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.
It can cause uncomfortable symptoms, such as hot flashes and weight gain. For most women, medical treatment isn’t needed for menopause.
It is the time that marks the end of your menstrual cycles. It’s diagnosed after you’ve gone 12 months without a menstrual period. However, menopause can happen in your 40s or 50s, but the average age is 51 in the United States.
Additionally, menopause is a natural biological process. But the physical symptoms, such as hot flashes, and emotional symptoms may disrupt your sleep, lower your energy or affect emotional health. Although, there are many effective treatments available, from lifestyle adjustments to hormone therapy.
When does menopause begin and how long does it last?
Most women first begin developing 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 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 two years earlier for Black and Latina women. Moreover, more studies are needed to understand the onset of menopause for women of color.
There are many factors that help determine when you’ll begin, including genetics and ovary health. Perimenopause 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 at some point after their mid-40s. Other women skip perimenopause and just enter suddenly.
About 1 percent of women begin menopause before the age of 40, which is called premature menopause or primary ovarian insufficiency. About 5 percent of women undergo menopause between the ages of 40 and 45. This is referred to as early menopause.
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.
Symptoms of Menopause
In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Sleep problems
- Mood changes
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Loss of breast fullness
Signs and symptoms, including changes in menstruation, can vary among women. Most likely, you’ll experience some irregularity in your periods before they end.
Skipping periods during perimenopause is common and expected. Often, menstrual periods will skip a month and return, or skip several months and then start monthly cycles again for a few months. Periods also tend to happen in shorter cycles, so they are closer together. Despite irregular periods, pregnancy is possible. If you’ve skipped a period, but aren’t sure you’ve started the menopausal transition, consider a pregnancy test.
Menopause can result from:
- Naturally declining reproductive hormones. As you approach your late 30s, your ovaries start making less estrogen and progesterone — the hormones that regulate menstruation — and your fertility declines. In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually — on average, by age 51 — your ovaries stop releasing eggs, and you have no more periods.
- Surgery that removes the ovaries (oophorectomy). Your ovaries produce hormones, including estrogen and progesterone, that regulates the menstrual cycle. Surgery to remove your ovaries causes immediate menopause. Your periods stop, and you’re likely to have hot flashes and experience other menopausal signs and symptoms. Signs and symptoms can be severe, as hormonal changes occur abruptly rather than gradually over several years.Surgery that removes your uterus, but not your ovaries (hysterectomy) usually doesn’t cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone.
- Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures may still be desired. Radiation therapy only affects ovarian function if radiation is directed at the ovaries. Radiation therapy to other parts of the body, such as breast tissue or the head and neck, won’t affect menopause.
- Primary ovarian insufficiency. About 1% of women experience menopause before age 40 (premature menopause). Premature menopause may result from the failure of your ovaries to produce normal levels of reproductive hormones (primary ovarian insufficiency), which can stem from genetic factors or autoimmune disease. But often no cause of premature menopause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones.
Common complications of menopause include:
- Vulvovaginal atrophy
- Dyspareunia, or painful intercourse
- slower metabolic function
- osteoporosis, or weaker bones with reduced mass and strength
- mood or sudden emotional changes
- periodontal disease
- urinary incontinence
- heart or blood vessel disease
Why does menopause occur?
Menopause is a natural process that occurs as the ovaries age and produces fewer 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.
A new blood test is known as the PicoAMH Elisa diagnostic test. This test is used to help determine whether a woman has entered menopause or is getting close to entering menopause.
This new test may be helpful to women who show symptoms of perimenopause, which can also have adverse health impacts. Early menopause is associated with a higher risk of osteoporosis and fracture, heart disease, cognitive changes, vaginal changes and loss of libido, and mood changes.
Your doctor can also order a blood test that will measure the level of certain hormones in the blood, usually FSH and a form of estrogen called estradiol.
During perimenopause, FSH and estrogen levels fluctuate daily, so most healthcare providers will diagnose 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:
- thyroid function tests
- blood lipid profile
- liver function tests
- kidney function tests
- testosterone, progesterone, prolactin, estradiol, and chorionic gonadotropin (hCG) tests
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
- vaginal atrophy
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
- Anti dandruff shampoos, commonly ketoconazole 2 percent and zinc pyrithione 1 percent, used for hair loss
- Eflornithine hydrochloride topical cream for unwanted hair growth
- 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 recurrent UTIs
- Sleep medications for insomnia
- Denosumab, teriparatide, raloxifene, or calcitonin for post menstrual 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.
Here are some at-home tips for managing menopause symptoms:
Keeping cool and staying comfortable
Dress in loose, layered clothing, especially during the night time 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 flush.
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 to 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, such as:
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.
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:
- vitamin E
- flax seed
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.
Similarly, researchTrusted Source from 2015 found no evidence to support claims that omega-3 fatty acids can improve vasomotor symptoms associated with menopause.
Menopause is the natural cessation, or stopping, 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 the 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 affect your quality of life. Generally, menopause symptoms can be managed or reduced using natural remedies and lifestyle adjustments.