This is the time that marks the end of the menstrual cycles. Menopause is diagnosed after you have gone 12 months without a menstrual period. It can happen in the 40s or 50s. In the United States, the average age for menopause is 51 . This is a natural biological process. The physical symptoms of menopause, such as hot flashes and emotional symptoms can affect your emotional health, lower your energy and disrupt your sleep. There are many treatments which can be used for menopause, such as hormone therapy and lifestyle adjustments.
Symptoms: In the months or years which are leading to menopause (a period known as perimenopause), you can experience some of the following signs and symptoms:
- Loss of breast fullness
- Thinning hair and dry skin
- Weight gain and slowed metabolism
- Mood changes
- Sleep problems
- Night sweats
- Hot flashes
- Vaginal dryness
- Irregular periods
The symptoms of menopause, including the changes in menstruation, are different for every woman. In the most cases, women will experience some irregularities in their periods before they end. It is very common and expected to be skipping periods during the menopause. In many cases, menstrual periods will skin a month and return or they can skin several months and then start monthly cycles again for a few months. Also periods tend to happen on shorter cycles which mean that they are closer together. But it is possible to be pregnant so if you have skipped a period and you are not sure that you have started the menopausal transition, then you should make a pregnancy test.
Menopause Symptoms Causes
Causes: Here are some causes for menopause:
- Primary ovarian insufficiency: It is known that about 1% of women experience menopause before age 40 (known as premature menopause) . The menopause can be result from an ovarian insufficiency (this is a condition when your ovaries fail to produce normal levels of reproductive hormones) which is caused by autoimmune disease or genetic factors. But there are many cases when the cause is not found. Doctors are recommending hormone therapy for these women at least until the natural age of menopause in order to protect the heart, bones and brain. 
- Natural decline of reproductive hormones: It is known that when women approach their late 30s, then their ovaries start to make less progesterone and estrogen (these are hormones that regulate the menstruation) and your fertility declines. When you are in your 40s, then your menstrual periods may become shorter or longer, lighter or heavier and less or more frequent until eventually (on average is by the age of 51) stop producing eggs and you do not have periods. 
- Chemotherapy and radiation therapy: These are cancer therapies which can induce the menopause and this is causing symptoms, such as hot flashes during or shortly after the course of the treatment. The fertility and the halt to menstruation are not always permanent following the chemotherapy so the birth control measures should be used. 
- Hysterectomy: The hysterectomy which has removed the uterus but not ovaries usually is not causing immediate menopause. You will no longer have periods but your ovaries will still release eggs and produce progesterone and estrogen. The surgery which removes both the ovaries and uterus is causing immediate menopause. You will notice that your periods will stop immediately and you are having more chances to get hot flashes and other menopausal signs and symptoms that can be severe and these hormonal changes happen abruptly rather than over several years. 
Complications: Your risk of certain medical conditions increases after the menopause, such as
- Weight gain: After the menopause metabolism slows and many women gain weight during the menopause.
- Sexual function: The loss of elasticity and the decreased moisture production lead to vaginal dryness which can cause discomfort and slight bleeding during the sexual intercourse.
- Heart and blood vessel disease: When the estrogen levels decline, then the risk of cardiovascular disease increases. The heart disease is the leading cause for many women. 
 Stoppler MC, Shiel WC. Menopause. eMedicine Health.
 Hewlett M. Mahalingaiah S. Update on primary ovarian insufficiency. Current Opinion in Endocrinology, Diabetes and Obesity. 2015;22(6):483–9.
 Su HI, Freeman EW. Hormone changes associated with the menopausal transition. Minerva Ginecologica. 2009;61(6):483–9.
 Australasian Menopause Society. Early menopause due to chemotherapy and radiotherapy. Retrieved from www.menopause.org.au/hp/information-sheets/319-early-menopause-due-to-chemotherapy-radiotherapy
 Duke University Medical Center. Hysterectomy increases risk for earlier menopause among younger women, study finds. Science Daily. 2011.
 Huang CH, Li CL, Kor CT, Chang CC. Menopausal symptoms and risk of coronary heart disease in middle-aged women: A nationwide population-based cohort study. PLoS One. 2018;13(10):e0206036.