Permanent cessation of menstrual bleeding in women is called menopause, which is due to loss of function of ovarian follicles. Consecutive 12 months amenorrhea (absence of menstruation is called amenorrhea) should be present to diagnose menopause. Normally menopause occurs in between 45 and 55 years of age. In the United States the average age of menopause is 51 years. Women who smoke, menopause can appear two years ahead of normal time.

Peri-menopause is the term used to refer the period preceding menopause. During peri-menopause the menstrual cycle becomes irregular along with waning of fertility. The period of peri-menopause lasts for two to eight years with an average of four years. During peri-menopause, menstruation should be absent for at least a year to call that menopause has begun. The period after menopause is called post menopause and during this period a woman may suffer typical health problems.

Diagnosis of menopause:

Women after 40 years of age with irregular menstrual bleeding can be diagnosed as peri menopause and during this period the irregularity of menstruation increases, e.g. amenorrhea may be become more frequent. Once peri-menopause sets in, continuous absence of menstrual bleeding for successive 12 months is called menopause. Essentially menopause is diagnosed clinically and no test is done or required for diagnosis of menopause.

Transition from peri-menopause to menopause:

The transition from peri-menopause to menopause may be a problem for women taking oral contraceptive hormone therapy to alleviate symptoms of peri-menopause. It may be difficult to determine whether to switch over to hormone replacement therapy (HRT) or not and if yes, when and how. Hence this should be individualized. The doses of estrogen and progestogen in HRT are lower than oral contraceptives and can not prevent pregnancy. Those willing to use barrier method of contraception should do so and advised to do so. During use of barrier method, if natural menstrual bleeding occurs oral contraceptives should be resumed. This should be repeated every year till permanent cessation of menstrual bleeding or menopause.

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