You can file menopause under near-universal experiences that no one really talks about, right next to periods and miscarriages. (You might have learned about hot flashes and night sweats through pop-culture osmosis, but that’s pretty much the extent of our collective education on the topic.) There's still a long way to go in dispelling the misconceptions, understanding the truly effective treatment options and demystifying the rarely discussed aspects of this phase in a person's life, during which the ovaries effectively close up shop and stop producing eggs.
Quick biology lesson: You have a finite reserve of eggs, and once you run out, your body responds by dialing down your production of estrogen. This then triggers a hormonal rollercoaster that impacts parts of your body well beyond your reproductive system.
Eventually, the process ends with a depletion of estrogen — which puts you squarely into menopause. This transition, though, can stretch over the course of years. With that, here’s what you should know.
Stages of menopause
Menopause can be divided into three stages: “There's premenopause, perimenopause, and postmenopause,” says Dr. Stephanie Faubion, M.D., the director for the Center for Women's Health at the Mayo Clinic and medical director for The North American Menopause Society. “Menopause and postmenopause are the same thing.” If that sounds confusing, that’s because it is: Entire papers have been written about the inconsistencies in the criteria and reporting of each stage, even in scientific research. Let’s take a closer look at each stage.
Premenopause
Premenopause (which Faubion refers to as the “late reproductive stage”) is hallmarked by regular periods. “Your cycle length could vary month to month, but it's less than a seven-day variation,” says Faubion. “What that means is you could have a 26-day cycle and a 32-day cycle.” That would still be considered regular, even if they’re not happening on the exact same day in your cycle month after month, and it means that you haven’t missed a period yet.
The average age for this is 47, per one study in Menopause. One clue that you’re entering this time is the variation in the length of your cycle. But even if you do have regular periods, “women [may] have the same symptoms as women in menopause transition — hot flashes, night sweats, sleep disturbances, mood disturbances, joint aches, et cetera — and they're not expecting to have those,” she says.
Perimenopause
Once you reach a variation in your period lengths that’s greater than seven days, you’ve officially entered perimenopause, which Faubion calls “the start of menopause transition,” which then ends once you completely miss a period.
After that, perimenopause continues on until you’ve reached a full year without a period. You’ll still be experiencing the symptoms of perimenopause during this time, which can last anywhere from two to eight years — with the general average being four years.
Menopause and Postmenopause
Menopause, also called postmenopause, is defined as not having your period for 12 months. It “lasts for the rest of your life, but you don't know you're actually in menopause until you've gone a year without a period,” says Faubion.
She points to the STRAW +10, a criteria updated in 2012 that’s considered the gold standard among providers for menopause staging. “When you look at that, don't be confused — menopause and postmenopause are used interchangeably,” she says.
Signs and symptoms of menopause
The symptoms of menopause (which, again, begin during premenopause) run the gamut. “Think about all the small ways in which estrogen impacts our bodies,” says board-certified obstetrician-gynecologist Dr. Kerry-Anne A. Perkins, M.D. It helps you focus, keeps skin moisturized, regulates your metabolism, affects your body temperature and helps protect bones from osteoporosis, among many other roles.
So, “when it's decreased, it influences everything,” says Perkins. That includes vasomotor symptoms — those hot flashes and night sweats — as well as trouble sleeping, irritability or mood swings, vaginal dryness, and dry, thin skin. Hormonal weight gain is another symptom. “We tend to gain weight during menopause, which is a function of aging, but more weight around your midsection is due to the loss of estrogen,” says Faubion. The exact reason is unclear, but it might be because sex hormones control fat distribution. Estrogen encourages your body to burn fat a higher rate in your midsection — without it, more belly fat accumulates.
These symptoms can sometimes create a domino effect of more symptoms. For instance, "people may have an issue sleeping through the night because they're having a lot of hot flashes, and it leads to them being depressed," says Perkins. "This becomes a cycle that can go on for years."
How do you know when menopause starts?
The symptoms make it pretty clear when the perimenopause part of menopause begins. “It's fatigue, it's irritability, it's painful sexual activity, it’s acne, it's hair growth issues,” says Perkins. “Menopause affects our bodies in so many different ways.” You might suspect that something is going on, but until you have symptoms, she says, you may not put two-and-two together. And some people don’t have any symptoms at all — in which case the only clue would be the irregularity in your menstrual cycle.
Menopause causes
Age is the biggest cause of menopause, but other medical conditions can factor in. Cancer treatment can contribute to surgical menopause, in that the ovaries may get removed during a surgical procedure, says Perkins. (Radiation close to the ovaries can also cause you to go into menopause.)
Perkins has also found that some autoimmune diseases can trigger menopause. “I find a lot of lupus patients are showing up at 30 and have no ovarian reserve left, and they're going into menopause,” she says. The connection is likely due to the role that sex hormones play in lupus, according to studies.
Menopause diagnosis
You could go to your doctor for bloodwork, but you don’t really need it. “We will treat your symptoms no matter where you are on the menopause transition,” says Faubion. “If you're starting to have some cycle-length variation and the occasional hot flash, we don't need a blood test to tell you that.”
In fact, she says, blood tests can be unreliable since there are such major variations in hormones from day to day. “We could check the same test two days in a row and it'd be completely different,” she says.
Most of the time, if you’re in the right age range and your symptoms check out, then she’ll proceed with treatment. The exception is if you’re not in the right age range — say, you’re experiencing hot flashes and missing your period in your early 30s. That would merit a closer look from your docs.
Menopause treatment
Menopause treatment will vary depending on your symptoms and the stage. Because of mismatched signals between your brain and ovaries during pre- and perimenopause, “your estrogen level is shooting way higher than it normally did during your normal reproductive years,” says Faubion. “And when it falls, that's when you sweat and have headaches and mood disturbances.” It’s the pendulum-like hormonal variations that cause symptoms during this time — versus once you’re in menopause, during which the symptoms are caused by a lack of estrogen.
Medication
For pre- and perimenopause, “even just a birth control pill is going to help control symptoms,” says Faubion. (And that includes symptoms that involve irregular periods.) In most cases, she says, she’ll prescribe a low-dose oral contraceptive pill to take care of symptoms like hot flashes. “Another option is an IUD that has a progestin, which will help take care of bleeding issues [as in heavy periods] around perimenopause,” she says.
Hormone therapy
Hormone therapy is the gold standard for treating symptoms of menopause, according to Faubion. “It’s the most effective therapy, and it’s dramatically underused.” She recently reported new data showing that hormone-therapy usage rates have never been lower, with fewer than 4% of women in their 50s using it. That’s possibly due to a fear of “high” estrogen levels in the body contributing to certain hormonally driven cancers, like breast cancer, which arose after a 2002 study concluded that the risk of hormone therapy outweighed the benefits. A reexamination of that original study along with a 2023 review of newer literature determined hormone therapy during menopause to be safe and effective among the right patients — namely, those who are under 60 and have been in menopause for less than 10 years.
“We can often use a very low dose of estrogen — not anywhere near what ovaries would produce — to control symptoms post-menopause,” says Faubion. That typically happens via a transdermal patch. In addition to estrogen, the hormone progesterone (which also declines during menopause) is typically included in HRT as well.
Dietary supplements
Protein and micronutrients — specifically, certain vitamins — are essential during menopause. For one, protein is key to maintaining muscle mass, which is lost with age. “Most females are eating 50 or 60 grams of protein,” says Perkins. That number should be closer to 1-2 grams per kg body weight. (If you weigh 190 pounds, that’s 86-172 grams per day.)
Then, to support your overall health during this transition, she points to vitamins. “For our hormones to be produced and for our brain and or organs to function well, they need micronutrients, like vitamin A, vitamin E and vitamin D,” she says. “We need to have adequate amounts of all of these at baseline.” While it’s always preferable to get vitamins via your food, you can opt for a multivitamin if that’s a better option for you.
As for over-the-counter supplements that promise to make your hot flashes and night sweats disappear, don’t bother. “There's no over-the-counter supplement that has been shown to be effective for hot flashes,” says Faubion.
Self-care
Basic self-care, like good sleep and a balanced diet, can go a long way. One powerful habit is exercise — which can not only help regulate your mood, but also address multiple menopause symptoms like hot flashes and mood swings, according to Perkins. With regular physical activity, “the likelihood of you having severe symptoms when you're going through menopause is much slimmer than compared to someone who is sedentary,” she explains. That’s because exercise seems to improve the control and regulation of your body’s thermoregulation system.
Another promising way of addressing some menopause symptoms is through stress-reduction skills like meditation and yoga, with one study in Scientific Reports finding that it significantly reduced symptoms of depression and anxiety among women during menopause.
Menopause complications
Menopause may seem like a reproductive matter, but it can cause complications throughout the rest of the body — although they can be hard to discern from good, old aging. “In midlife, you have a number of things happening at the same time,” says Faubion.
One thing you can blame squarely on menopause is a loss of bone density. “We lose about 12% of our bone density across the menopause transition, and between the ages of 50 and 80, we lose about 30% of our bone density,” says Faubion. “That is related to the loss of estrogen in menopause, and we continue on a downward track from there.”
The risk of heart disease also goes up, although the exact reason is still fuzzy at this time. It “has something to do with the loss of estrogen, because typically all our cardiovascular risk factors track upward after menopause,” she says. But women also tend to develop high blood pressure, experience an increase in cholesterol, and gain weight around their midsections during menopause. “That all adds up to we're at greater risk for heart disease, and you've also got aging blood vessels on top of that,” says Dr. Faubion.
Menopause can also worsen your brain health, increasing your risk of dementia. That’s because “brain aging is vascular aging, the same as it is for the heart,” says Faubion. “Our risk for dementia is delayed compared to heart disease risk because it just takes longer for it to manifest. But all these things really start to track after midlife.”
The bottom line
Menopause isn’t just a matter of your periods disappearing. Instead, it’s a drawn-out process that can affect every aspect of your life. The good news? There are very effective treatments out there that can make this transition more comfortable for you. “Women don't have to suffer,” says Faubion. “We used to say, ‘Don't worry, these symptoms will last a year or two and go away.’” And research shows that this just isn’t true — giving you all the more reason to address your symptoms as soon as they get in the way of your life.
FAQs
The average age for menopause in the United States is 51, but this can differ between ethnicities. Black women, for example, enter menopause 8.5 months earlier than white women, and they experience perimenopause for longer.
Menopause lasts the rest of your life, though the symptoms do not in most cases. Perimenopause can range in how long it lasts, but the symptoms can last for years; for instance, hot flashes tend to last seven to nine years on average.
First, know that you don’t gain a significant amount of weight. “We do know that there is a recomposition of weight from certain areas to others, and so you might have a more abdominal growth, but the actual weight difference that we see is a five-pound difference,” says Perkins.
However, your metabolism naturally goes down with age. So, if you eat the same foods, do the same exercise and otherwise maintain the status quo, “you will gain about five pounds each year,” says Perkins. “The amount of calories that your body requires to maintain actually just goes down over time. And so you are going to end up gaining weight if you eat the same amount.” All to say: You might lose weight after menopause if you’re mindful of your nutrition and your physical activity, but it’s not a given.
This content is for informational purposes only and does not constitute medical advice, diagnosis or treatment. It should not be regarded as a substitute for guidance from your healthcare provider.