these symptoms for up to 20 years after menopause.
Dr. Lisa Kramer, a gynecologist specializing in menopause, reports:
"I have women in my practice who are in their 70s and 80s and still experiencing hot flashes."
What if I don't have regular periods due to contraceptives?
If you do not have a period due to taking hormones like an IUD or hormonal birth control pills, it can be challenging to determine if you are in menopause and at what stage you may be. This is because we cannot know if your ovaries are still producing hormones. Without these specific contraceptive methods, we would not know whether you would still have your periods or not.
Observing your symptoms—or their absence—is often the best way to determine if you are experiencing menopause.
What if I've had a hysterectomy?
Many women wonder if they will automatically go through menopause after a hysterectomy. If you've had a hysterectomy—meaning your uterus has been removed but your ovaries remain—your periods will stop because menstrual blood comes from the uterus.
Your ovaries will continue to produce hormones as usual, as long as they are functioning. You won't know when your last period would have been—but this is irrelevant for treatment options. What matters most are your symptoms and how you feel.
On average, women who undergo hysterectomy before menopause tend to experience menopause earlier than those who do not have a hysterectomy.
How does menopause affect fertility?
Fertility begins to decline around the mid-30s, particularly after the age of 35. Women's fertility decreases each year and continues to decline during perimenopause.
Contraceptive Options Just because you reach menopause doesn't mean you no longer need to consider contraception. If you are between 40 and 44 years old and have unprotected intercourse over the course of a year, the chance of pregnancy is about one in five. This probability decreases to about one in ten between the ages of 45 and 49. Therefore, you still need to use contraception if you do not wish to become pregnant.
It is rare (but not impossible) to become pregnant over the age of 50. You can consider stopping contraception when you are 55 years old.
Is a blood test worthwhile?
FSH and estrogen levels can be measured in the blood, making a blood test helpful in determining if your periods have stopped due to menopause, especially if you are under 40 years old.
Fluctuating Hormone Levels It's important to note that FSH levels can fluctuate daily during perimenopause. Therefore, a blood test may not be very reliable in determining if your periods have stopped or will stop soon.
FSH Testing and Symptom Management If you have symptoms, your periods have stopped, and you are over 45 years old, checking your FSH level won't change the options for managing your symptoms. It also won't provide useful information such as how long the symptoms will last or how severe they will be.
Benefits of a Blood Test However, a blood test can be useful, especially if your periods have stopped due to contraceptives. If you are using hormonal contraceptives that stop periods (like the IUD or mini-pill), a high FSH level can help your doctor determine when you can discontinue the contraceptives.
For more information on blood tests for estrogen levels, click here.
Successfully navigating through menopause
Did you know that women today can expect to live over 40% of their lives after menopause?
What better reason to take care of your menopausal symptoms and long-term health?
Seize this opportunity to make the most of your post-menopausal years and enjoy them to the fullest!
Learn more about staying healthy during the postmenopausal phase of life and explore different options for managing your menopausal symptoms.