Menopause
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.
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 two 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 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, 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.
What is peri-menopause (the menopausal transition)?
Peri-menopause refers to the time leading up to menopause when a woman may start experiencing changes in her menstrual periods such as irregular periods or changes inflow. Cycles can be shorter or longer in length. Symptoms may also include hot flushes and night sweats, aches and pains, fatigue or irritability as well as premenstrual symptoms such as sore breasts. These changes may be caused by fluctuations in the production of hormones from the ovary. Some women can experience menopausal symptoms for 5-10 years before their final menstrual period1. There is no way to predict the age at which a woman’s menopausal symptoms will start or how long they will last.
Contraception in the peri-menopause
A woman’s fertility declines naturally in her 40s and the risk of pregnancy after the age of 50 years is estimated at less than one percent but women may ovulate twice in a cycle and as late as three months before the final period. Women are advised to keep using contraception until two years after their last period if they experience the menopause under the age of 50, and for one year after the last period if aged 50 years or more2. Women using combined oral contraception (the Pill or the vaginal ring which contain estrogen and a progestogen) are generally advised to cease by the age of 51 years and switch to a non-hormonal or progestogen-only method. The risks of Ethinyl oestradiol-containing methods increase with age, especially if the woman is a smoker over the age of 35 (for detailed information on the advantages and disadvantages of contraceptive methods in the peri-menopause and advice on stopping contraception at menopause see the information sheet Contraception).
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:
- less frequent menstruation
- heavier or lighter periods than you normally experience
- vasomotor symptoms, including hot flashes, night sweats, and flushing
An estimated 75 percent of women experience hot flashes with menopause.
Other common symptoms of menopause include:
- insomnia
- vaginal dryness
- weight gain
- depression
- anxiety
- difficulty concentrating
- memory problems
- reduced libido, or sex drive
- dry skin, mouth, and eyes
- increased urination
- sore or tender breasts
- headaches
- racing heart
- urinary tract infections (UTIs)
- reduced muscle mass
- painful or stiff joints
- reduced bone mass
- less full breasts
- hair thinning or loss
- increased hair growth on other areas of the body, such as the face, neck, chest, and upper back
Complications of Menopause
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
- cataracts
- 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 less reproductive hormones.
The body begins to undergo several changes in response to lower levels of:
- estrogen
- progesterone
- testosterone
- follicle-stimulating hormone (FSH)
- luteinizing hormone (LH)
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 known as the PicoAMH Elisa diagnostic test was recently approved by the Food and Drug AdministrationTrusted Source. 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.
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 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
Treatments for Menopause
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
- 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 postmenstrual osteoporosis
Home remedies and lifestyle changes for Menopause
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 with your individual health needs.
Practicing relaxation techniques
Practice relaxation and breathing techniques, such as:
- yoga
- box breathing
- meditation
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:
- soy
- vitamin E
- isoflavone
- melatonin
- 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. More research is needed.
Similarly, researchTrusted Source from 2015 found no evidence to support claims that omega-3 fatty acids can improve vasomotor symptoms associated with menopause.
Outlook for Menopause
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 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.
Frequently Asked Question about Menopause
My hot flashes aren’t as intense as the ones my friends describe. Is this normal?
While hot flashes (or flushes) are very common in perimenopause, not all women experience them, and not all flashes are of the same intensity. Hot flashes can be as mild as a light blush or severe enough to wake you from a sound sleep and be associated with perspiration (called night sweats). Most hot flashes last 30 seconds to five minutes. They usually disappear within a few years after menopause, but in some women, they can continue for decades.
Now that I’ve begun menopause, should I be concerned about birth control?
You will know for sure that you have experienced menopause when you have not had your period for an entire year. Until you have gone one year without a period, you should still use birth control if you do not want to become pregnant. After menopause, you should continue to practice safe sex techniques by using latex condoms to reduce the risk of sexually transmitted infections.
I’m perimenopausal and have been told I should be taking low-dose birth control pills. Why?
It is common in perimenopause to be given medications to regulate cycles and a common medication is given is the lower dose birth control pill. Compared to regular birth control pills, the lower dose of estrogen in very-low-dose pills may be safer for perimenopausal women. (Perimenopause typically begins several years before your final period.) While regular birth control pills contain 30 to 50 micrograms of estrogen, these low-dose pills contain only 0.3 to 0.45 micrograms and can be increased as needed.
What are some of the benefits of taking low-dose birth control pills?
Should I take Hormone Replacement Therapy?
Hormone replacement therapy (HRT) is designed to help women whose menopausal symptoms — hot flashes, night sweats, insomnia, mood swings, vaginal dryness — are severe and affecting her quality of life. These symptoms can go on for years after your last period.
HRT replaces or supplements the hormones your body doesn’t make anymore. Most women who use it take a combination of estrogen and progesterone. Estrogen is what helps most with symptoms like hot flashes and vaginal dryness; progesterone is added to protect against uterine cancer and bone loss (osteoporosis).
Besides hormone replacement therapy, how can I treat hot flashes?
While HRT relieves hot flashes for many women, there are other drug treatments that may offer relief. These include both over-the-counter and prescription therapies you may recognize for their more common medical uses. Over-the-counter therapies include various vitamins, ibuprofen products, and soy protein found in foods.
Prescription treatments include:
- HRT
- Low-dose depression drugs fluoxetine (Prozac), paroxetine (Paxil), or venlafaxine (Effexor)
- Clonidine, blood pressure medication
- Gabapentin, an anti-seizure drug
- Brisdelle, a paroxetine formula specifically for hot flashes
- Duavee, a conjugated estrogens/bazedoxifene formula designed to treat hot flashes
Are there natural treatments available for menopause symptoms?
Natural or bioidentical supplements containing compounds that act like estrogens — such as soybeans or wild yams — may provide some of the benefits of estrogen in relieving menopausal symptoms. They commonly include estradiol, estrone, estriol, progesterone, testosterone, and dehydroepiandrosterone (DHEA). These products are not regulated by the US Food and Drug Administration (FDA and the dose of hormones can vary from batch to batch.
Other botanicals, including black cohosh, have shown some promise for reducing menopausal sweats, or hot flashes. You should always check with your doctor before using any of these supplements.
Sex has become painful since menopause. What can I do?
The pain you are experiencing during sex is may be due to vaginal dryness associated with declining estrogen levels during menopause. Talk to your doctor about the possible causes of painful intercourse. There are a number of lubricants you can try to relieve the symptoms. Ask your doctor or pharmacist for a suggestion. There are also local estrogen treatments — cream, tablets, and an estrogen ring — that treat vaginal dryness. An oral drug taken once a day, Osphena, is also available. The drug makes vaginal tissue thicker and less fragile, resulting in less pain for women during sex.
Can menopause cause changes in a woman’s voice?
The majority of women do not experience a voice change during menopause, although this may be a problem for some.
What can I do about facial hair I’ve developed as a result of menopause?
Botanical supplements containing compounds that act like estrogens — such as soy — may provide some of the benefits of estrogen in relieving menopausal symptoms, but research results are contradictory. Other botanicals, including black cohosh, have shown some promise for reducing menopausal sweats, or hot flashes. However, more research is needed to define the benefits and risks of these alternative treatments, and you should always check with your doctor before using them.