Menopause

Menopause is the time when you stop having menstrual periods. Once you reach menopause, you are no longer able to become pregnant or have babies.

Most people who experience menopause are women. Transgender men and some non-binary people (those who don’t identify as men or women) may also experience menopause.

The time between when you start having your menstrual period and when you begin menopause is called premenopause. This timeframe may also be called your childbearing years.

The menopausal transition happens gradually, in three stages:

• Perimenopause is when your hormone levels begin to change. It typically begins in your early 40s and lasts for several years. However, it can start as early as your late 30s or as late as your early 50s. During perimenopause, you may notice certain mental and physical symptoms (see below) triggered by the change in your hormone levels. During perimenopause, hormone fluctuations can cause irregular periods, characterized by cycles that may be shorter, longer, lighter or heavier than usual.
• Menopause is when you haven’t had a menstrual period for 12 months in a row. It typically happens between age 45 and 55.
• Postmenopause is the time after your periods have stopped. Most of the symptoms of menopause ease during this time.

What causes menopause?

Menopause is a natural stage of life. As you get older, your ovaries don’t produce as much of the hormones estrogen and progesterone. You need these hormones for menstruation and pregnancy.

Eventually, your ovaries stop producing hormones and no longer release eggs. At this point, you stop having your menstrual period.

Some factors influence the age at which you reach menopause. You may reach menopause earlier due to:

• Genetics
• A history of smoking
• Obesity
• Medical conditions such as autoimmune diseases
• Cancer treatments such as chemotherapy or radiation treatment to the ovaries
• Surgery to remove the ovaries
• Early ovary failure

Menopause before age 40 is called premature menopause, and menopause between ages 40 and 45 is called early menopause.

If you think you may be entering perimenopause, you can track your changes. Keep a calendar of your menstrual cycle, including a journal of your physical and emotional symptoms.

As your periods become less predictable, you may want to figure out whether you’re in transition to menopause. High levels of FSH may indicate that you are moving toward menopause. Although over-the-counter (OTC) test kits are available to check your follicle-stimulating hormone (FSH), these tests aren’t always accurate. Your FSH levels change a lot before menopause and taking birth control pills can affect them, too.

If you have concerns about menopause, talk to your health care provider.  If they suspect something else could be causing your symptoms, they can test your blood for FSH, estradiol (E2) and thyroid hormones. These tests can figure out if your symptoms are caused by menopause or something else and help you come up with a plan.

Top concerns about menopause

Menopause can be a big event in your life. It marks the end of your childbearing years. It is also a time of transition and change that can impact your health and well-being.

You may experience feelings of loss, grief or sadness. Or you may feel relieved to be free from the worry of getting pregnant. All feelings during this time are perfectly normal.

Before and during menopause, you may worry about:

• Physical changes: Hot flashes, night sweats, vaginal dryness, weight gain, bone loss and decreased sex drive can cause discomfort and disrupt your daily life.
• Emotional changes: Mood swings, increased irritability, anxiety and depression can be difficult to manage and can impact your relationships and work performance.
• Health risks: Menopause increases the risk of osteoporosis, heart disease and stroke.
• Cognitive changes: Difficulty concentrating, memory problems and forgetfulness can be frustrating and can impact your daily activities.
• Body image: Menopause can lead to weight gain and fat redistribution. It may be hard for you to accept these changes, and you may feel self-conscious or have low self-esteem.
• Relationships: Hot flashes and night sweats can disrupt sleep and intimacy, and mood swings and irritability can make it difficult to communicate with loved ones.

What are the symptoms of perimenopause and menopause?

For several years before menopause, as your hormone levels fluctuate and decline, you may notice symptoms such as irregular menstrual cycles, hot flashes, night sweats, vaginal dryness, mood swings, sleep problems and difficulty concentrating.

Learn more about perimenopause and menopause symptoms.

What are the treatment options for perimenopause and menopause?

Some people in perimenopause have mild symptoms. For others, they are more intense and can interfere with sleep, work and social activities. Lifestyle changes, hormone replacement therapy and other medications can help relieve symptoms.

For those experiencing severe symptoms like hot flashes or vaginal dryness, hormone therapy, which involves taking estrogen or a combination of estrogen and progesterone, may be recommended under medical supervision to alleviate discomfort.

Learn more about perimenopause and menopause treatments.

What happens during postmenopause?

Postmenopause is the stage of life after menopause. Often, many perimenopause symptoms ease up. However, lower estrogen levels now put you at higher risk of certain health conditions.

Learn more about postmenopause.