Most women cease to have periods between the ages of 45 and 55, with the average age ofonset of menopause being 51. Some women may even continue having their periods intheirlate 50s. Ovarian function can begin declining many years before menopause in certain cases.Although genetics play the most crucial role in determining the age of onset of menopause,environmental factors that causeadecline in ovarian function, such aschemotherapy andsmoking, can cause menopause to occur prematurely.

Perimenopause is the time period before menopause has occurred. During perimenopause, the body slowly starts transitioning into menopause as the production of sex hormones by the ovaries reduces. Some symptoms of menopause, such as hot flashes, may start to occur during perimenopause. Irregularity in your menstrual cycle may also occur although complete cessation of menstruation does not take place. Menopause is the stage in which the menstrual cycle ceases completely for one year.

The commonest symptom of low estrogen levels in the body is hot flashes, occurring in approximately three in every four women. Mood swings and pain in muscles and joints (arthralgia) are also common. Some of these symptoms are caused by a combination of lifestyle factors, aging, and changing hormone levels.

When a hot flash occurs, you will feel a rise in your body temperature. The top half of your body is most commonly affected with your skin becoming flushed. Dizziness, sweating, and palpitations often follow this rise in temperature, leaving you feeling cold afterwards. Some women experience hot flashes every day or even several times during one day. Hot flashes may continue to occur for several years after menopause.
Certain triggers of hot flashes can be avoided to reduce their frequency and intensity. These include:
*Caffeine and alcohol consumption
*Eating spicy food
*Stress
*Going to hot places

Smoking and obesity also worsen hot flashes. Some techniques that can help cope with hot flashes and associated symptoms are:
*Wearing multiple layers of clothing and using a fan in the office space or home
*Performing breathing exercises that reduce hot flashes
Hormone therapy and medications such as birth control pills can help reduce hot flashes.
If managing hot flashes with simple techniques is not working for you, consult your healthcare
provider.

Decreasing estrogen levels result in lowered calcium levels in our bones. This leads to a loss of bone density–a condition known as osteoporosis. With weaker bones, the chances of fracturing your spine, hip, and other bones increases. This bone loss can be very rapid at the beginning of menopause. You can keep your bones strong by:
*Increasing vitamin D intake through supplements
*Doing weight training exercise regularly
*Avoiding alcohol and smoking
*Eating calcium-rich foods such as green, leafy vegetables, and dairy products

Some prescription medications can also help prevent bone loss.

Symptoms associated with your heart, such as palpitations, may occur during menopause. The flexibility of your blood vessels is affected by reduced estrogen levels. It is, thus, important to avoid smoking, maintain a healthy weight,
and exercise regularly to reduce the risk of developing heart disease.

Weight gain due to changes in hormone levels is common during menopause. Other factors, such as aging, may also be responsible for weight gain. Maintaining a balanced diet and doing regular exercise are important to ensure that your weight does not increase too much. Obesity is a major risk factor for conditions such as heart disease and diabetes.
Some tips for managing your weight are:
*Make modifications to improve your lifestyle
*Eat a balanced diet with high calcium and low sugar levels
*Ensure that you get at least 150 minutes of moderate or 75 minutes of intense exercise
*Incorporate weight training into your exercise regimen

Even in individuals of the same family, the symptoms of menopause can vary because the rate of ovarian decline is different in different people; therefore, each individual requires a unique way of managing the symptoms. What works for one family member may not work for the other. Consulting a doctor about the management of your symptoms is a good step to ensure that you get the treatment you need.

If you have undergone surgical removal of your uterus, hot flashes can serve as an indicator that you are going through menopause.The same is the case if you have undergone endometrial ablation due to heavy menstruation. In case you don’t experience any symptoms, your healthcare provider can perform a blood test to determine the extent of functioning of your ovaries. Knowing the levels of estrogen in your body is beneficial because you may require a bone density assessment to rule out osteoporosis

Many hormone therapies have been approved by the FDA for treating hot flashes and preventing bone loss. Depending upon your health status and the severity of your symptoms, the risks and benefits can vary. Before you try any such therapy, talk to your doctor as it may not be right for you.

Hormone therapy is contradicated in certain medical conditions. You may decide not to undergo hormone therapy for personal or medical reasons. Certain lifestyle changes can help alleviate many of the symptoms of menopause without the need for hormone replacement.These modifications include but are not limited to:
*Maintaining a healthy weight
*Exercising regularly
*Reducing room temperature
*Avoiding food items that trigger symptoms
*Wearing layers and light cotton clothing

Acupuncture, self-hypnosis, herbal therapies, some antidepressants as well as other medicines can help reduce the symptoms of menopause such as hot flashes. Over-the-counter lubricantsand estrogen creams can helpalleviate vaginaldryness.