About all

Age women go through menopause: The request could not be satisfied


About menopause | The Royal Women’s Hospital

Menopause is a natural event for women.

In the lead-up to menopause, your ovaries may not produce an egg each month. This can lead to changes in the hormones circulating in your body. Specifically, oestrogen levels may be increased and progesterone levels may be lower. After menopause, oestrogen levels also fall considerably. Women are considered ‘postmenopausal’ one year after their final menstrual period. Menopause usually occurs naturally at around age 50 but may happen earlier due to chemotherapy, radiation treatment or surgery.

What is the menopause?

Menopause consists of three stages:

  • The menopause transition (also called perimenopause). These are the years leading up to the final menstrual period and the year after the final menstrual period. During this time, changes in your hormones may lead to symptoms such as hot flushes and changes in menstrual bleeding patterns. Night sweats (hot flushes occurring at night) can cause sleep disturbances and affect your mood and concentration during the day. Some women are still able to conceive during the menopause transition so you should continue to use contraception until at least twelve months after your final period if you don’t wish to become pregnant.
  • Natural menopause is the spontaneous, permanent end to menstrual periods that is not caused by medical treatment or surgery. It is confirmed by twelve consecutive months of no menstrual bleeding.
  • Postmenopause is the time beyond one year after your final menstrual bleeding and lasts for the rest of your life.

How will menopause affect me?

Menopause affects every woman differently. Most women (around 85 per cent) get some hot flushes and/or night sweats but are able to manage these without treatment. Around 20 per cent of women have symptoms which are troublesome and/or prolonged and these women may consider treatment. The experience of menopause and symptoms differ in women from different ethnic groups, for example, for some Asian women, body and joint aches and pains are the most troublesome symptom.

Factors that may affect your experience of menopause
  • Your age at menopause. Younger women who were not expecting to go through menopause may have more difficulty than women at the average age.
  • What you are expecting of menopause. Women who expect to have troublesome menopausal symptoms are more likely to experience troublesome symptoms when they go through menopause. So, a positive and informed approach to menopause may help.
  • Many women are relieved that they no longer have menstrual periods and are no longer fertile. 

When does menopause begin?

Menopausal symptoms (hot flushes, night sweats, menstrual changes) usually start from around age 47 years. The final menstrual period is usually about age 51 but can vary considerably. There is currently no reliable way to predict when you will experience menopause and what your menopausal symptoms will be like.

When menopause happens before 40 years it is called ‘premature’, and when it happens before 45 years it is called ‘early’. Menopause after age 45 years is considered normal and there is no upper age limit to when it can begin. However, most women have experienced menopause by age 55 years.

Why does menopause happen?

The reasons for menopause are not well understood. Currently, we think that menopause happens because the ovaries run out of eggs. This leads to changes in the hormones produced by the ovaries and the hormones from the brain that control the ovaries. Eventually, the ovaries stop producing eggs and menstrual periods stop permanently. After menopause, the ovaries continue to produce oestrogen at lower levels and also testosterone.

When menopause comes early

There are risks associated with early menopause:

  • Loss of fertility at a younger age.
  • An increased risk of osteoporosis and fracture in women who do not take menopausal hormone therapy (MHT).

Early menopause is particularly difficult for women who have not yet started or completed their families. 


The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.

Predict When You’ll Go Through Menopause

Despite great advances in reproductive health, figuring out when you’ll go through menopause is really more of an art than a science. There’s no simple screening, and even tests that measure hormone levels won’t tell you exactly when your periods will cease, says James Liu, MD, chairman of the department of obstetrics and gynecology at University Hospitals Case Medical Center in Cleveland. But there are some clues that can help you make a smart guesstimate. (Want to pick up some healthier habits? Sign up to get healthy living tips delivered straight to your inbox!)

For starters, it helps to pay attention to averages. “Most women go through menopause somewhere between the ages of 45 to 55, with the average being about age 51,” says Liu. That said, natural menopause sometimes occurs in the early 40s or even before. (When it happens before 40, it’s considered “premature menopause.”) And some women continue menstruating until their late 50s.

So which camp will you be in? Ask yourself these four questions before placing any bets.

1. When did your mother go through menopause?

Troels Graugaard/Getty Images

This is probably the biggest factor, so if your mom didn’t reveal when she went through “the change,” you may want to inquire. “Most women go through a natural menopause at about the same age as their mothers, within a few years either later or earlier,” explains Liu, who is also a specialist in reproductive endocrinology and a professor of obstetrics and gynecology at Case Western Reserve University School of Medicine. In fact, several studies have shown that women whose mothers went through menopause early had about a sixfold increase in their odds of a premature or early menopause themselves.

MORE: 11 Highly Effective Solutions For Sciatic Nerve Pain

2. Are you a smoker?
Cigarette smoke is toxic to your lungs and your heart, and it seems to wreak havoc on a woman’s ovaries as well. “We’ve known for years that smoking is bad for your health, but many people don’t quite understand just how bad it is in terms of reproductive health,” says Aaron Styer, MD, an obstetrician, gynecologist, and reproductive endocrinologist at Boston’s Massachusetts General Hospital.

One recent study, published online in the journal Tobacco Control, looked at data collected from nearly 94,000 women and found that smokers had a 26% increased risk of menopause before age 50, compared with women who never smoked. Ex-smokers tended to have a similar fate, but it’s still worth quitting: The longer you smoke and the more you smoke (in terms of number of cigarettes), the more likely you are to reach menopause at an earlier age. While you’re at it, stay away from secondhand smoke; it’s also tied to earlier menopause.

MORE: 7 Weird Reasons You’re Gaining Weight

3. Did you ever have chemo?

Caiaimage/Sam Edwards/Getty Images

Cancer treatment can save your life, but it might put an end to your fertile years. Chemotherapy may damage the ovaries and cause your periods to halt, though the ultimate impact depends on your age and the type and amount of chemicals used, according to the Office on Women’s Health. Some young women who undergo chemo eventually start menstruating again. But if you’re already close to the typical age of menopause, your periods probably won’t return, according to the Cleveland Clinic.

4. What’s your BMI?
More research is needed, but a study published in the journal Menopause found that women who are considered overweight or obese based on their body mass index (BMI) are somewhat more likely to go through menopause at an older age, compared with thinner women. (Looking to drop some weight? Here are 6 ways to get started when you have 50+ pounds to lose.)

Wondering if you should also factor in the age at which you got your first period, whether you’ve used hormonal birth control, how many children you’ve had, and whether you breastfed? Don’t bother. Many people believe that these things matter for menopause, but there’s no evidence that they do, says Styer.

This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io

What Is Perimenopause And How Young Can It Start? : Shots

Katherine Streeter for NPR

Katherine Streeter for NPR

Sarah Edrie says she was about 33 when she started to occasionally get a sudden, hot, prickly feeling that radiated into her neck and face, leaving her flushed and breathless. “Sometimes I would sweat. And my heart would race,” she says. The sensations subsided in a few moments and seemed to meet the criteria for a panic attack. But Edrie, who has no personal or family history of anxiety, was baffled.

She told her doctor and her gynecologist about the episodes, along with a few other health concerns she was starting to notice: Her menstrual cycle was becoming irregular, she had trouble falling asleep and staying asleep, and she was getting night sweats. Their response: a shrug.

It wasn’t until Edrie went to a fertility clinic at age 39 because she and her partner were having trouble conceiving that she got answers. “They were like, ‘Oh, those are hot flashes. It’s because you’re in perimenopause,’ ” she says.

If you haven’t heard the term “perimenopause,” you’re not alone. Often when women talk about going through menopause, what they’re really talking about is perimenopause, a transitional stage during which the body is preparing to stop ovulating, says Dr. Jennifer Payne, who directs the Women’s Mood Disorders Center at Johns Hopkins University.

“Technically, menopause is only one day in a woman’s life, which is exactly when she has not had a period for 12 months,” she says. “It’s the period of time leading up to menopause that causes all the trouble.”

And it can start earlier than you might think. Many listeners wrote to us in response to our call-out for individual experiences with menopause to say that they struggled to get medical support for perimenopause in their mid-30s and early 40s.

When Edrie went back to her OB/GYN with the fertility clinic’s conclusion, she says the doctor shrugged again and told her that menopause is a normal part of life. She wasn’t satisfied with that answer. “Yeah, it’s a normal part of life, but it would be great if we could talk about it and figure out strategies.”

With that spirit in mind, we reached out to endocrinologists, gynecologists and psychiatrists for advice about navigating this major life transition.

How early can perimenopause start?

It’s quite possible for women to start to notice things changing in their mid-30s. Most women arrive at menopause between the ages of 45 and 55, but perimenopause can start as much as a decade beforehand. And about 1% of women in the U.S. reach menopause at age 40 or younger.

How do you know if you’re starting perimenopause?

The most telling symptom is changes in your menstrual cycle, says psychiatrist Hadine Joffe, the executive director of the Connors Center for Women’s Health and Gender Biology at the Brigham and Women’s Hospital in Boston.

“It’s the menstrual cycle pattern that really defines this lead-up to menopause,” she says. During perimenopause, periods “might be shorter, then a long one, or then a skipped one, or then the flow might be different,” says Joffe.

There’s no blood or hormone test that can “diagnose” perimenopause. Joffe says a hormone test isn’t helpful because hormonal cycles become erratic and unpredictable during this stage.

“There’s not really one point in time when a hormone test is done that can be definitive,” she says. Even if you took several tests over time, “you might get a very different readout.”

Surprisingly, sometimes doctors aren’t prepared to help women recognize the start of this life phase. Edrie was upset at her doctors’ responses — or lack thereof. “I felt so disappointed in the medical industry. How many women has my OB/GYN seen and not recognized the symptoms of perimenopause?”

What symptoms to expect

Be prepared for your PMS symptoms to possibly shift, becoming either more or less extreme, says Dr. Cynthia Stuenkel, a founding member of the North American Menopause Society and a professor and endocrinologist at the University of California, San Diego, School of Medicine. “Women might not get the same kind of breast tenderness or mood shifts that they may have noted in the past,” she says.

Mood problems like depression can spike during perimenopause, especially among women who have previously experienced them. Many of our listeners wrote in to say that during perimenopause, they felt incredibly irritable and quick to anger in a way that they had never experienced before.

And of course, many — but not all — women experience hot flashes, though they may not recognize them. “It’s hard, because no one sits us down and teaches us, ‘Here’s what a hot flash feels like,’ ” Stuenkel says. “I’ve seen women who think they’re having panic attacks, or heart palpitations. That can be frightening.”

Other common symptoms include more frequent urinary tract infections, difficulty sleeping through the night, vaginal dryness that can make sex painful, night sweats and a decrease in libido.

What treatments are there for symptoms?

Some symptoms, like heavy or irregular periods, can be managed with an oral contraceptive, which can “shut down the body’s own erratic hormonal fluctuations,” says Stuenkel.

“This can kind of be a lifesaver,” she says. Such medication may help with hot flashes, too.

In some cases, doctors may prescribe menopausal hormone therapy, or very low doses of hormones to supplement estrogen levels. Stuenkel says it’s not a fit for everyone, but it doesn’t deserve the bad reputation it has in some circles. She says there was an “exodus” from the use of hormone replacement therapy after the Women’s Health Initiative trial halted a study over safety concerns in 2002. But many clinicians now feel much more comfortable using hormone therapy again and usually recommend low doses, selectively, for shorter periods of time.

For people who cannot take estrogen therapy, or choose not to, Stuenkel says some drugs in the antidepressant family, such as SSRIs and SNRIs, can help with hot flashes. Stuenkel says, “While they’re not perfect, they can take the edge off and help enough so that women can get a better night’s sleep.”

There are an abundance of nonhormonal, nondrug treatment options for managing symptoms, some of which have significantly more evidence backing them than others. In 2015, a North American Menopause Society panel found that cognitive behavioral therapy and hypnosis were significantly effective in treating hot flashes. The same panel also found that popular herbal remedies (like black cohosh, dong quai and evening primrose) are “unlikely to help,” although some NPR listeners who wrote in said they got relief from some of those treatments.

For depressive and anxiety symptoms, women may want to seek out professional counseling or a psychiatrist.

When do I need to see a doctor?

You might not need to at all. Some people sail right through menopause with little trouble. But if you are experiencing symptoms that are interfering with your life, it’s worth making an appointment. Some of these symptoms could indicate other problems that need treatment, such as fibroids or even cancer.

Ways to cope with symptoms

For people approaching this stage of life or who are already going through it, here are four steps for making this transition more manageable.

1. Get educated

“Information is key,” says Joffe. She suggests that people approaching perimenopause age empower themselves with knowledge.

The Massachusetts General Hospital Blum Center has a curated list of suggested books. The National Women’s Health Information Center has a section on menopause and perimenopause. The American College of Obstetricians and Gynecologists also has a perimenopause FAQ.

2. Monitor your health

Joffe encourages people to track symptoms: “menstrual patterns, hot flash patterns, mood issues, major life triggers.” Using a paper calendar or an app to monitor symptoms can make it easier to give your doctor details that can be otherwise hard to remember.

“Knowing that information, somebody can say, ‘Well, over the last six months, I only had two periods or I had hot flashes almost every day,’ ” Joffe says, “or, ‘My mood was as bad as it gets for only two days or for a third of the time. ‘ ”

And if you bring a thorough health history to your physician and they still give you a shrug, consider a specialist. “There are OB/GYNs that specialize in perimenopause and menopause,” Joffe says.

3. Practice smart self-care

Joffe encourages women to protect themselves from things that might worsen their mood or well-being. This includes reducing stress when they can and making sure they get enough sleep.

“Sleep is critical,” she says. “Getting a good night’s sleep, and making sure it’s not broken in the middle of the night.”

There are lots of online tools and apps to help with sleep, she adds.

And familiar health advice like getting enough exercise, eating well and moderating alcohol consumption apply to perimenopause too, says Dr. Steven Goldstein who is the co-author of Could It Be … Perimenopause? and a professor of obstetrics and gynecology at the New York University School of Medicine.

At her doctor’s suggestion, Edrie developed a mindfulness practice. She says, “I thought it sounded a little ‘woo-woo’ at first, but being able to pay attention to what my body is doing and why helps me separate those symptoms from what I need to get through my day. So I’m not overwhelmed by what my body is putting me through.”

4. Cultivate community

Most of the women who wrote to NPR about their experiences going through perimenopause said that they felt alone and isolated during this transition.

Having a community to talk to can make it easier to cope with the changes, says Payne, who’s going through perimenopause herself. She says she has found support from a few close friends from college.

“To be able to reach out to a group of women who are our same age and say, ‘Did you go through this? And, you know, it does provide support. I think that’s another version of a coping skill,” she says.

Edrie says she joined a few Facebook groups dedicated to perimenopause and found one in particular where she got tips on coping with one of her most troublesome symptoms: brain fog. The conversations made her feel understood and validated.

“I can post about it in this group, and, you know, 10 women will be like, ‘Oh, last week, that totally happened to me,’ or like, ‘I forgot my kid’s computer on the top of my car and drove away,’ ” she says.

She says that being able to commiserate helps her get through symptoms “that maybe don’t have a magic pill.” Some of her online friendships have even taken shape offline. Edrie has met up with some of the Facebook group members while touring the country with her band.

Now she’s a big proponent of finding community and speaking out. “As we get older, we get more and more quiet about what’s going on with our bodies and ourselves and our lives. We kind of just, buck up and deal with it.”

“And I feel like if we talked more about the things that are happening to our bodies — even if we can’t actually do anything about some of these things — it would just be better for society in general if we were more vocal about it.

Menopause 101: What to Expect as a Woman

Menopause is something every woman will experience, yet it is a topic so rarely spoken about. As a woman, you should always know what to expect when it comes to your own body–especially as it ages. This is why we’ve written Menopause 101: everything you need to know about menopause, its common symptoms, menopause treatment, and the different phases of menopause.

Just like young girls go through puberty, women go through another major transition with their bodies in middle age called menopause. Estrogen and progesterone production from female reproductive organs starts to taper off, and periods eventually stop.

Read further to learn everything you need to know about menopause as a woman.

What is menopause?

Many define menopause as the process that happens when a woman hasn’t had a period for 12 straight months (and isn’t pregnant nor sick). But menopause is a whole lot more than that. It’s a typical part of aging for females.

As women age, their hormone levels naturally begin to decrease and their ovaries stop releasing eggs–therefore, they stop having periods and can no longer become pregnant. The majority of women go through menopause in their 40s and 50s, although everyone’s body is different.

Women undergoing surgery to remove their uterus or ovaries for certain medical reasons (e.g., cancer, endometriosis, etc.) will experience menopause.

To put it in medical terms, menopause is part of a natural biological process in which menstruation and fertility stop for women. Menopause shows itself through physical side effects, but it can also have a huge impact on mental health and overall well-being. In Menopause 101, you’ll learn how to anticipate the signs and symptoms of menopause and effectively treat them.

The stages of menopause

There are three distinct stages of menopause and each comes with its own set of symptoms:


Perimenopause begins to happen anywhere from three to five years before actual menopause. It is the process by which hormone levels begin to drop. The majority of women start experiencing perimenopause in their late 40s. Many confuse menopause with perimenopause, as this is the phase where the common symptoms are hot flashes, insomnia, elevated heart rate, and mood swings. Periods also become much more irregular during this phase with menstrual flow becoming either lighter or heavier. Women can become pregnant during this phase; however, it is far less likely.


Menopause is the phase after perimenopause when women do not menstruate for a full year. Getting to this point can take on average anywhere from one to three years, and it varies depending on the individual.


This is the stage that comes after it has been a full year since the last menstruation cycle.

During this period, women often continue to experience symptoms such as hot flashes, night sweats, urinary problems, elevated heart rate, and mood swings.

At what age does menopause begin?

The process of menopause will look different for every woman. There are several factors that determine when a female starts experiencing menopause, with the biggest one being genetics i.e. the age of the woman’s mother when she experienced menopause.

Studies have found timing with menopause to be heavily genetically determined. One, in particular, showed the up to 20 percent of women that experienced early menopause also had relatives that had experienced it.

Early menopause also occurs when a woman experiences ovarian failure, or with surgeries like hysterectomy (removal of the uterus) and oophorectomies (removal of the ovaries). In addition, cancer treatments like chemotherapy can affect the reproductive system and cause women to reach menopause earlier.

However, the following (contrary to popular belief) have not been found to have an effect on the age a woman begins menopause:

  • The age of the woman during her first menstrual period
  • Pregnancy and number of pregnancies
  • Whether the woman breastfed or not
  • Hormonal birth control methods

It’s important to keep track of your menstruation and health symptoms–particularly as you age. Make sure to go for regular check-ups where the doctor will check your blood and hormone levels for any abnormalities.

How long does menopause last?

The three different phases on menopause can last a few years–up to five in many cases. Again, the process is different for each individual woman depending on the state of her health and genetic makeup. Some may begin to experience perimenopause ten years before their last period, and others may have it over and done with in just a year–it all really depends.

What happens to your body during menopause?

During menopause, there is a major transformation happening with the hormone levels in the body. All of the physical symptoms of menopause are caused by the fluctuation in hormone levels. It’s important to be aware of what the common symptoms are and ask your doctor about them.

Also, it’s important to note that while your body is going through changes, menopause is not an illness, nor does it mean the end of your sexuality. Here are some changes that will occur:

  • Irregular periods
  • Lower levels of the following hormones:
    • Estrogen
    • Progesterone
    • Testosterone
    • Follicle-stimulating hormone (FSH)
    • Luteinizing hormone (LH)
  • Loss of active ovarian follicles

What are the early signs of menopause?

The beginnings of menopause typically start in women’s late 30s when the ovaries begin to make less estrogen and progesterone. Many women begin to see changes in their menstrual cycle in their early 40s. It will be different from person to person.

Also bear in mind that for special circumstances like a hysterectomy, chemotherapy, premature ovarian failure, or other medical condition will bring on menopause sooner.

What are the symptoms of menopause?

Symptoms of menopause vary from person to person, and each symptom itself can have different levels of intensity. It’s also important to remember that menopause symptoms do not just show up as physical but emotional as well. Here is a general list of the array of symptoms any woman going through menopause may experience:

  • Irregular periods
  • Loss of libido
  • Mood swings
  • Lack of energy
  • Hot flashes
  • Sweating
  • Racing heart
  • Headaches
  • Dizziness
  • Vaginal dryness
  • Hair loss/hair thinning
  • Pain during sex
  • Insomnia
  • Concentration difficulty
  • Lapses in memory
  • Weight gain & bloating
  • Breast pain/tenderness
  • Digestive problems
  • Depression and anxiety
  • Osteoporosis
  • Dry skin
  • Painful joints

Health conditions like illness, hysterectomy, cancer treatments, or smoking can exacerbate some of these menopause symptoms. Also, every woman’s menopause experience is unique to her. One person may experience a large range of symptoms, while another might experience only two. Be sure to monitor your own changes in your body and try not to measure your own menopause experience against another woman. If you feel like something unusual is happening, you should always consult with your doctor.

What is a hot flash?

An estimated 75% of women experience hot flashes while going through menopause. A hot flash is when you suddenly feel warm or hot, followed by feeling cold. Typically, the skin flushes and the heart beats faster. Hot flashes that occur during sleep are labeled as night sweats.

While hot flashes vary from woman to woman, the often last around one to two minutes. They can be mild or severe and change in frequency depending on the woman.

Some women might continue to experience hot flashes as they enter into postmenopause, though, certain medications can also bring them on.

What kind of complications are there?

A select few women may experience complications from menopause. While our intention is not to scare you, it’s important to notice any abnormal changes in your body and bring them to your doctor for examination. That way, any complications you encounter can be dealt with efficiently. These can include:

  • Vulvovaginal atrophy
  • Painful intercourse
  • Slowed metabolic function
  • Cardiovascular disease
  • Osteoporosis
  • Periodontal disease
  • Cataracts;
  • and more

Treating menopause symptoms

Thankfully, there are many ways to treat the symptoms of menopause. One of the first important things people can do is to eat a diet rich in fruits and vegetables, calcium, and whole grain. A good baseline is always important.

For women suffering from severe symptoms, hormone therapy might be an option suggested by your doctor. Hormone therapy treatment can help reduce the intensity of hot flashes and night sweats, vaginal atrophy, osteoporosis, and more.

Other types of medication can be issues to help improve:

  • Topical treatments for hair loss
  • Lubricant for vaginal dryness
  • Sleep medications
  • Antibiotics for UTIs
  • Medication for osteoporosis

Some other natural ways to treat menopause include meditation, acupuncture, and other relaxation techniques in addition to a healthy diet combined with adequate exercise. For the emotional parts of menopause, it could be helpful to find support via a friend, group, therapist, online community, or a combination of those things.

At the end of the day, know that you’re never alone when it comes to menopause. It is a completely normal experience that every female will experience. We hope this article on Menopause 101 gives you a good starting point from which to understand this body transition unique to women.

To learn more about healthy aging in women, read our other article here for tips for aging well.

What is the age of menopause? How will I know when to expect the menopause?

Many of us are caught off-guard by the first signs of menopause. We wouldn’t expect to have menopausal symptoms while we still have periods. What does it mean to be in the menopause?

Menopause age can vary widely – it usually takes place between the ages of 48 and 55.

What age do women go through menopause at?

There’s a lot of confusion out there, I find a lot of women, myself included, wonder ‘what age do you expect menopause?’ For most of us, the menopause will happen between the ages of 48 and 55. The average age for women to experience menopause in Ireland is 50 years. We can start to experience symptoms up to eight years before that time, during a phase called ‘perimenopause’. For some of us, menopause could commence in our 30s and for others in our 50s. You will also find that most information available concerning menopause will give you slightly different average ages or age ranges. This can lead to confusion, but it is because we are all different.

For most of us, our last period will be preceded by the phase of menopausal changes and transition known as the perimenopause. During this phase, we may experience a wide variety of symptoms of the menopause including hot flushes, mood swings, insomnia and anxiety. Some symptoms will be barely perceptible. Others will be intense. Some of us may experience these symptoms but may not associate them directly with the menopause as they can be quite commonplace, such as a lack of confidence, anxiety, a loss of interest in sex and difficulty sleeping.

What age do you expect menopause?

It is true that the age at which we reach menopause is related to the age at which our mothers reached menopause. Women who have had babies late in their childbearing years tend to have a later menopause. Some women may go through early or premature menopause – before the age of 40, and again this may be hereditary. There is not necessarily a link between the onset of puberty and menopause. For example, if your periods started late you will not always have late menopause.

What is the average age for menopause in Ireland?

When and how menopause begins varies from one woman to the next. However, the average menopause age for Irish women is 50. Menopause is defined as the point when you have your last ever period. It will only be in retrospect that you are aware of this occurrence, and you will need to have had no periods for 12 months for menopause to have occurred. Most of our symptoms take place during the phase called perimenopause, 4-8 years before menopause. When women talk about going through the menopause, this is the stage that they are really talking about.

Other symptoms, such as osteoporosis and urinary incontinence, are more likely to occur after the menopause.

For most women, the key symptoms of menopause ease one year after their final period. At this stage hormone fluctuations become more stabilised. However, for some of us, symptoms carry on longer, many years after the time of official onset of menopause. It is also possible, in rare cases, for some women to have occasional symptoms, such as hot flushes, into their 60s and sometimes 70s.

Menopause: Symptoms, causes, and treatments

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Menopause is a transition into a new phase of life. It begins when the menstrual cycle finishes. Menopause is not a health problem, and some experience it as a time of liberation. However, hormonal changes and other factors involved can cause discomfort.

Menopause usually starts between the ages of 40 and 58 years in developed countries, where the average age is 51 years. For some, it will occur earlier due to a medical condition or treatment, such as the removal of the ovaries.

Around the time of menopause, many females experience physical symptoms such as hot flashes, night sweats, vaginal dryness, and a reduced sex drive. It can also lead to anxiety, changes in mood, and a reduced sex drive.

These symptoms may start before menstruation ends, and they can last for several years. The impact on a person’s quality of life can range from mild to severe. However, there are ways of managing these symptoms.

Each person will experience menopause differently. Many have full, active lives throughout the transition and afterward, and some feel relieved by no longer having to deal with menstruation or birth control.

Maintaining a healthful diet and getting regular exercise can help a person feel better and boost their overall health in the long term. For those who experience menopause symptoms, treatments and support are available.

In this article, find out more about what to expect during menopause.

Menopause is the stage of life that follows the end of the menstrual cycles. Each person may experience menopause differently.

It can last for several years, and there are three stages:

Perimenopause is the transitional time that starts before menopause and includes the 12 months that follow a person’s last period.

Menopause starts either 12 months after the last period or when menstruation has stopped for a clinical reason, such as the removal of the ovaries.

Postmenopause refers to the years after menopause, although it can be difficult to know when menopause finished and postmenopause starts.

How long do menopause symptoms last? Find out here.

Around menopause, various physical and mental changes can occur, causing symptoms. Some of these start before menopause, and some continue after it.

The changes involved in perimenopause and menopause include:

Lower fertility

As a female approaches the end of the reproductive stage, but before menopause begins, estrogen levels start to fall. This reduces the chances of becoming pregnant.

Irregular menstruation

The first sign that menopause is approaching is usually periods occurring less regularly. They may come more or less frequently than usual, and they may be heavier or lighter.

Anyone who has concerns about menstrual changes should see a doctor, as these changes can also indicate pregnancy or some health issues.

Is it normal to have brown spotting after menopause?

Vaginal dryness and discomfort

Vaginal dryness, itching, and discomfort may start during perimenopause and continue into menopause. A person with any of these symptoms may experience chafing and discomfort during vaginal sex. Also, if the skin breaks, this can increase the risk of infection.

Atrophic vaginitis, which involves thinning, drying, and inflammation of the vaginal wall, can sometimes occur during menopause.

Various moisturizers, lubricants, and medications can relieve vaginal dryness and associated issues.

Learn more about atrophic vaginitis here.

Hot flashes

Hot flashes are common around the time of menopause. They cause a person to feel a sudden sensation of heat in the upper body. The sensation may start in the face, neck, or chest and progress upward or downward.

A hot flash can also cause:

  • sweating
  • red patches to form on the skin

Some people experience night sweats and cold flashes, or chills, in addition to or instead of hot flashes.

Hot flashes usually occur in the first year after menstruation ends, but they can continue for up to 14 years after menopause.

What does a hot flash feel like? Find out here.

Sleep disturbances

Sleep problems can arise during menopause, and they may stem from:

  • anxiety
  • night sweats
  • an increased need to urinate

Getting plenty of exercise and avoiding heavy meals before bedtime can help with managing these issues, but if they persist, contact a healthcare provider.

Click here for some tips on how to get better sleep.

Emotional changes

Depression, anxiety, and low mood are common during menopause. It is not unusual to experience times of irritability and crying spells.

Hormonal changes and sleep disturbances can contribute to these issues. Also, a person’s feelings about menopause may come into play. For example, distress about low libido or the end of fertility can contribute to depression during menopause.

While feelings of sadness, irritability, and tiredness are common during menopause, they do not necessarily indicate depression. However, anyone who experiences a low mood for 2 weeks or longer should see a doctor, who will be able to advise about the best course of action.

Anyone who has concerns about sleep or any changes related to menopause should contact a healthcare provider.

An article published in 2018 suggests that there may, in some cases, be a link between menopause and suicide. Anyone who is thinking about suicide should seek help from a counselor or health professional. There are also anonymous hotlines available.

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

Trouble focusing and learning

In the lead-up to menopause two-thirds of women may have difficulty with concentration and memory.

Keeping physically and mentally active, following a healthful diet, and maintaining an active social life can help with these issues. For example, some people benefit from finding a new hobby or joining a club or a local activity.

Physical changes

Various physical changes can develop around the time of menopause.

People may experience:

  • a buildup of fat around the abdomen
  • weight gain
  • changes in hair color, texture, and volume
  • breast reduction and tenderness
  • urinary incontinence

However, the link between these changes and menopause is not always clear. Some may occur independently at the same time as the transition, and age and lifestyle can also play a role.

What are the most effective ways to lose weight during menopause?

Increased risk of some health conditions

After menopause, the risk of certain health issues appears to increase. Menopause does not cause these conditions, but the hormonal changes involved may play some role.

Osteoporosis: This is a long-term condition in which bone strength and density decrease. A doctor may recommend taking vitamin D supplements and eating more calcium-rich foods to maintain bone strength.

Find out more about osteoporosis treatments.

Cardiovascular disease: The American Heart Association (AHA) note that, while a decline in estrogen due to menopause may increase the risk of cardiovascular disease, taking hormone therapy will not reduce this risk.

Breast cancer: Some types of breast cancer are more likely to develop after menopause. Menopause does not cause breast cancer, but hormonal changes involved appear to increase the risk.

Skin changes can also occur around the time of menopause. Find out more.

Most information about menopause describes the experiences of cisgender, heterosexual women. However, menopause can affect anyone who is born with ovaries.

A person who transitions to male but who retains their ovaries may experience menopause when their ovaries stop producing eggs.

If a person starts taking supplementary testosterone as part of their transition, they may experience menopause symptoms then. Also, menopause symptoms can develop when a person undergoes surgery to remove their ovaries.

When transitioning involves any of these experiences, the symptoms of menopause will be the same as those of cisgender women.

However, transgender people can face additional difficulties, depending on the attitude of their medical team. It is essential that transgender people have access to healthcare providers who understand their needs and can address them effectively.

Menopause is not a health problem but a natural transition. However, it can involve unwanted physical and mental changes.

Anyone who has concerns about these changes should seek medical advice. A doctor may recommend one or more of the following:

Hormone therapy

This treatment helps balance the body’s hormone levels by providing supplemental estrogen and a synthetic version of the hormone progesterone.

Hormone therapy comes in various forms, including skin patches and topical creams. It can help reduce the occurrence of hot flashes and other menopause symptoms.

However, using it may increase the risk of developing certain diseases and health conditions.

A person should not use hormone therapy if they have risk factors for the following health problems, or if they have a personal or family history of these issues:

  • heart disease
  • blood clots
  • high levels of triglycerides in the blood
  • gallbladder disease
  • liver disease
  • stroke
  • breast cancer

It is important to discuss the possible benefits and risks of hormone therapy with a doctor before deciding to use it.

Other treatments

A person may find that the following can also help relieve symptoms:

  • over-the-counter gels and other products for vaginal dryness
  • prescription pills, creams, and rings for vaginal dryness
  • low-dose hormonal birth control pills for hot flashes, vaginal dryness, and mood changes
  • low-dose antidepressants for hot flashes, even among people who do not have depression

Tips for managing the challenges of menopause include:

  • getting regular exercise
  • practicing relaxation and deep breathing exercises
  • having a healthful diet that includes plenty of fresh fruits, vegetables, and whole grains
  • quitting smoking and avoiding secondhand smoke
  • limiting the intake of alcohol
  • seeking counseling for anxiety, mood changes, and relationship concerns
  • establishing good sleeping habits and getting plenty of rest
  • doing Kegel exercises to strengthen the pelvic floor
  • talking to friends and family about the experience of menopause
  • exploring new ways of enjoying intimacy with a partner
  • joining a club, volunteering, or taking up a new hobby

Can I use coconut oil for vaginal dryness?

Keeping an active sex life

Menopause can reduce a person’s sex drive and lead to vaginal dryness, but it also removes the need for birth control. For some, this can make sex more enjoyable.

Having sex often can increase vaginal blood flow and help keep the tissues healthy.

Some tips for maintaining sexual health and activity during menopause include:

  • staying physically active
  • avoiding tobacco products, recreational drugs, and alcohol
  • taking the time to become aroused, which will improve lubrication
  • doing Kegel exercises to strengthen the pelvic floor
  • not using any strong soaps around the vagina, as these can worsen irritation

Also, menopause symptoms lead some people to find satisfying forms of sex that do not involve the vagina as much or at all.

It is worth remembering that, while a woman cannot become pregnant once menopause starts, it is still important to use barrier protection during penetrative sex to protect against sexually transmitted infections.

Often, sexual partners will be getting older — and may be experiencing menopause — at the same time. They, too, may be feeling a drop in sex drive. Opening up about any concerns can help both partners feel better and explore new forms of intimacy.

What can I do about breast tenderness during menopause?

Menopause is a stage in life, not an illness. Most women experience natural menopause during midlife. However, surgery and other factors can cause menopause to start earlier.

Natural menopause

A female’s reproductive years last from puberty to menopause — from one natural transition to another.

Toward menopause, the levels of the hormones estrogen and progesterone in the body fall because they are no longer necessary to support reproduction. These changes trigger menopause.

Surgery and treatment

If a person undergoes surgery to remove their ovaries, they will experience menopause. If this happens before middle age, doctors may refer to it as “early menopause.”

A doctor may recommend hormone therapy to reduce some symptoms, but as always, it is important to discuss the risks as well as the potential benefits of this treatment.

Some treatments, such as chemotherapy and radiotherapy, can cause the ovaries to stop working either temporarily or permanently. The likelihood of this happening depends on the person’s age and the type and location of the treatment.

A person who experiences menopause because of a clinical treatment will experience the same symptoms as a person who experiences natural menopause. However, the symptoms may appear more abruptly, because the physical change is more sudden.

A person may also experience sadness or depression about an early loss of fertility. Some people decide to freeze eggs or pursue other options for having children later in life before undergoing this type of treatment. Counseling is often available.

It is also important to discuss related health effects with a doctor, as people who experience menopause early may have a higher risk of developing heart disease and osteoporosis.

Premature menopause

Some people experience menopause earlier than others for reasons other than medical interventions.

Doctors consider menopause to be “premature” if it develops before the age of 40 and “early” if it starts between the ages of 40 and 45. Early menopause naturally occurs in around 5% of females.

Sometimes, menopause develops early if a person has:

  • a genetic condition that affects the chromosomes, such as Turner’s syndrome
  • an autoimmune disease
  • in rare cases, an infection, such as tuberculosis, malaria, or mumps

Anyone who experiences changes in menstrual patterns before the age of 45 should see a doctor.

Menopause is not an illness, but many people benefit from seeing their doctors when menstruation ends.

A doctor can often confirm whether the reason for this change is perimenopause or menopause by asking some questions. They may also test hormone levels and perform other analyses of the blood and urine to rule out health issues. No tests, however, can conclusively indicate that menopause has begun.

People can check their hormone levels at home with testing kits, some of which are available for purchase online.

For many people, menopause is not the only transition that occurs during middle age. Changes in relationships and work or home life — such as children moving away — can also have a significant impact. When more than one of these changes occurs in a short period, it can feel overwhelming.

However, many people live active, healthy lives throughout menopause and for many decades afterward, and midlife can often be the start of a new chapter.


Do males go through a kind of menopause?


Not quite. The natural aging process for people with male reproductive organs involves a gradual decline in testosterone over a lifetime.

For people with ovaries, menopause is a relatively short period of time during which there is a significant drop in the production of estrogen and progesterone. This may result in the undesired symptoms described in this article.

Carolyn Kay, M.D.Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Menopause | Down’s Syndrome Association

What is the menopause?

The menopause occurs when a woman’s ovaries stop producing eggs each month and her periods stop. This happens as a result of normal/natural changes in sexual hormones that come with age.

Is the menopause different for women with Down’s syndrome?

Usually women with Down’s syndrome reach the menopause earlier than is seen in the general population. The average age for women to reach the menopause in the general population is 51 years old.  For women with Down’s syndrome the average age to reach the menopause is 46 years old but it can happen up to ten years earlier than in the general population.

What are the symptoms?

Women with Down’s syndrome will go through the same stages and experience the same symptoms as any other woman as the body stops producing eggs and the hormones needed to reproduce.

There are three stages (known as peri-menopause, the menopause and post-menopause). The menopause is said to have taken place if a woman has not had a period for 12 months or more. At any time in these stages she may experience any of the following symptoms:

  • Hot flushes
  • Tiredness
  • Aches and pains
  • Weight gain and food cravings
  • Depression and mood swings
  • Changes in skin and hair condition

Often the emotional symptoms of the menopause will be dismissed as challenging behaviour caused by the woman’s learning disability, rather than being correctly diagnosed. This difficulty can be compounded by the fact that women with Down’s syndrome often have problems describing their symptoms. They are often not aware of a “hot flush”; being unable to tell the difference between a flush and feeling hot due to the weather, for example. The better informed the woman is the better she will be able to recognise her own symptoms, and the easier a diagnosis will be. It is therefore essential that women with Down’s syndrome be educated about what will happen to their bodies as they get older, before it begins to affect them. Often people with a learning disability don’t “pick up” this sort of information socially as other people would, so the information given must be clear and unambiguous.

As menopausal symptoms can be so varied, if a woman of this age group has a change in her level of functioning a general medical assessment to rule out other medical causes is important, including checking thyroid functioning and for depression.


Most women will not need treatment for the menopause but if a woman has troubling symptoms her GP may recommend treatment such as hormone replacement therapy.


As a natural alternative to HRT, a healthy and balanced diet may help when women are experiencing menopausal symptoms. As well as minimising weight gain and reducing food cravings, eating the right things can reduce tiredness and hot flushes and help the menopausal woman to maintain an emotional equilibrium. As a general rule she should try to steer clear of highly processed (junk) and salty foods and eat a diet rich in fresh fruit and vegetables. Particularly beneficial are those foods that contain high levels of natural plant oestrogens. The most important of these is soya, which can be found in soya beans and soya products like tofu, miso, soya milk and soya yoghurt. Also beneficial are nuts and seeds, pulses like chickpeas, lentils, aduki and mung beans, as well as apples, cherries, plums, rhubarb, cranberries, broccoli, carrots, french beans, peas, potatoes, and mushrooms. Soya can also be taken in supplement form. Visit your local health food shop for more information. For those suffering from hot flushes, cutting down on spicy foods, hot drinks and alcohol may help.



90,000 What you need to know about him now – Wonderzine

Psychological changes

“Psychologically, everything became more difficult for me. What I used to do “with one left hand” suddenly turned out to be overwhelming, ”says Irina (46 years old). – Now I think that this is a good defense mechanism, which, in fact, should be thanked. But at first, when I suddenly discovered that I simply could not persuade myself, or force, or spur me on, I experienced it very hard. Like a betrayal. “Larisa (53 years old) recalls that at the beginning of menopause, she “was capricious, sharply became whiny and touchy,” and compares the onset of menopause with prolonged PMS.

The psychological symptoms of menopause at different times included a tendency to depressive states, anxiety, irritability, apathy, and outbursts of anger. Despite the fact that hormones can affect the emotional state, now scientists tend to look more broadly at the causes of psychological changes in women of menopause.During menopause, a woman can really experience stress, but it is not always the result of hormonal fluctuations. Often, for women, the age of menopause coincides with the separation of grown children, the end of a career, a divorce or the beginning of a new relationship, the need to care for elderly parents. Also, a woman’s sense of self depends on how menopause is treated in her culture. In a society that views menopause as a “disease”, women perceive it more negatively than where menopause is seen as a natural process inherent in age.

Psychologist Sophia Shapotailo agrees with the fact that different women experience menopause in different ways: “Someone comes alive and invigorates, someone may perceive menopause as a loss. It is good to have close people nearby at this moment, ready to be attentive to the experiences of a woman, not to devalue. It is important to know that mood swings during this period are completely normal. Perhaps a woman now needs help to find points of support, to make plans for the future. A state of apathy that lasts a long time requires special attention.Or behavior that is sharply uncharacteristic for a person. Here you may need the support of a specialist – a psychologist or a doctor. ”

90,000 What is menopause? – Melsmon

“There are no incurable diseases, there is a lack of knowledge. And aging is a disease that can be treated .. “

V. I. Vernadsky

The word “climax” in translation from Greek means “step”. And, perhaps, it is very important to treat it in this way – as another step, another height that must be overcome with some effort.It is simply ridiculous to worry about this, but it is very useful to prepare for a new stage of life, you just need to think about how best to enter into a time of change. And this applies to both women and men.

There are many definitions and interpretations of this term. The simplest and most understandable sounds like this:

Climacteric period (Greek klimakter stage; age transition period; synonym: menopause, menopause) is the physiological period of a person’s life, during which, against the background of age-related changes in the body, involutional processes in the reproductive system dominate.

Menopause in women

In terms of the production of female sex hormones, a woman’s entire life is divided into several stages: premenopause (from the moment of the first menstruation to the end of regular menstruation), perimenopause (period before and after menopause), menopause (time of the last menstruation ) and postmenopause (the period starting twelve months after menopause until the end of life).

Perimenopause, menopause and postmenopause are conventionally combined into menopause – climacteric period .


This period begins, on average, 4 years before menopause (average age 45-47 years) and lasts for 12 months after the cessation of menstruation.

The first sign of perimenopause is changes in the menstrual cycle, both in duration and in the amount of blood loss.

Perimenopause is a time of great hormonal changes in a woman’s body. The level of estrogen – the female sex hormone – begins to fluctuate and decreases steadily.


Menopause is the time of the last natural bleeding (menstruation). It can only be established after 12 months without bleeding. The average age at onset of menopause is 51–53 years, although women who smoke can reach menopause 1.5–2 years earlier.Currently, it has been clearly proven that the time of the onset of menopause is in direct proportion to the initial follicular supply of a woman’s ovaries and the processes of apoptosis that take place in them throughout life, which determines their functional state.


Twelve months after menopause, women enter the postmenopausal period, which lasts up to 65-69 years, gradually moving into old age.

In the climacteric period, the immune defense gradually decreases, the frequency of autoimmune diseases increases. , meteorological stability develops (reduced resistance to fluctuations in ambient temperature), age-related changes occur in the cardiovascular system. The level of low and very low density lipoproteins, cholesterol, triglycerides and glucose in the blood increases; increased body weight due to hyperplasia of fat cells. As a result of a violation of the functional state of the higher nervous centers against the background of a decrease in the level of estrogen in the body, a complex of vegetative-vascular, mental and metabolic-endocrine disorders often develops, the so-called climacteric syndrome, which is a complication of the natural course of menopause and is observed in 30-60% of women.

Manifestations of climacteric syndrome

are reduced to the appearance of vasomotor and emotional-mental disorders. They are expressed in:

  • Hot flashes, excessive sweating, headaches, hypertension or hypotension, chills, heart palpitations, irritability, drowsiness, weakness, anxiety, depression, inattention, forgetfulness.
  • Urogenital changes (dryness in the vagina, pain during intercourse, itching and burning, increased urination) and skin aging (dry and brittle nails, dry and hair loss, wrinkles).
  • Late metabolic disorders – osteoporosis and cardiovascular diseases.

Polymorphism of clinical manifestations of climacteric syndrome is often difficult to fit into the given scheme and only complex diagnostics, including the whole range of laboratory, instrumental studies, urological and gynecological examinations, will help to evaluate the whole picture.

With the current development of medicine, it is important to understand that modern diagnostic methods make it possible not only to determine that the female body is beginning to prepare for menopause, but also to identify a predisposition to certain diseases that can manifest themselves after the onset of menopause.

We must be calm about the fact that after 40 years, at least once a year, we will have to undergo a comprehensive examination. And all the negative aspects inherent in menopause can be corrected with the help of timely hormone therapy, which will not allow the development of age-associated diseases and all the conditions described above.

A gynecologist-endocrinologist will warn you about the onset of menopause and suggest treatment options, taking into account all the characteristics of your body and the symptoms that have already appeared.The main thing is not to postpone the visit to the doctor and subsequently show up regularly with the interval that is necessary specifically in your case and recommended by a specialist.

It is also imperative that simple daily rules are followed. This is not just a whim or a tribute to the healthy lifestyle fashion. This is an elementary culture of life of any modern woman who does not want to grow old, get sick and who wants to remain active and in demand at any age!

At the very beginning, we used the words of Vladimir Ivanovich Vernadsky, a prominent scientist, thinker and public figure of the last century, that old age is just a disease, and if it is a disease, then it can and should be treated!

Prevention of climacteric disorders

You can do a lot for yourself, just by slightly adjusting your lifestyle, in connection with the onset of physiological changes:

  • Eat a healthy diet. Good nutrition contributes greatly to the overall health of a person. During menopause, the diet should contain a variety of fruits, vegetables, and grains. Eliminate fatty, spicy, salty foods from your diet. Reduce consumption of meat, sausages, smoked meats. Take drugs with calcium, vitamin D, drugs with Omega 3 polyunsaturated fatty acids every day (your doctor will help you choose the dosage). Drink alcohol and caffeine in moderation. Do not smoke.
  • It is important for menopausal women to drink plenty of water : Experts recommend about 1.5-2 liters per day.Water replenishes the loss of fluid from excessive sweating during hot flashes and helps to reduce their frequency.
  • Exercise (at least half an hour a day), try to keep an active lifestyle, this will help reduce hot flushes and is the prevention of osteoporosis. Walk more, walk more, use the stairs, even if there is an elevator.
  • Do not wear synthetic fabrics . Synthetic fabrics interfere with heat dissipation and impair ventilation, which contributes to overheating and an increase in the frequency of hot flashes.In addition, synthetic clothing absorbs moisture worse and accelerates the appearance of an unpleasant sweat odor. It is better to give preference to clothing made of cotton, linen or viscose. These recommendations also apply to bed linen.
  • Do not overexert yourself . Tension, stress, fatigue provoke hot flashes, so a woman during menopause should not take on too many responsibilities. Do not try to do everything at once, alternate work with rest, pay attention to your health.A good night’s sleep is of great importance, it significantly reduces stress levels and helps to reduce the frequency of hot flashes. Learn how to relax properly, for this you can start doing yoga and meditation.

Compliance with these simple rules will allow you to calmly climb the next step, the next height of your life, and then a new life time will begin without unpleasant sensations and any problems!


90,000 menopause symptoms and an action plan.

Let’s talk about the important

Every day, women come to see doctors with complaints of malaise. Sometimes, under the guise of various diseases, there is a beginning, and maybe a continuing climax. Now in Russia there are about 41% of such women.

45-55 years – this is the time when a woman’s body must be rebuilt. This is natural, but the “naturalness” of this phenomenon does not negate the fact of the woman’s psychological anxiety, the desire to stop this process.

The main cause of menopause is the interruption of the production of the female hormone estrogen.

Everyone knows that the ovaries gradually stop working during this period, menstruation disappears, and at the same time the woman loses the opportunity to give birth to a child.

But estrogen, as you understand, affects not only the reproductive system:

  • circulatory system : hot flashes appear – a sharp fever for 1-2 minutes, pain in the heart is possible.

  • Nervous system : mood swings, irritability, worries

  • genitourinary system : incontinence, vaginal dryness, influence on microflora

  • Skin : Dryness and wrinkles

  • skeletal system: increased risk of fractures, bones become fragile

The development of these symptoms is influenced by heredity, hormonal factors, environment and health status.

They do not appear all at once.

Menopause: symptoms and their appearance

  • early symptoms (before menopause + about 2 years) – fever and chills, sweating, pain in the head, muscles and joints, “goose bumps”, weight lines, decreased libido, insomnia and fatigue.

  • further – 2-5 years after menopause, dryness and itching appear in the intimate area, pain with PA, incontinence, poor condition of the skin, hair and nails.

  • The next stage is – vascular and joint disease.

Many women during menopause are sure that the symptoms of menopause cannot occur with the presence of menstruation. Usually, such patients take the deterioration of well-being for the manifestation of age-related diseases. This leads to self-medication and medication, many of which are understandably ineffective.

Often this happens at an age when a woman has taken place in a career, a family, when the children have already grown up and she has much more time for herself.All these problems did not fit into her plans in any way.

What to do with menopause?

  1. See your gynecologist

  2. Depending on the age and condition of the woman, hormone therapy, a complex of vitamins, and care products can be prescribed.

  3. Work with your doctor to find a diet and exercise routine to relieve symptoms

  4. Try to surround yourself only with pleasant emotions and loved ones.

And finally: remember that this is just a new stage in your life – of course, with its advantages 😉

Taking care of your health

obstetrician-gynecologist 1st category

Frolova Yulia Evgenievna
8 (846) 300-40-72

Back to list

90,000 Is there sex after menopause and 7 more frank questions to the gynecologist | HEALTH

And there are many questions that did not torment our grandmothers, because the lifestyle, priorities and possibilities of medicine were completely different.Do I need to protect myself during menopause? When is it not too late to have children? Are expensive drugs that doctors prescribe right and left so necessary and safe? ..

The Ural experts answered the most popular questions of our readers: Elena Piskunova, Ph.D., obstetrician-gynecologist, head of the department of gynecology at the Center for Cosmetology and Plastic Surgery named after S.V. Nudelmana, a member of the European Association of Urogynecologists (IUGA), the Russian Association of Endoscopic Gynecologists, the American Association of Endoscopic Gynecologists (AAGL), and Yulia Pertsova , obstetrician-gynecologist, gynecologist-endocrinologist, ultrasound diagnostics doctor at the Olmed Medical Center Russian Association of Specialists in Aesthetic Gynecology.

Shall we cancel the climax?

– Modern medicine works miracles. Is it possible to completely cancel menopause?

Elena Piskunova: – The climacteric period is one of the normal periods in a woman’s life, everyone experiences it. But at the same time, you can live a full, high-quality life without losing your ability to work and interest in life.

This is the transition period between regular menstruation and confident menopause (the year when regular menstruation is absent).Concomitant signs: increased fatigue, hot flashes, night sweats, intermittent sleep, loss of interest in life – the desire to “lie on the couch.” Possible urogenital disorders (cystitis, dry mucous membranes, decreased sexual desire), changes in the quality and condition of the skin, hair, nails, etc. These external manifestations are a signal that the body has not learned to live in conditions of hormone deficiency and to accurately dose the decreased amount of estrogen for vital functions. This condition must pass.

In conditions of estrogen deficiency, internal changes occur, such as loss of calcium in the bones and the development of osteoporosis, changes in insulin levels and weight gain, increased blood pressure, impairment of memory, concentration, attention, and eye problems. Age-related changes cannot be reversed, but they can be postponed for a sufficiently long period. In order to feel good and not to lose the quality of life, one must visit a doctor – first of all, not with illnesses, but for a preventive purpose, in order to discuss their age characteristics and form an individual algorithm of behavior for a certain period of life.

Julia Pertsova: – On average, menopause occurs at about 50 years, but this time can vary greatly. Some women tolerate it very hard, with impaired blood pressure, nervous disorders and other changes. To neutralize the manifestations of the menopause and help the body cope with hormonal changes, a healthy lifestyle is important: proper food, diet, it is important to reduce stress levels, bad habits and destructive behavior. Sleep should be 8 hours, and you need to fall asleep before 23 hours.Water procedures and hardening have a very beneficial effect on the nervous system. Physical activity is required, at least 40 minutes a day of walking.

The basis of a healthy diet is plant food, it contains substances with antioxidant and anti-inflammatory properties that prevent thrombus formation, regulate blood pressure, enzyme activity, normalize blood glucose levels, correct the lipid profile and myocardial state.

Are special drugs for menopause a risk factor for oncology? Why are they assigned to everyone in a row?

Yu.Pertsova: – Now there are no hormones that we divide into male and female. All sex hormones – estrogen, progesterone, and even testosterone – are equally necessary for both men and women. Each hormone has its own role. A woman first encounters sex hormones during puberty, and then blooms and lives throughout her life until the onset of menopause. In the climacteric period, everything that determined the state of health and well-being disappears along with the cessation of the production of sex hormones.The external reflection of menopause very quickly affects the skin, because it is she who loses collagen, which is responsible for turgor. In the first two years of menopause, a loss of 30% of collagen occurs.

Substitution drugs neutralize all undesirable manifestations of hormone deficiency and add to youth, postponing and preventing age-related diseases. For a full examination and identification of the risks of side effects and contraindications when prescribing hormone replacement therapy for a woman after 45 years of age or at the first manifestations of menopausal disorders, it is imperative to visit a doctor.

E. Piskunova: – We cannot say that specialized drugs are vital. But we unequivocally vote that they can and should be applied. There is a big misconception that only in Russia doctors offer specialized drugs to relieve the symptoms of menopause, in fact, they are widely used all over the world. We offer a standard approach that is no different from the European one.

Before you start taking any hormonal drugs, a comprehensive examination is mandatory.The task of the doctor is, first of all, to exclude life-threatening conditions: the presence of strokes, thrombosis, ulcerative processes, autoimmune diseases, oncology, pronounced stages of varicose veins, etc. With caution, drugs are prescribed for peptic ulcer disease, high blood pressure or an increase in triglycerides.

The doctor selects drugs individually, and by themselves they do not cause cancer. If oncology occurs, then it happens in the presence of drugs, but not as a result.If you fulfill all the appointments, come to control visits and consult a doctor with any changes in your well-being, the drugs have only a positive effect. As a result, even this period of her life, a woman can live qualitatively, fully and with dignity.

Features of sex with menopause

What are the differences in female sexuality during menopause, should I use contraception?

Y. Pertsova: – With age, the level of estrogen decreases more than the level of testosterone.Namely, testosterone is responsible for sexual activity. And it turns out that testosterone does not disappear anywhere and does not fall. So the desire doesn’t go away. Women’s physiology is such that it is after menopause that you sometimes want more sex. A modern woman who has entered the climacteric period no longer has a bunch of somatic diseases, like our grandmothers, and can live a full sexual life without thinking about the possibility of getting pregnant.

If the cycle still comes, albeit irregularly, it is better to protect yourself, since single ovulations are possible and there are risks of unwanted pregnancy.In this case, it is better to visit a gynecologist and, together with a doctor, choose the most appropriate method of contraception, taking into account all the health features of a particular woman. Physiological inconveniences will help to overcome modern pharmacological agents, such as lubricating gels.

Late pregnancy: trends and risks

In the West, pregnancy has become a trend after 30 or even 40 years. What do our doctors think about this?

Y. Pertsova: – Indeed, recently more and more famous personalities are choosing pregnancy at an older age.The duration of an active life of the population is rapidly increasing due to the achievements of modern medicine, in addition, many want to first become financially independent, to realize themselves in a career.

There are certain advantages of pregnancy after 40 years: a long-awaited late child is a great joy, it brings a lot of positive emotions and prolongs the life of the parents. According to some scientific studies, late children are smart and talented. Mature parents are calmer, wiser and more conscientious.They are the best educators, make mistakes less often and treat children more carefully. As a rule, at the age of 40, the financial situation of the parents is better than at the age of 20. The energies of your life are renewed, together with the baby a lot of new and interesting things come into your life.

But there are many disadvantages of being born after 40: the likelihood of infertility is greater and the risk of miscarriage is higher. It is more likely that a woman will have to resort to high reproductive technologies or receive special medical support.The likelihood of having a baby with serious congenital diseases increases.

E. Piskunova: – We cannot present medical indications like “at 40 it’s too late to carry a pregnancy” or “at 40 you cannot have your first child”. The first pregnancy at forty in Russia is not yet a very common fact, but, nevertheless, it takes place. The doctor, in my opinion, can only place some medical accents when carrying a pregnancy is clearly contraindicated or there are confirmed individual risks.And at what period of her life a woman has decided for herself that it is important for her, that she wants it – we always leave this decision to her.

Getting pregnant after thirty-seven is somewhat more difficult than at a younger age. After thirty-seven years, the number of ovulatory cycles drops sharply, this is statistically calculated: ovulation occurs every three to four months. This is at its best, ideally. There will be more risk. And this means that the woman will be examined more thoroughly.

In particular, a special analysis for the risk of genetic mutations is usually recommended.If during the first screening ultrasound (at 12-13 weeks) possible malformations are identified, there is still a possibility to terminate the pregnancy. The next screening period will be at 18–20 weeks, during this period any inferiority in the development of the fetus must be clearly identified, and the woman still has the opportunity to terminate the pregnancy. After 22 weeks, this is already prohibited by law and everything is done to preserve the fetus, if necessary, intrauterine operations are performed.

Should advertising be trusted?

What are panty liners for?

E.Piskunova: – A healthy woman does not need a daily sanitary napkin. Her linen remains clean, normally there should be no smell or discharge. If there is a smell, you do not need to buy a pad, but go to the doctor. And in general, the use of all these lactacids, epigen-sprays – yes, it does not harm health, but they are unnecessary for a healthy woman. If you cannot do without additional funds, you should go to the doctor and solve your health problem.

How to choose a gynecologist?

E.Piskunova: – It is desirable that one doctor observe you throughout your life – you get used to the doctor, and he knows your characteristics and is able to build a coherent monitoring system for you. Therefore, patients usually follow the doctor from clinic to clinic. And it is not so important whether you are being observed in a paid clinic or in a free one, the head and hands of a professional are important.

If for some reason you are faced with the need to change a doctor or a hospital, it is certainly very important to pay attention to the availability of certificates.In addition, your doctor should be versatile, have knowledge of both endocrinology and the treatment of inflammatory diseases; and if he is also an operating practitioner, that’s just great.

It is equally important how the reception is arranged: the confidentiality of the environment provides the necessary condition for confidentiality. If the doctor is a man, it is very important that a nurse is present at the appointment.

Why visit a gynecologist regularly if nothing bothers you?

Yu.Pertsova : – The absence of complaints does not mean complete health. Even if you feel good, you cannot be sure that you are completely healthy. Routine examinations and screening studies contribute to the early diagnosis of oncopathology and a number of gynecological diseases, which can save not only life, but also reproductive function. Every year, every woman should visit a gynecologist with a diagnosis (examination by a doctor with anamnesis, bimanual palpation and examination of the mammary glands, taking a smear for oncocytology, as well as colposcopy and ultrasound diagnostics, if indicated).

Some symptoms should be alerted to visit a doctor unscheduled: pain in the lower abdomen, the appearance of bloody discharge outside the menstrual cycle, in the postmenopausal period and after sexual activity. The appearance of odorless discharge, itching, burning, yellowish, greenish discharge, menstrual irregularities. Other issues that require a visit to the doctor: selection of contraception, frequent change of sexual partners, non-pregnancy during the year.

90,000 Articles of the Primula Medical Center

Menopause is a period of life when the function of the reproductive system
begins to decline.This is due to the age-related decrease in the levels of genital
hormones due to the extinction of ovarian function. Normal climax
starts at 40-45 years old. But after 35 years, a gradual
decreased levels of ovarian hormones.

There are cases of early (before 40 years) and late (after 55 years)
menopause. Often women under 40 do not even think about such a problem.
At the same time, cases of early menopause are now becoming more frequent.
Therefore, even at a young age, you need to know the symptoms of menopause in order to
consult a doctor in time for help.

Usually the climacteric period lasts 1.5-2 years, but all
individually and every woman experiences it differently. Stages
menopause: 1. Premenopause: begins after 40 years and can last up to
10 years. It is characterized by a gradual decrease in the production of ovarian
hormones, which is manifested by periods of irregular menstruation. Often this
the stage does not cause severe discomfort. 2. Menopause: characterized by
complete cessation of menstruation due to the almost complete cessation
ovarian function.The duration of the stage is 1 year. 3. Postmenopause: lasts from
3 to 15 years old.

How is menopause and how dangerous is it?

Climax begins with emotional instability against the background of changes
menstrual cycle, hot flashes, feelings of heat. Some
women may experience insomnia or, conversely, increased drowsiness.
The first age-related changes in appearance, skin and hair appear
become more dry, thin and brittle. In the future, there appear
changes in the genitourinary sphere: urinary incontinence, dry mucous membranes
urinary tract, decreased sex drive.Later changes
begin to affect other systems: cardiovascular (occurrence
and worsening of the course of ischemic disease, arterial hypertension),
metabolism (obesity, diabetes mellitus), osteoporosis progresses and
atherosclerosis. And this is not a complete list of “points of application”

All of the above explains the need to treat menopause. For this
you need to see a doctor. Most often, given the emerging
menstrual irregularities, a woman turns to an obstetrician-gynecologist,
therefore they begin the examination and follow-up treatment
climacteric syndrome.To choose a method of treatment, it is necessary
it is imperative to undergo an initial examination, the volume of which is also
determined by the doctor. In the future, the type of therapy is selected. It could be like
hormone therapy (“gold standard”) and alternative methods
(herbal medicine, psychotherapy, physiotherapy, acupuncture, homeopathy).
The main thing is the timely identification of the first symptoms of menopause and
the right treatment for him.

90,000 Sergey Tertychny: “The vagina is subject to age-related changes”

Many girls mistakenly assume that childbirth has the greatest influence on the condition of the vagina.They do not take into account such serious factors as active sports, sex life, weight loss and weight gain, hormonal fluctuations and age. No matter how difficult it is to admit it, the above aspects of life really affect the intimate zone of the fairer sex. With the doctor obstetrician-gynecologist of the medical center “Active-Medical” Sergey Vasilyevich Tertychny we will talk about what age-related changes in the vagina should be prepared for every woman.

  • Youth: estrogen on guard for health

– At the age of 16-18, the girl’s body is fully developed, of course, this also applies to the genitourinary system, – says Sergey Tertychny. – The vaginal mucosa is well hydrated, has a pink tint, the walls of the vagina are elastic, and the muscles of the pelvic day are in good tone. The hormone estrogen is responsible for the elasticity of the vulva and the moisture in the vagina. At this age, the body produces a sufficient amount of it.

  • Youth: vaginal folds and increased attention to hygiene.

– In the period from 20 to 30 years old, women may pay attention to changes in the structure of the vaginal mucosa. Against the background of the peak in the amount of estrogen, additional combing and folding appear in the vagina, the doctor continues.

– It is believed that vaginal folds appear only in those women who practice vaginal muscle training (wumbling).This is true?

– This is a myth. A normal vagina in youth always has this structure. It is she who provides a high quality of intimate life, sensitivity, a feeling of narrowness of the vagina due to its elasticity and extensibility.

– With the active use of condoms, many girls may have a problem with dry vaginal mucosa and lack of lubrication. What to do in such cases?

– Either use additional lubricant or choose another method of contraception.At the age of 20-35, when women are experiencing the peak of their sexual life, they develop basic habits related to intimate hygiene. We, doctors, do not get tired of repeating to our patients that synthetic underwear, especially thongs, and an irregular change of pads can cause unpleasant consequences – the development of bacterial infections. Use a special gel for intimate hygiene without perfume, give preference to cotton underwear. Too much douching can also cause many problems.Some women still resort to douching instead of barrier contraception, and even add vinegar to the water. Such “water procedures” wash out the natural microflora of the vagina, change its acidity, creating favorable conditions for the growth of pathological flora.

  • Blossoming: pregnancy, childbirth and their consequences.

– After 30 years, women who prefer hormonal contraception, which prevents the maturation of eggs, sometimes complain of dryness and burning …

– In most cases, this is due to the fact that the amount of vaginal lubrication decreases, – comments Sergey Tertychny. – During this period, I recommend that my patients pay attention to the tone of the intimate muscles in order to avoid prolapse of the pelvic organs after childbirth. Similar phenomena occur due to a decrease in the amount of collagen in the body. Sometimes we have to deal with the polar attitude of patients towards the field of women’s health. Some women do not even think about the fact that the genitals can change with age, others – on the contrary, pay increased attention to this area: they attend all kinds of women’s trainings, practice Kegel exercises, train the muscles of the vagina with the help of vaginal balls.

– Now more and more women prefer to give birth between 30 and 40 years old. During natural childbirth, the vaginal tissue is often injured. Scars form at the site of tears and cracks, thus, the elasticity and extensibility of the vagina deteriorates. Many people after childbirth complain about the deterioration in the quality of sexual life due to the fact that the vagina becomes wider …

– At a young age, the processes of tissue regeneration occur much faster, this is directly related to the general state of health of the young mother, her immunity, – explains the doctor .- That is why we recommend not to postpone childbirth “for later”. I note that the state of the genitals is negatively affected by the imposition of sutures of the perineum, and too fast childbirth, and the impressive size of the fetus. After childbirth, the hormone prolactin, which is responsible for lactation, takes on the role of “first fiddle”, and the level of estrogen is significantly reduced. This negatively affects the elasticity and moisture of the vaginal mucosa.

Also, due to “hormonal storms”, the labia and the perineal area can also darken, this confuses many of my patients.Do not be afraid of such changes in the body. When the hormonal background improves, the skin and mucous membranes will acquire their usual shade. In any case, modern technologies used in aesthetic gynecology allow women to restore the prenatal appearance of the genitals. The main thing is not to be ashamed of these processes and feel free to seek advice from your doctor. Patients can count on minimally invasive procedures , which we perform on an outpatient basis, in just a few visits.It can be either laser therapy , or complex approach . The technique is chosen by the doctor, guided by an individual approach to each patient.

  • Maturity: preparation for menopause.

Between the ages of 40 and 50, the body gradually begins to prepare for menopause. The level of the hormone estrogen gradually decreases. This affects the tone of the walls of the vagina and the pelvic floor in general. Women pay attention to dryness of the mucous membrane, to reduce the intensity of hair growth in the bikini area.This is how hormonal changes are manifested.

– Closer to the age of 50, women come to me who complain about the prolapse of the walls of the vagina, and sometimes the cervix, – comments Sergey Tertychny . – These processes negatively affect the quality of sex life. Sex ceases to bring pleasure, painful sensations appear instead. Intimate plastic , which we offer in such cases, relieves women of discomfort, improves the quality of intimate life.

The reason for the decrease in elastic tissues is not only age-related changes that provoke a decrease in estrogen production, but also a certain lifestyle of the patients, as well as a genetic predisposition. Women who are actively involved in sports run the risk of getting pathology of the pelvic organs. We are talking about lovers of “pulling iron” in the gym and professional athletes specializing in weightlifting. This also applies to representatives of non-female professions, who are forced to constantly lift weights.Sometimes the prolapse of the pelvic organs leads to such unpleasant consequences as urinary incontinence. This is due to a weakening of the bladder sphincter. Don’t be shy about this problem! Modern medicine can help ladies of Balzac’s age to cope with this delicate problem, the doctor reassures.

  • Withering: Menopause.

In the period from 50 to 60 years, most women face such a problem as age-related vaginal dryness.Violation of the normal microflora of the vagina is associated with a critical decrease in estrogen levels. Natural folding gradually disappears, elasticity decreases, the vaginal mucosa is smoothed. Considering that the amount of lubrication also decreases, it is understandable why many women experience discomfort during sex at this age.

– To combat these changes, it is worth using a systematic approach: control and correction of hormone levels, laser treatment methods, intimate biorevitalization, augmentation (filler injection) of sensitive areas (clitoris and G area), the use of lubricants during intimacy, – explains doctor .- It is possible and necessary to deal with age-related changes in the vagina. Menopause occurs in every woman at one time: for someone it happens a little earlier, for someone later earlier. This may depend on weight and genetics: if the mother had an early menopause, then the woman is already at risk for menopause. When menopause has come, and enough time has passed since the last menstrual period (a year or two), half of the patients begin to see specialists for itching, burning, discomfort and discharge.All this is associated with hormonal changes and the onset of postmenopause.

Discomfort in the intimate area and atrophic changes in the vaginal mucosa, which occur in postmenopause, are well compensated by hormone replacement therapy, which is selected by a gynecologist. In this case, the quality of life really improves. Many postmenopausal women are sexually active at sixty-five or even sixty-eight years old. They are very pleased that modern medicine makes it possible to change their intimate life for the better.Now there are 90,026 a wide range of rejuvenating corrective procedures: hardware laser rejuvenation techniques and various injections, mesotherapy, hyaluronic acid injections. All this is done to saturate the vaginal mucosa, improve its quality and, as a result, the general well-being of the woman.

If you need consultation Sergey Vasilyevich Tertychny, call the medical center “Active-Medical”, and sign up by phone: (097) 320-15-27; (093) 881-84-09; (095) 112-31-95, (0512) 777-888 .Our doctor will be happy to answer your questions. Here, if necessary, you can quickly pass all the tests, find out which anti-aging corrective procedures are right for you, and go through them at our medical center.

Author: Olga Chaika

Climax: can physiology be controlled

In Belarus, about 800 thousand women of the country suffer from climacteric disorders. And only half of them go to the doctor. The issues of effective medical support of patients with these disorders were discussed by the participants of the republican conference with international participation “Modern problems of menopause”.The meeting brought together over 500 specialists from Belarus, Ukraine and Russia.

Interdisciplinary view of early symptoms

Svetlana Soroka,
Chief obstetrician-gynecologist of the Ministry of Health

In recent decades, the life expectancy of the population has been increasing. And a third of it in a modern woman is postmenopausal. At the same time, at the age of 45-50, many are the most socially active, at the peak of their careers.

Obstetricians-gynecologists, cardiologists, therapists, endocrinologists for the first time interdisciplinaryly considered topical issues of medical care for patients during the period of extinction of reproductive function.We will also invite oncologists, psychotherapists, sexologists to the next conference. After all, visits to a doctor by women experiencing menopause are primarily associated with vasomotor and emotional-mental disorders; then urogenital disorders, metabolic syndrome, signs of osteoporosis, angina pectoris, Alzheimer’s disease join.

When symptoms from the cardiovascular, musculoskeletal and other systems appear, patients turn to the appropriate specialist, not suspecting that the reason is estrogen deficiency.It has been proven that female sex hormones protect the heart and blood vessels, maintain the normal state of the skin, mucous membranes, etc. The doctor’s task is to notice age-related features in time, to differentiate ailments associated with menopause, and, together with an obstetrician-gynecologist, to choose a treatment method.

Early intervention is extremely important. The pathological course of the perimenopausal period occurs in 20-40% of women and can result in severe disorders. One of the common “scenarios” is that uncorrected hormonal changes lead to pelvic organ prolapse, and surgical intervention is required.

“For many years obstetricians-gynecologists have improved the provision of medical care to women of reproductive age and adolescent girls.

The first conference on the topic of menopause is evidence of the special attention to the ladies of the “golden age
”. It is predicted that their share in the world by 2015 90 014 9013 will be 46%. This means that and the number of visits to obstetricians-gynecologists will increase
and other specialists.Our doctors must be ready to provide qualified assistance. »

Plant Power – Against Feeling Bad

Lyudmila Mozheiko,
Head of the Department of Obstetrics and Gynecology
, BSMU, Dr. med. Sci.,

An alternative method for correcting climacteric disorders is herbal medicine. There are two groups of drugs: SERM (selective estrogen receptor modulators) and natural drugs (phytoestrogens / phytohormones).

In Russia, herbal preparations already represent 30% of the pharmacy assortment.

Phytotherapy should be consulted if there is an absolute contraindication to HRT (or several relative ones) or the patient refuses hormones. It is appropriate to use herbal remedies for mild and moderate climacteric syndrome, surgical menopause, in women with a history of cancer. The possibility of using herbal remedies in combination with tamoxifen after mastectomy is being studied.

Such drugs are most effective during the premenopausal period. They reduce the severity of the manifestations of the climacteric syndrome by 2–2.5 times. The second important effect is a weak estrogenic effect and no effect on the proliferative processes of the endometrium. In addition, phytoestrogens lower LDL levels.

Do not forget about non-drug methods of correction of menopause disorders. Among them – aero- and hydrotherapy (dousing, circular shower), carbon dioxide, pearl, oxygen, radon, iodine-bromine baths, manual massage of the collar zone, acupuncture, electrosleep, anodic galvanization of the brain and cervical-facial region, electrophoresis of sympathetic sympathetic regions of the upper cervical nodes.

Medical Bulletin, 7 November 2013