What Causes Natural Menopause? A Deeper Discussion.

Natural menopause happens in women who haven’t had surgery, chemotherapy, or other treatments that bring on menopause. It occurs when a woman’s ovaries produce less estrogen (estradiol), and her body becomes less responsive to it. The ovaries, which hold a woman’s eggs, are the main source of estrogen. As we age, the number of eggs in the ovaries decreases, leading to these changes.

How does the menstrual cycle work?

During the reproductive years, the menstrual cycle is a coordinated process between the ovaries and the brain. The brain releases a hormone called FSH (follicle-stimulating hormone), which tells the ovary to prepare an egg. As the egg matures, it releases estrogen. This eventually causes the brain to release another hormone, LH (luteinizing hormone), which triggers ovulation (the release of an egg). After ovulation, the ovary produces progesterone, which prepares the body for pregnancy. If pregnancy doesn’t happen, progesterone levels drop, and a woman has her period.

What happens as menopause approaches?

As a woman nears menopause, her body produces less of two important hormones: inhibin B and AMH (anti-mullerian hormone). Inhibin B normally helps control FSH, while AMH helps protect the eggs. When these hormones decrease, the ovaries release eggs more quickly, leading to fewer eggs over time. This causes irregular periods and lower estrogen levels.

Simply put, menopause happens because the ovaries stop producing enough estrogen and progesterone as the number of eggs decreases.

At first, a woman’s periods may stay regular or become a bit shorter, often with more intense PMS symptoms. Eventually, periods will become more spaced out until they stop altogether. During this transition (called perimenopause), hormone levels can be all over the place—sometimes high, sometimes low—depending on the day.

Because hormone levels fluctuate so much, checking them through lab tests usually doesn’t help us treat menopause symptoms. Instead, we focus on treating a woman based on the symptoms she’s experiencing. The average age of menopause is 52. If a woman is, say, 46 and still having irregular periods but also experiencing hot flashes or other menopause symptoms, we’ll treat her based on those symptoms.

Treatment options for menopause are flexible and should be based on your preferences and medical history.

Many women want hormone therapy to relieve their symptoms, while others prefer non-hormonal options. The key is having a thorough discussion about all the options and creating a personalized plan that fits your needs.

For women who have had an endometrial ablation (a procedure that stops menstrual bleeding), they will still go through menopause even without periods. The symptoms—like hot flashes—are enough to indicate menopause is happening, and lab tests usually aren’t needed to start treatment.

Another hormone, testosterone, also decreases as we age, and we’ll discuss that in another post.