Menopause

Menopause is the stage of life when menstrual periods stop permanently. A person has reached menopause after 12 consecutive months without a period. The years leading up to this point are called perimenopause, or the menopausal transition. During this time, hormone levels change, and periods may become irregular.

Menopause and perimenopause are natural stages of aging. Some people have mild symptoms, while others may experience hot flashes, sleep disruption, mood changes, sexual health concerns, or other physical and emotional changes that affect daily life.

Most people experience menopause between ages 45 and 55. The average age in the United States is around 51 to 52, but timing varies.

After menopause, lower levels of estrogen may increase the risk of certain health conditions, including heart disease and osteoporosis. For people who experience early or premature menopause, these risks may begin at a younger age.

This page provides information to help individuals understand menopause, manage symptoms, and support long-term health. It also offers guidance and resources for health care providers.

What is Menopause?

Menopause is when menstrual periods stop permanently, and pregnancy is no longer possible. A person is considered to have reached menopause after 12 months in a row without a period or spotting.

Menopause is not a disease or disorder. It is a normal part of aging. It does not happen all at once. As the body transitions to menopause over several years, periods may become irregular, and symptoms may occur. The time leading up to menopause is called the menopausal transition, or perimenopause. Most people begin the menopausal transition between ages 45 and 55, the average age of menopause in the United States is 52.

After menopause, the ovaries make very low levels of the hormone's estrogen and progesterone. These lower hormone levels can increase the risk for certain health problems. Some people have no or mild symptoms during the menopausal transition. Others may experience changes that affect sleep, mood, or overall well-being. A health care provider can help review treatment options if needed.

Early or Premature Menopause

Menopause that happens before age 45 is called early menopause. Menopause that happens before age 40 is called premature menopause. Premature menopause is also known as primary ovarian insufficiency (POI).

Early or premature menopause happens when the ovaries stop making hormones and periods stop at a younger age than usual.

Possible Causes

Early or premature menopause may happen naturally or for medical reasons. Causes can include:

  • Family history
  • Smoking
  • Chemotherapy or pelvic radiation
  • Surgery to remove both ovaries
  • Certain health conditions, such as autoimmune diseases
  • Chromosome conditions

Sometimes, early or premature menopause happens without a clear cause.

Possible Effects

People who experience early or premature menopause may:

  • Have common menopause symptoms at a younger age
  • Be unable to become pregnant using their own eggs
  • Higher risk of serious health problems, such as heart disease and osteoporosis, due to lower estrogen levels

Some people may also experience emotional distress related to earlier-than-expected changes in fertility. If symptoms or emotional concerns affect daily life, talk with a health care provider about support and treatment options.

Signs and Symptoms

Category Common Symptoms
Menstrual Changes
  • Irregular periods
  • Skipped periods
  • Changes in cycle length
  • Heavier or lighter bleeding
  • Spotting
Temperature Changes
  • Hot flashes
  • Night sweats
  • Flushing
  • Cold chills
Sleep Changes
  • Difficulty falling asleep
  • Difficulty staying asleep
  • Night waking
  • Sleep disruption
  • Daytime fatigue
Sexual Health Changes
  • Vaginal dryness
  • Pain during sex
  • Reduced vaginal lubrication
  • Changes in sexual desire
Urinary Changes
  • Urinary urgency
  • Urinary frequency
  • Leakage with coughing/sneezing/laughing
  • Increased UTIs
Emotional and Cognitive Changes
  • Mood changes
  • Irritability
  • Anxiety
  • Increased risk of depression
  • Brain fog
  • Difficulty concentrating
  • Memory changes
Physical Changes
  • Joint or muscle discomfort
  • Body composition changes
  • Weight distribution changes
  • Skin changes
  • Fatigue

Treatments

Many menopause symptoms can be managed. Treatment depends on your symptoms, health history, and personal preferences. A health care provider can help you decide what options are right for you.

Hormone Therapy

Systemic menopausal hormone therapy (MHT) delivers hormones, like estrogen and progesterone, through the body to help relieve hot flashes, night sweats, and vaginal dryness. Systemic estrogen therapy, a type of MHT, protects against the bone loss that occurs early in menopause. This can help prevent weak and brittle bones, also known as osteoporosis. Systemic therapy may reduce the risk of colon cancer.

  • During perimenopause, low-dose hormonal birth control may help manage hot flashes, mood changes, and heavy or irregular periods.
  • After menopause, hormone therapy replaces some of the estrogen and progesterone the body no longer produces.
  • Hormone therapy may be taken as a pill or patch. Vaginal estrogen products (local hormone replacement) can treat vaginal dryness and some urinary symptoms associated with menopause.

Symptoms, age, previous medical history and family history are important considerations in starting these therapies. It is recommended to discuss and make this decision with your doctor or obstetrician-gynecologist, to tailor and choose the best option for your needs. Local hormone therapy is different from systemic hormone therapy. These low-dose vaginal treatments help relieve vaginal dryness, improve urinary symptoms and have a better safety profile, but do not treat hot flashes.

Non-Hormonal Medicines

Non-hormonal prescription medicines may help if hormone therapy is not recommended.

  • Some antidepressants can reduce hot flashes.
  • Other medicines are approved to treat moderate to severe hot flashes.
  • Prescription options are available for painful sex caused by vaginal changes.

A health care provider can review the benefits and possible side effects of these options.

Everyday Symptom Management

Lifestyle changes and over-the-counter products may also provide relief.

For hot flashes:

  • Dress in layers.
  • Use a fan.
  • Avoid triggers such as alcohol, caffeine, or spicy foods.
  • Practice slow, deep breathing.

For vaginal dryness:

  • Use water-based lubricants during sex.
  • Use vaginal moisturizers regularly.

For sleep:

  • Keep a regular sleep schedule.
  • Limit caffeine and alcohol.
  • Keep your bedroom cool, dark, and quiet.

For mood and overall well-being:

  • Get regular physical activity.
  • Manage stress.
  • Stay socially connected.

Some herbal or "natural" products are marketed for menopause symptoms, but many are not proven to be effective and may carry risks. Talk with a health care provider before using supplements.

Menopause and Long-Term Health

After menopause, lower hormone levels and aging together can affect several areas of health.

  • Heart disease and stroke. Cardiovascular risk increases after menopause.
  • Osteoporosis. Bone loss occurs more quickly, raising the risk of fractures.
  • Changes in cognitive health. Midlife vascular risk factors are linked to cognitive changes over time.
  • Urinary incontinence. More common with aging and certain health conditions.
  • Oral health concerns. Dry mouth and cavities may increase.

Early or Premature Menopause

Early or premature menopause can increase health risks at a younger age.

People who experience early or premature menopause may have:

  • A higher risk of serious health problems, such as heart disease and osteoporosis
  • More severe menopause symptoms
  • Emotional distress related to earlier-than-expected changes in fertility

Changes in bone density, heart health, body shape and composition, or physical function may also occur over time.

Screenings and Preventive Care

Regular checkups and screening tests remain important after menopause.

Your health care provider may recommend:

  • Mammograms
  • Pap and HPV testing
  • Blood pressure and cholesterol checks
  • Screening for diabetes and heart disease
  • Height measurements to monitor bone loss
  • Vaccines such as flu, COVID-19, shingles, RSV, and pneumonia

Talk with a health care provider about which screenings are appropriate for you.

Staying Healthy After Menopause

There are steps you can take to support your health:

  • Quit smoking and avoid secondhand smoke
  • Get regular physical activity
  • Include muscle-strengthening and weight-bearing exercises
  • Eat a balanced diet with adequate calcium and vitamin D
  • Practice safe sex to reduce the risk of sexually transmitted infections

When to see a Healthcare Provider?

If your menopause symptoms bother you or interfere with your daily life, talk with a health care provider. They can help you understand your options and decide whether treatment may be helpful.

During your visit, you may discuss your symptoms and how much they affect you, your age and overall health, your family health history, and whether treatments such as menopausal hormone therapy are appropriate for you.

You should also contact a health care provider if you experience ongoing sleep problems, significant forgetfulness or changes in thinking, mood changes that last more than a few weeks, or bleeding after menopause (after 12 months without a period). These symptoms may need further evaluation.

Resources and Support

Information for Individuals

Information for Healthcare Providers

Sources

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