Everything You Should Know About Menopause

Medically reviewed by Cynthia Cobb, DNP, APRN on January 17, 2018Written by Jennifer Huizen on January 17, 2018

Overview

Menopause occurs when a woman hasn’t menstruated in 12 consecutive months and can no longer become pregnant naturally. It usually begins between the ages of 45 and 55, but can develop before or after this age range.

Menopause can cause uncomfortable symptoms, such as hot flashes and weight gain. For most women, medical treatment isn’t needed for menopause. Read on to learn what you need to know about menopause.

When does menopause begin and how long does it last?

Most women first begin developing menopause symptoms about four years before their last period. Symptoms often continue until about four years after a woman’s last period. A small number of women experience menopause symptoms for up to a decade before menopause actually occurs, and 1 in 10 women experience menopausal symptoms for 12 years following their last period.

The median age for menopause is 51, though it may occur on average up to 2 years earlier for African American and Latina women. More studies are needed to understand the onset of menopause for non-Caucasian women.

There are many factors that help determine when you’ll begin menopause, including genetics and ovary health. Perimenopause often occurs before menopause. Perimenopause is a time when your hormones begin to change in preparation for menopause. It can last anywhere from a few months to several years. Many women begin perimenopause some point after their mid-40s. Other women skip perimenopause and enter menopause suddenly.

About 1 percent of women begin menopause before the age of 40, and about 5 percent undergo menopause between the ages of 40 and 45. This is referred to as early or premature menopause, or primary ovarian insufficiency.

Perimenopause vs. menopause vs. postmenopause

During perimenopause, menstrual periods become irregular. Your periods may be late, or you may completely skip one or more periods. Menstrual flow may also become heavier or lighter.

Menopause is defined as a lack of menstruation for one full year.

Postmenopause refers to the years after menopause has occurred.

What are the symptoms of menopause?

Every woman’s menopause experience is unique. Symptoms are usually more severe when menopause occurs suddenly or over a shorter period of time. Conditions that impact the health of the ovary, like cancer or hysterectomy, or certain lifestyle choices, like smoking, tend to increase the severity and duration of symptoms.

Aside from menstruation changes, the symptoms of perimenopause, menopause, and postmenopause are generally the same. The most common early signs of perimenopause are:

An estimated 75 percent of women experience vasomotor symptoms with menopause.

Other common symptoms of menopause include:

Complications

Common complications of menopause include:

Why does menopause occur?

Menopause is a natural process that occurs as the ovaries age and produce less reproductive hormones.

The body begins to undergo several changes in response to lower levels of:

One of the most notable changes is the loss of active ovarian follicles. Ovarian follicles are the structures that produce and release eggs from the ovary wall, allowing menstruation and fertility.

Most women first notice the frequency of their period becoming less consistent, as the flow becomes heavier and longer. This usually occurs at some point in the mid-to-late 40s. By the age of 52, most U.S. women have undergone menopause.

In some cases, menopause is induced, or caused by injury or surgical removal of the ovaries and related pelvic structures.

Common causes of induced menopause include:

  • bilateral oophorectomy, or surgical removal of the ovaries
  • ovarian ablation, or the shutdown of ovary function, which may be done by hormone therapy, surgery, or radiotherapy techniques in women with estrogen receptor-positive tumors
  • pelvic radiation
  • pelvic injuries that severely damage or destroy the ovaries

How is menopause diagnosed?

It’s worth talking with your healthcare provider if you’re experiencing troublesome or disabling menopause symptoms, or you’re experiencing menopause symptoms and are 45 years of age or younger.

There’s no single test to diagnose menopause, but your doctor can order a blood test that will measure the level of certain hormones in the blood, usually FSH and a form of estrogen called estradiol. Consistently elevated FSH blood levels of 30 mIU/mL or higher, combined with a lack of menstruation for one consecutive year, is usually confirmation of menopause. Saliva tests and over-the-counter (OTC) urine tests are also available, but they’re unreliable and expensive.

During perimenopause, FSH and estrogen levels fluctuate daily, so most healthcare providers will diagnosis this condition based on symptoms, medical history, and menstrual information.

Depending on your symptoms and health history, your healthcare provider may also order additional blood tests to help rule out other underlying conditions that may be responsible for your symptoms.

Additional blood tests commonly used to help confirm menopause include:

Treatments

You may need treatment if your symptoms are severe or affecting your quality of life. Hormone therapy may be an effective treatment in women under the age of 60, or within 10 years of menopause onset, for the reduction or management of:

  • hot flashes
  • night sweats
  • flushing
  • vaginal atrophy
  • osteoporosis

Other medications may be used to treat more specific menopause symptoms, like hair loss and vaginal dryness.

Additional medications sometimes used for menopause symptoms include:

  • topical minoxidil 5 percent, used once daily for hair thinning and loss
  • antidandruff shampoos, commonly ketoconazole 2 percent and zinc pyrithione 1 percent, used for hair loss
  • eflornithine hydrochloride topical cream for unwanted hair growth
  • topical lubricants and anti-inflammatory agents for severely dry eyes
  • selective serotonin reuptake inhibitors (SSRIs), commonly paroxetine 7.5 milligrams for hot flashes, anxiety, and depression
  • nonhormonal vaginal moisturizers and lubricants
  • low-dose estrogen-based vaginal lubricants in the form of a cream, ring, or tablet
  • ospemifene for vaginal dryness and painful intercourse
  • prophylactic antibiotics for UTIs
  • sleep medications for insomnia
  • denosumab, teriparatide, raloxifene, or calcitonin for postmenstrual osteoporosis

Home remedies and lifestyle changes

There are several ways to reduce minor-to-moderate menopause symptoms naturally, using home remedies, lifestyle changes, and alternative treatments.

Common at-home tips for managing menopause symptoms include:

Keeping cool and staying comfortable

Dress in loose, layered clothing, especially during the nighttime and during warm or unpredictable weather. This can help you manage hot flashes.

Keeping your bedroom cool and avoiding heavy blankets at night can also help reduce your chances of night sweats. If you regularly have night sweats, consider using a waterproof sheet under your bedding to protect your mattress.

You can also carry a portable fan to help cool you down if you’re feeling flushed.

Exercising and managing your weight

Reduce your daily calorie intake by 400 to 600 calories to help manage your weight. It’s also important to exercise moderately for 20-30 minutes a day. This can help:

  • increase energy
  • promote a better night’s sleep
  • improve mood
  • promote your general well-being

Communicating your needs

Talk to a therapist or psychologist about any feelings of depression, anxiety, sadness, isolation, insomnia, and identity changes.

You should also try talking to your family members, loved ones, or friends about feelings of anxiety, mood changes, or depression so that they know your needs.

Supplementing your diet

Take calcium, vitamin D, and magnesium supplements to help reduce your risk for osteoporosis and improve energy levels and sleep. Talk to your doctor about supplements that can help you for your individual health needs.

Practicing relaxation techniques

Practice relaxation and breathing techniques, like:

Taking care of your skin

Apply moisturizers daily to reduce skin dryness. You should also avoid excessive bathing or swimming, which can dry out or irritate your skin.

Managing sleeping issues

Use OTC sleep medications to temporarily manage your insomnia or consider discussing natural sleep aids with your doctor. Talk to your doctor if you regularly have trouble sleeping so they can help you manage it and get a better night’s rest.

Quitting smoking and limiting alcohol use

Stop smoking and avoid exposure to secondhand smoke. Exposure to cigarettes may make your symptoms worse.

You should also limit your alcohol intake to reduce worsening symptoms. Heavy drinking during menopause may increase your risk of health concerns.

Other remedies

Some limited studies have supported the use of herbal remedies for menopausal symptoms caused by estrogen deficiency.

Natural supplements and nutrients that may help limit menopause symptoms include:

There are also claims that black cohosh may improve some symptoms, such as hot flashes and night sweats. But in a recent review of studies, little evidence was found to support these claims. More research is needed.

Similarly, research from 2015 found no evidence to support claims that omega-3 fatty acids can improve vasomotor symptoms associated with menopause.

Outlook

Menopause is the natural cessation, or stopping, of a woman’s menstrual cycle, and marks the end of fertility. Most women experience menopause by the age of 52, but pelvic or ovarian damage may cause sudden menopause earlier in life. Genetics or underlying conditions may also lead to early onset of menopause.

Many women experience menopause symptoms in the few years before menopause, most commonly hot flashes, night sweats, and flushing. Symptoms can continue for four or more years after menopause.

You may benefit from treatment, such as hormone therapy, if your symptoms are severe or affecting your quality of life. Generally, menopause symptoms can be managed or reduced using natural remedies and lifestyle adjustments.

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