As menopause nears, the ovaries make less estrogen. One of the earliest and most common signs that menopause may be approaching is a change in your menstrual periods. You may skip one or more periods. The amount of flow may become lighter or heavier. Bleeding may last a shorter or longer time than is usual for you.

Even though periods tend to be irregular around the time of menopause, you should be aware of bleeding that is not normal for you. This could be a sign of a problem. Talk to your doctor if you:

• Notice a change in your monthly cycle.
• Have very heavy bleeding with clots.
• Have bleeding that lasts longer than normal.
• Bleed more often than every three weeks.
• Bleed after sex or between periods.

At some point, your ovaries stop making enough estrogen to thicken the lining of your uterus. This is when your menstrual periods stop.

Menopause also can occur when your ovaries are surgically removed. This may trigger severe symptoms because your hormone levels decrease all at once.

Although the removal of the uterus (a hysterectomy) ends menstrual periods, it will not cause menopause unless your ovaries also are removed. If your ovaries remain after surgery, typically you will go through menopause around the normal age.

See also:

• ObGyn care for midlife/menopause
• Alternatives to hysterecomy
• Midwifery