Menopause A Second Beginning

Today I would like to talk about menopause, a period that, when well managed, can actually be spent more healthily and energetically. Recently there has been a trend to call menopause not by the negative nuance of "menstruation has closed" (pyegyeong) but by the meaning of "menstruation has been completed" (wangyeong). However, since the official medical term is still menopause, I will write "menopause" in this article, while carrying forward the warm gaze it contains. In the clinic, quite a few people accept menopause as "the end as a woman" and become discouraged. But menopause is not an end; it is closer to a starting line for newly designing the second half of life.

Menopause is a state that is diagnosed only when there has been no menstruation for 12 months after the final period. In other words, it is not an event suddenly declared one day as "from today, menopause," but a change confirmed in hindsight after the passage of one year. Medically, it refers to the point when ovarian function is naturally lost so that ovulation and menstruation no longer occur.

So it is hard to conclude "I skipped a period or two, so it's menopause." This is because, on the way to menopause, it is common for cycles to lengthen and then return again, repeatedly. According to material from the Korean Society of Menopause and the National Health Information Portal of the Korea Disease Control and Prevention Agency, menopause in Korean women generally occurs between ages 45 and 55, with the average age reported around 50. Material from the North American Menopause Society (NAMS, 2022) also presents the average menopausal age of Western women as around 51, so you may think of it broadly with around 50 as the reference.

If the timing of menopause is earlier than average or the bleeding pattern differs from usual, it is safer to check through an examination whether it is a simple menopausal change or whether another cause is hidden.

What comes before menopause itself is the menopausal transition (perimenopause). The menopausal transition refers to the transitional period from the reproductive years to menopause, generally beginning in the mid-to-late 40s and continuing until about one year after the final period. During this period, the female hormones secreted by the ovaries, especially estrogen, gradually decline, and changes appear all over the body.

The cycle becoming irregular and the volume increasing or decreasing are often the first noticeable signs. In the clinic, there are really many who ask "my periods are sparse—is this menopause?" and this very irregularity is the most common appearance of the transition. If your cycle has changed from before, it would be good to also read the article for those wondering whether sparse periods mean menopause.

The reason it is good to understand the transition in advance is clear. Instead of feeling anxious thinking "why is this happening," you can accept it as "my body is finding a new balance" and start management a step ahead. If you want to know the mechanism of bodily change in more detail, the article summarizing the changes and symptoms that occur in the body during the menopausal transition is helpful.

Symptoms around menopause tend to appear with different textures by period rather than all crowding in at once. Organizing the flow by period in a table, based on material from the National Health Information Portal of the Korea Disease Control and Prevention Agency, gives the following.

The type and intensity of these symptoms vary greatly between individuals. Some pass with almost no discomfort, while others struggle enough to have their daily life disrupted. If you are troubled by disturbed sleep, the story about menopausal insomnia and sleep will help, and if hot flashes bother you, the article on why you should not leave hot flashes untreated is a useful reference.

What is important is that these symptoms are not "aging you must endure" but "changes that can sufficiently improve with management."

According to several surveys, even in states that need management or treatment for menopausal symptoms, a considerable number of women are reported to simply endure without any particular measures. As I said in the original article, the fact that nearly half cannot receive help even when it is available is always a regrettable point.

In the clinic, there are usually two misunderstandings behind that. One is the thought "everyone is like this when they get older, so I must endure," and the other is a vague fear that "I heard hormone therapy is dangerous." In fact, those who come in also carry much worry about hormone therapy at first.

But after going through thorough consultation and deciding together on a management direction suited to the individual, in many cases the vague anxiety turns into a concrete plan and they become much more at ease. Quite a few also tell me their quality of life improved together. If you are hesitant about hormone therapy, you can first consult comfortably about menopausal concerns via chat.

Fear of hormone therapy mostly stems from old information. The current evidence has changed a lot from then. According to the position statement of the North American Menopause Society (NAMS, 2022), hormone therapy is reported as the most effective method for relieving vasomotor symptoms such as hot flashes and night sweats and the genitourinary syndrome of menopause (GSM), and is also evaluated as helping prevent bone loss and fractures.

The key is "for whom, and when." NAMS summarizes that in relatively healthy women who are within 10 years of the onset of menopause and under 60, the benefits generally outweigh the risks. This is the concept often called the "window of opportunity." Conversely, it is not recommended in those who have had a hormone-dependent tumor such as past breast cancer, and please keep in mind that whether to treat and the method are a tailored decision made by weighing an individual's medical history and risk factors.

If you are curious about when to start hormone therapy and how long to continue it, the article addressing the start timing and duration of menopausal hormone therapy is helpful, and if you have vague worries about treatment, the FAQ on whether hormone therapy is safe is helpful.

Of course, hormone therapy is not the only path. If symptoms are mild or hormone therapy is not suitable, other options such as lifestyle management, local treatment, and non-hormonal therapy can also be considered together.

As life expectancy has lengthened, so too has life after menopause. If we view the average menopausal age as around 50, there is a high likelihood of spending nearly half of life after menopause. In that case, shouldn't we change this period from "time to endure" to "time to cultivate"?

Organizing the parts to pay particular attention to in post-menopausal management gives the following.

• Bone health: when estrogen declines, bone density can decrease rapidly, so osteoporosis prevention management is important
• Cardiovascular health: it is good to pay attention to changes in cholesterol/blood pressure and check them steadily
• Urogenital health: vaginal dryness and frequent bladder discomfort directly affect quality of life, so it is better not to leave them unaddressed
• Regular checkups: even without symptoms, it is safer to look ahead at changes through menopausal checkups and gynecological exams

Many people in their 20s to 40s could not take care of themselves while attending to work, childbirth, child-rearing, and family. So in clinical experience, the menopausal period is, on the contrary, also the best time to resolve "now I will spend time for myself." If you want to know more deeply the principles of bodily change across menopause as a whole, I recommend also reading the article summarizing menopausal bodily changes, symptoms, causes, and mechanisms.

Menopause is certainly a signal of a major change the body sends, but how you accept and manage that signal can completely change the life that follows. Above all, you do not have to endure it alone. Rather than vaguely enduring, I recommend checking your body's condition in the clinic once and finding the direction that suits you together. Whatever the symptom around menopause, if you inquire comfortably via chat consultation, I will guide you step by step. In the very place you thought was the end, I will prepare a second beginning together with you.

Written by: Lee Dong-hee Director · Obstetrics and Gynecology Specialist · View medical staff profile

First published November 4, 2023 · Last reviewed May 30, 2026

References: North American Menopause Society NAMS Hormone Therapy Position Statement (2022), Korea Disease Control and Prevention Agency National Health Information Portal Menopause (2024), Korean Society of Menopause (2024)

This article is intended to provide general health information and does not replace individual diagnosis or treatment. If you have symptoms, please consult through an examination.