Menopause is time in a woman's life when her periods (menstruation) eventually stop and the body goes through changes that no longer allow her to get pregnant. It is a natural event that normally occurs in women age 45 - 55.

Perimenopause; Postmenopause

Some women have vaginal bleeding after menopause. This is often nothing to worry about. However, you should tell your health care provider if this occurs. It may be an early sign of other health problems, including cancer.

Decreased estrogen levels have been linked with some long-term effects, including:

• Bone loss and osteoporosis in some women
• Changes in cholesterol levels and greater risk of heart disease

Call your health care provider if:

• You are spotting blood between periods
• You have had 12 consecutive months with no period and suddenly vaginal bleeding or spotting begins again, even if it is a very small amount

Menopause is a natural and expected part of a woman's development and does not need to be prevented. You can reduce your risk of long-term problems such as osteoporosis and heart disease by taking the following steps:

• Control your blood pressure, cholesterol, and other risk factors for heart disease.
• Do NOT smoke. Cigarette use can cause early menopause.
• Eat a low-fat diet.
• Get regular exercise. Resistance exercises help strengthen your bones and improve your balance.
• If you show early signs of bone loss or have a strong family history of osteoporosis, talk to your doctor about medications that can help stop further weakening.
• Take calcium and vitamin D.

American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG Committee Opinion No. 420, November 2008: hormone therapy and heart disease. Obstet Gynecol. 2008;112:1189-1192.

Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause. 2010;17:25-54.

North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause. 2010;17:242-255.

Col NF, Fairfield KM, Ewan-Whyte C, Miller H. In the clinic. Menopause. Ann Intern Med. 2009;150:ITC4-1-ITC4-15.

Brunner RL, Aragaki A, Barnabei V, et al. Menopausal symptom experience before and after stopping estrogen therapy in the Women's Health Initiative randomized, placebo-controlled trial. Menopause. 2010;17:946-954.

Freeman EW, et al. Efficacy of escitalopram for hot flashes in healthy postmenopausal women. JAMA. 2011;305:267-274.