The menopause is associated with serious long-term consequences, some of them driven by falling, and others by persistently low sex hormone levels.

 At first progesterone levels begin to ebb, often in one's early 40s, followed by full-bore progesterone depletion which leads to heavy bleeding. Then estrogen becomes highly erratic, waxing and waning which thereby fuels flushes and menstrual irregularity even while the ovaries continue to function, albeit fitfully. After that the levels of estrogen, although still highly erratic, dip below some critical point, fueling the final cessation of menses, a marker of permanent estrogen depletion. In many, testosterone production continues for some five or so years thereafter, in the process buffering menopausal symptoms. However in those with an artificial form of menopause such as that induced by surgical removal of the ovaries, both estrogen and testosterone levels together fall abruptly off a cliff, hence the more severe problems these women experience.