A woman’s monthly periods permanently stop at menopause, usually measured from when she has missed her period for twelve consecutive months. Aging naturally depletes a woman’s ovarian egg cells, therefore menopause marks the permanent end of fertility. Hormone tests alone cannot tell when you are in menopause.

Perimenopause comes first

Your transition begins several years before actual menopause. Changing levels of estrogen in your body cause the normal signs of perimenopause: irregular periods, hot flashes, vaginal dryness, sleep disturbances, and mood swings.

Knowing if you are in perimenopause can give you peace of mind. The doctor may be able to diagnose perimenopause by reviewing your medical history, your menstrual history, and your other signs and symptoms. You can ask your doctor to test you for other causes of your symptoms, such as thyroid disease. A complete medical examination can reveal problems that act like perimenopause.

Your body changes in perimenopause, then at menopause, so extra attention to your health will help keep you feeling well.

Contraception options during perimenopause

Your changing hormone levels still allow pregnancy, because you are still fertile. We recommend birth control of some kind until a year after your last period.

Effective birth control options include:

  • birth control pills, patches, or rings
  • progestin pills, implants, and injections
  • intrauterine devices (IUDs)
  • sterilization (tubal ligation, fallopian tube inserts, vasectomy)
  • barrier methods (condoms, diaphragm, spermicide)

Early menopause

Surgery on your ovaries and loss of normal function of your ovaries before you are 40 (primary ovarian insufficiency or POI) can give you menopause-related symptoms. Lower estrogen levels can affect your bone density and possibly your brain and sexual functions. Early menopause means that you have become infertile before the typical menopause age of 51.

Natural menopause

Natural menopause typically happens between ages 40 and 58. Smokers may get there about two years earlier than nonsmokers, although fertility medications, use of birth control pills, your age at first period, and your race seem not to affect the age at menopause.


You will have lower levels of reproductive hormones, especially estrogen. Low estrogen can cause:

  • hot flushes and night sweats
  • mood swings, depression, and difficulty concentrating
  • insomnia
  • vaginal dryness, painful intercourse, and urinary incontinence
  • skin thinning and decreased elasticity

Lower androgen levels can contribute to the loss of sex drive.

Be sure to report abnormal vaginal bleeding to the doctor, because it might be caused by a precancerous or cancerous uterus or endometrial lining. Lower levels of reproductive hormones also increase the risk of osteoporosis, bone fractures, heart attack, and stroke.


A general health screening at menopause should include

  • pelvic exam with PAP smear
  • clinical breast exam and mammography
  • X-ray screening for osteoporosis
  • colonoscopy and fecal occult blood testing
  • blood tests including lipid and thyroid screening


A healthy lifestyle can help lower your risk of osteoporosis, bone fractures, and heart disease.  A nutritious diet, vitamin D and calcium supplements, regular weight-bearing exercise, and eliminating cigarettes and alcohol combine to boost your health.

To alleviate or reduce menopausal symptoms, hormone replacement therapy may help, but take the lowest possible dose for the shortest time to reduce the risk of breast cancer, blood clots, heart attack, and stroke.


Your estrogen levels will continue to decrease, so vaginal dryness and hot flashes may continue. Your risk for related diseases like osteoporosis increases.

All menopausal women must consider their bone health, quitting smoking, their alcohol use, their cardiovascular risk, and cancer screening and prevention. Address these with your doctor, so that together you can discuss lifestyle changes to help maintain your health and vitality. Menopausal symptoms like hot flashes may be helped with hormone replacement therapy.

Wherever you are…

…in your perimenopause, menopause, or postmenopause, come in to see Dr. Nangrani for a checkup. If you have uncomfortable symptoms, we may be able to make you feel better.

For more information, see The North American Menopause Society site.

You, our client, are our top priority here at Vedas. Located in The Woodlands, Texas, our North Houston office is conveniently located only minutes from I-45 (Houston’s North Freeway). We offer you a free consultation for personalized information on menopause in The Woodlands. Come get acquainted with Dr. Nangrani, our board-certified Medical Director. She has practiced for over 15 years. Please call our office to schedule your consultation (281) 298-5476

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