Overview

Menopause is a normal and natural part of aging.

As you enter your 40s, your body will likely produce less and less estrogen until you no longer menstruate. Once you stop menstruating and have had no periods for 12 months. you will have reached menopause.

Natural menopause, which happens without medical intervention, occurs in three stages:

Many people confuse menopause with perimenopause. Perimenopause is the stage when a woman begins to transition into menopause. Some common symptoms of the perimenopausal phase include:

During perimenopause, your body begins to make less estrogen. This continues until the last one or two years of perimenopause until your hormone levels drop rapidly. Perimenopause can start up to 10 years before you enter menopause. It often begins in your 40s, but some women enter perimenopause in their 30s.

Doctors will determine that you’ve reached menopause when you haven’t had a period for 12 consecutive months. After that, you will enter the postmenopausal stage.

If you’ve had your ovaries surgically removed, you’ll experience “sudden” menopause.

Duration

Perimenopausal symptoms can last four years on average. The symptoms associated with this phase will gradually ease during menopause and postmenopause. Women who’ve gone an entire year without a period are considered postmenopausal.

Hot flashes, also known as hot flushes, are a common symptom of perimenopause. One study found that moderate to severe hot flashes could continue past perimenopause and last for a median of 10.2 years. That’s longer than the generally accepted timeframe for the duration of hot flashes.

Researchers also found that black women and women of average weight experience hot flashes for a longer period than white women and women who are considered overweight.

It’s possible for a woman to experience menopause before the age of 55. Early menopause occurs in women who go through menopause before they’re 45 years old. It’s considered premature menopause if you’re menopausal and are 40 years old or younger.

Early or premature menopause can happen for many reasons. Some women can go through early or premature menopause because of surgical intervention, like a hysterectomy. It can also happen if the ovaries are damaged by chemotherapy or other conditions and treatments.

Symptoms

You’ll experience a host of symptoms while going through perimenopause (for example, your periods become irregular). The frequency, intensity, and duration of symptoms vary widely from person to person during perimenopause and as you approach menopause.

Once in menopause (you haven’t had a period for 12 months) and on into postmenopause, the symptoms may continue for an average of four to five years, but they decrease in frequency and intensity. Some women report their symptoms last longer.

The most common symptoms include:

  • Hot flashes. These cause you to feel a sudden rush of warmth in your face and upper body. They can last a few seconds to several minutes or longer. Hot flashes can occur several times a day or a few times a month.
  • Night sweats. Hot flashes during sleep can result in night sweats. Night sweats can wake you up and make you feel extra tired during the day.
  • Cold flashes. You may experience chills, cold feet, and shivering after your body cools down from a hot flash.
  • Vaginal changes. Vaginal dryness, discomfort during sex, low libido, and an urgent need to urinate are symptoms of genitourinary syndrome of menopause (GSM).
  • Emotional changes. These may include mild depression, mood swings, and irritability.
  • Trouble sleeping. Sleep problems such as insomnia can occur because of night sweats.

Other symptoms of perimenopause can include:

Some women may also experience:

  • headaches
  • racing heart
  • muscle and joint pain
  • focus and memory issues
  • hair loss or thinning
  • weight gain

If you experience any of these additional symptoms, visit your doctor to rule out other causes.

You can experience any of these symptoms throughout perimenopause. But hot flashes typically occur at the onset of perimenopause.

Management

Going through perimenopause and menopause can be uncomfortable and sometimes painful for many women. But it’s a normal and manageable part of aging. Here are some tips to help you manage your symptoms.

Hot flashes

Try these options to help you prevent and manage hot flashes:

  • Identify and avoid hot flash triggers like spicy foods or alcohol.
  • Use a fan at work or at home.
  • Take low-dose oral contraceptives if you still have your period.
  • Take slow, deep breaths when a hot flash starts.
  • Remove some layers of clothing when you feel a hot flash coming on.

Vaginal dryness

Vaginal dryness can be managed by using a water-based, over-the-counter (OTC) lubricant during sex or by using an OTC vaginal moisturizer used every few days. Your doctor can also prescribe medication to help with more severe vaginal discomfort.

If you’re reluctant to engage in intercourse with your partner, see your doctor.

Sleep problems and mood swings

Try these options to avoid sleep problems:

  • Avoid large meals, smoking, coffee, or caffeine after noon.
  • Avoid napping during the day.
  • Avoid exercise or alcohol close to bedtime.
  • Drink warm milk or warm caffeine-free tea before bed.
  • Sleep in a dark, quiet, and cool room.
  • Treat hot flashes to improve sleep.

Easing stress, eating right, and staying physically active can help with mood swings and sleeping problems. Your doctor may also prescribe medication to help with mood swings.

You should talk to your doctor about managing your symptoms and to rule out other conditions that may be causing your symptoms, like depression or asthma. It’s also helpful to join a support group for women in menopause so you have a safe place to share your concerns and issues.

Additional treatments

Your doctor may also prescribe menopausal hormone therapy (MHT) to help treat your symptoms. MHT (once known as hormone replacement therapy, or HRT) can ease:

  • hot flashes
  • night sweats
  • sleep problems
  • irritability
  • vaginal dryness

MHT may also help slow bone loss and reduce mood swings and mild depressive symptoms. Side effects of MHT include:

  • vaginal bleeding
  • bloating
  • breast swelling or tenderness
  • headaches
  • mood changes
  • nausea

Studies show that women who take MHT are at an increased risk of heart attack, stroke, and blood clots. The risks are similar for women using contraceptive pills, patches, and rings. However, women taking MHT are older, and the risks increase with age.

Many women can’t take MHT because of a previous illness such as cancer or because they take other medications.

Additional research found that the risk of getting breast cancer can increase with five or more years of continuous MHT use (of estrogen with progestogen, not estrogen alone).

Women who have had their uterus removed will use estrogen-only therapy.

Talk to your doctor to learn more about hormonal therapy before making a decision to use it.

When to seek help

It’s common and normal to experience irregular periods when you’re perimenopausal.

However, other conditions, like polycystic ovary syndrome (PCOS) or cervical cancer, can also cause irregular bleeding. See your doctor to rule out other causes if you:

  • suddenly experience very heavy periods or periods with blood clots
  • have periods lasting longer than usual
  • spot or bleed after sex
  • spot or bleed after your period
  • have periods close together

Osteoporosis and heart disease are long-term health risks associated with menopause. That’s because estrogen plays a significant role in protecting your bones and your heart. Without estrogen, you’re at an increased risk for both diseases. You should speak with your doctor about treatment options to protect yourself against both diseases.

You’re also at an increased risk of urinary tract infections because menopause can cause your urethra to become dry, irritated, or inflamed. Vaginal infections can also occur more frequently because your vagina has become dryer and thinner.

Report menopausal symptoms when visiting the doctor. Get assessed by your physician if you continue to have menopausal symptoms that are unbearable or last more than five years after your last menstrual period.

Benefits of menopause

Although menopause can cause uncomfortable symptoms for some women, this natural process has possible upsides, too. There are several potential benefits of menopause to consider:

  • A positive perspective. The Massachusetts Women’s Health Study, one of the largest longitudinal studies to focus on middle-aged women, found that most women had overwhelmingly positive or neutral attitudes toward menopause. Most women don’t seek outside help for menopause.
  • No change in health or health behaviors. The same study found that women’s health and health behaviors are unlikely to change with menopause. That means if you already lead a healthy lifestyle, you’ll likely stick with it.
  • The wisdom of experience. Menopause goes hand-in-hand with aging, which carries with it the value of life experience. Psychologist Sylvia Gearing, PhD, told the American Psychology Association’s Monitor on Psychology that, in her experience, women in menopause have increased “clarity, decisiveness, emotional intelligence,” and other positives.
  • No menstruation. Some women like that menstruation comes to an end with menopause, especially if they experienced heavy periods, cramping, or PMS. Once your monthly cycle stops, there’s no need to purchase tampons, pads, or other menstrual products.
  • No need for birth control after no periods for one year.

It’s still possible to become pregnant during perimenopause, so don’t abandon birth control right away. After a year without your period, it’s generally accepted that pregnancy isn’t possible without medical intervention, which may be a relief for some women.

You will still need to protect yourself from sexually transmitted diseases.

Outlook

Life after menopause isn’t much different than life during your reproductive years. Remember to eat right, exercise, and receive routine healthcare, including dental and eye exams.

When and how long symptoms of menopause last vary for each individual. It’s common for these symptoms during the entire time of perimenopause and into postmenopause to last about seven years.

A nutritious diet and regular exercise will help you maintain strong bones, while regular doctor visits will help you catch problems early.