Menopause

The menopausal transition is an important time in midlife to focus on health and make changes that can support health and well-being in the years ahead.

Overview

Menopause is the point in time 12 months after a woman’s last menstrual period. The menopausal transition is an important time in midlife to focus on health and make changes that can support health and well-being in the years ahead. Women experience menopause in different ways. Menopause may occur naturally with aging or as a result of surgery or certain medical treatments. The timing, onset, and symptoms can vary from woman to woman.

The years leading up to menopause are called menopausal transition, or perimenopause. Most women begin the menopausal transition between ages 45 and 55. In the United States, the average age of menopause is 51 to 52. During this time, a woman’s ovaries start to produce less estrogen and progesterone. These hormone changes cause symptoms of menopause. Symptoms related to menopause can last for between two and eight years, though the timing and symptoms vary greatly among women.

Although periods may become irregular during the menopause transition, pregnancy is still possible.  Women who do not want to become pregnant should continue to use birth control until the menopausal transition is complete.

The time after menopause is called postmenopause, a phase that lasts for the rest of a woman’s life.

Signs and Symptoms

Women experience the menopausal transition differently, and symptoms can vary in type and severity. Some have mild symptoms, while others have more severe symptoms that last for years. Common symptoms include:

Changes in Periods

During perimenopause, periods may be irregular. These may last longer or shorter or be lighter or heavier than usual. Women should see a healthcare provider if periods happen very close together, involve heavy bleeding, include spotting after sex or between periods, last more than a week, or return after more than a year without a period.

Hot Flashes

A hot flash is a sudden feeling of heat, most often in the upper body and face. The face and neck may become flushed, and red blotches may appear on the chest, back, and arms. Heavy sweating and cold shivering can follow. Most hot flashes last between 30 seconds and 10 minutes. They can happen several times an hour, a few times a day, or just once or twice a week.

Night Sweats

Hot flashes that happen at night are called night sweats and may disrupt sleep.

Sleep Problems

Many women have trouble sleeping during the menopausal transition. Long-term lack of sleep can lead to fatigue, lack of energy, and memory problems.

Bladder and Urinary Problems

Many women develop bladder or urinary problems during menopause. A loss of bladder control, or incontinence, may cause a sudden urge to urinate or urine leakage during exercise, sneezing, or laughing. Menopause also increases the risk of developing urinary tract infections.

Vaginal Dryness

Around menopause, the vagina may become drier. This can make sexual intercourse uncomfortable. Women may also experience a tightening of the vaginal opening, burning, and itching, which is called vaginal atrophy.

Mood Changes

Anxiety and depression can occur during menopause. These changes may be related to hormone shifts or lifestyle factors. Whereas abnormal periods, problems sleeping, mood swings, and hot flases are common during the menopause transition, more extreme feelings of irritability, anxiety, sadness, or loss of enjoyment may be signs of depression. Perimenopausal depression affects some women during the transition to menopause. A history of mental illness is a risk factor for mood related changes during perimenopause. 

Depression during the menopausal transition can contribute to suicidal thoughts and behaviors. If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.

Body Changes

The waist may get larger, muscle may be lost, and fat may increase. Skin can become thinner and drier. Joints and muscles may feel stiff or achy.

Brain Health

Some women also notice memory problems or trouble focusing.

Midlife is an important window for health, as changes during this time may influence health later in life. After menopause, women face a higher risk for certain health conditions, some of which are related to hormonal changes, while others may be related to aging:

  • Osteoporosis: The loss of estrogen causes women to lose bone density. This can make bones weak and prone to breaking. Bone loss increases in the first two years after menopause.
  • Heart disease: Heart disease may develop after menopause due to the loss of estrogen or to other problems related to normal aging. Weight gain, high blood pressure, and diabetes all put stress on the heart and can increase the risk of a heart attack or stroke. The loss of estrogen may also be associated with changes in cholesterol levels. Moreover, during midlife and menopause, high density lipoprotein (HDL) (often called “good cholesterol”), may not work as well as it used to before menopause. Even if HDL levels increase during the menopausal transition, it may not work as effectively to protect heart health after menopause.
  • Pelvic floor disorders: The lack of estrogen in menopause can cause supportive tissue in the pelvic cavity to weaken. This may allow the uterus, bladder, or walls of the vagina to fall into the vaginal opening.
  • Vaginal and urinary tract infections: Vaginal dryness can lead to vaginal or urinary tract infections.
  • Brain and cognitive health: Research suggests that menopause may also affect brain health. Studies have found links between menopausal symptoms, especially hot flashes and sleep disturbances, and changes in memory and brain function. These changes may be related to both hormonal shifts and cardiovascular health.

Causes and Risk Factors

In the natural process of menopause, a woman’s ovaries stop releasing eggs and making the hormones estrogen and progesterone. When this happens, a woman stops having her period and is no longer fertile.

Menopause can also occur because of:

  • Surgical removal of both ovaries
  • Chemotherapy or hormone therapy for the treatment of conditions such as breast cancer

Other factors that affect menopause include:

  • Smoking: Smoking is associated with an early onset of menopause and more severe menopausal symptoms.
  • Race and ethnicity: Menopausal symptoms can vary by race and ethnicity. Findings from the Study of Women’s Health Across the Nation (SWAN) show that Black women experience more frequent and longer-lasting vasomotor symptoms, such as hot flashes and night sweats, while Chinese and Japanese women report these symptoms less frequently.
  • Weight: Women who have overweight or obesity may experience more frequent and severe hot flashes.
  • Genetics: A woman’s genetics may influence the timing of menopause and severity of symptoms.

Recognizing Menopause

Women often notice the signs and symptoms of menopause without a formal diagnosis from their healthcare provider. Menopause is usually identified based on symptoms and menstrual history. A change in menstrual patterns and the appearance of hot flashes are usually the first signs.

A healthcare provider may ask questions about a woman’s age, symptoms, and family history to determine if the menopausal transition is a likely cause. In some cases, such as if a woman’s periods stopped at an early age, a healthcare provider may suggest a blood test to check hormone levels.

Although blood tests are not required, blood or urine tests can measure levels of the hormones estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). At menopause, the ovaries become less responsive to FSH and LH, so the body makes more of these hormones to compensate. Estradiol and other hormones decrease around menopause.

However, for most women, blood or urine tests are not needed to determine where they are in the menopause transition, as hormone levels fluctuate significantly during the menopause transition and limit the value of single measurement.

True menopause cannot be confirmed until one year after a woman’s final menstrual period.

During and after menopause, a woman should get regular physical, pelvic, breast, colorectal, and skin exams to monitor her health. Because bone loss increases after menopause, healthcare providers may order a bone density test, such as a dual-energy X-ray absorptiometry (DEXA) scan.

Treatment and Management

Menopause is a normal part of aging. Treatment depends on a woman’s symptoms, health history, and personal preferences. Many women find that they do not need treatment for their menopause symptoms. For those who do, a combination of lifestyle changes, nonhormonal medicines, and hormones may help.

My Menoplan is an evidence-based online resource developed by NIH-funded researchers to help people learn about the symptoms and treatments of menopause and create a personalized plan.

Women should discuss their symptoms, family history, and preferences with their healthcare provider to find the right approach.

Steps to Lower Risk for Health Problems

Women can take steps to lower their risk for related health problems such as heart disease and osteoporosis during and after the menopausal transition:

  • Be physically active most days of the week.
  • Eat a low-fat, low-cholesterol diet with plenty of vegetables, fruits, and whole grains.
  • Get enough calcium and vitamin D. Women between ages 51 and 70 should get 1,200 mg of calcium daily.
  • Maintain a healthy weight.
  • Limit or avoid alcohol and do not smoke.
  • Get regular checkups.
  • Avoid stress.

Menopausal Hormone Therapy

Menopausal hormone therapy (MHT), formerly called hormone replacement therapy (HRT), uses estrogen alone or estrogen combined with progesterone to treat menopause symptoms. MHT can relieve hot flashes, night sweats, vaginal dryness, and mood swings. It can also help prevent bone loss, and lower the chances of colorectal cancer.

MHT can be given as pills, patches, creams, gels, sprays, implants, injections, or vaginal ring inserts. Women who still have their uterus take both estrogen and progesterone. Women whose uterus has been removed need only estrogen.

However, MHT has both benefits and risks. For healthy women with bothersome menopausal symptoms who are younger than 60 or within 10 years of menopause onset, the benefit-risk profile of MHT is generally more favorable. Importantly, MHT is not appropriate for everyone. Several large studies found that some delivery routes of MHT increase the risk of heart disease, stroke, blood clots, and breast cancer in some women, primarily only those women who begin MHT greater than 10 years after menopause or after the age of 60. The risk of dementia in women who start MHT after age 65 may also be elevated. Women should talk with their healthcare provider to decide if MHT is right for them.

If hormone therapy is used, it should be at the lowest dose and for the shortest time possible.

Nonhormonal Medicines

Several nonhormonal prescription drugs are available to relieve hot flashes and night sweats:

  • Paroxetine (Brisdelle), an antidepressant approved by the U.S. Food and Drug Administration (FDA) to treat hot flashes
  • Fezolinetant (Veozah), an FDA-approved medicine that works in the part of the brain that regulates body temperature
  • Elinzanetant (Lynkuet), a newer FDA-approved medicine that also works in the part of the brain which regulates body temperature
  • Clonidine, a blood pressure drug
  • Gabapentin, a seizure drug that has been shown to reduce hot flashes

For vaginal dryness and pain during sex, the FDA has approved two nonhormone medicines — ospemifene and prasterone — to treat moderate to severe symptoms.

Treatments for Bone Loss

Medicinens commonly prescribed to treat osteoporosis include:

  • Bisphosphonates (such as alendronate and risedronate): Helps slow down the breakdown of bone to maintain bone density
  • Calcium and vitamin D: Supports bone health by maintaining strong bones, and vitamin D also helps the body absorb calcium
  • Calcitonin: A hormone that helps regulate calcium levels and slows bone loss
  • Parathyroid hormone: Helps build new bone and increases bone density
  • Raloxifene: Acts like estrogen in the bones to help slow bone loss and maintain bone density

Treatments for Irregular Periods

While irregular or missed periods are normal during perimenopause or the menopausal transition, women with very heavy bleeding or periods close together may want to talk to a healthcare provider about regulating their periods with low-dose birth control pills to regulate menstrual bleeding.

Living With Menopause

Several lifestyle changes may help women cope with common menopause symptoms.

Hot Flashes and Night Sweats

  • Sleep in a cool room in light clothing.
  • Keep a fan on at night.
  • Sip cold water or juice.
  • Avoid smoking, caffeine, and alcohol.
  • Take slow, deep breaths when a hot flash starts.

Bone Loss

  • Eat a healthy, low-fat, low-cholesterol diet that features lots of vegetables, fruits, and whole-grain foods.
  • Make sure to get at least 1,200 mg of calcium and 800–1,000 international units (IUs) of vitamin D each day.
  • Avoid drinking more than one alcoholic drink per day.
  • Don’t smoke.
  • Avoid consuming caffeine.
  • Achieve and maintain a healthy weight.
  • Exercise most days of the week, including exercise that elevates your heart rate, and weight-bearing exercises such as weightlifting or walking.

Sleep Problems

  • Be physically active most days.
  • Go to bed and get up at the same time each day.
  • Avoid napping in the late afternoon or evening.
  • Try not to watch television or use your computer or mobile device in the bedroom.
  • Wind down before bed by reading or taking a warm bath.
  • Keep your bedroom at a comfortable temperature.
  • Avoid alcohol, large meals, caffeine, and fluids before bedtime.

Vaginal Dryness

  • Use a water-based lubricant (not petroleum jelly).
  • Try over-the-counter vaginal moisturizers.
  • Ask a healthcare provider about local vaginal estrogen treatments such as creams, rings, or tablets.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on menopause.

Community Support

The following organizations provide information and support related to menopause:

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH has supported and continues to support several large studies on women’s health and menopause:

  • The Women’s Health Initiative (WHI) was a long-term national health study on preventing heart disease, breast and colorectal cancers, osteoporosis, and other diseases common among postmenopausal women. The WHI improved our knowledge of the health of older women. Although the original WHI study ended in 2005, extension and secondary studies continue, including:
    • WHI Strong and Healthy (WHISH)
    • WHI Sleep Hypoxia Effects on Resilience (WHISPER)
  • The Study of Women’s Health Across the Nation (SWAN) examines the physical, biological, psychological, and social changes that occur in a woman’s middle years. SWAN researchers are discovering important insights into women’s health. For example, researchers found that heart health is more strongly associated with menopause and reproductive aging than with chronological aging.

Other NIH-supported menopause research includes studies on:

  • The effects of acupuncture on hot flashes, whether hypnotherapy is a practical way to improve sleep in women with menopause symptoms, and the actions of phytoestrogens at the molecular and cellular level.
  • Antidepressants that could be prescribed to treat hot flashes.
  • Changes in body shape, composition, memory, and focus and how they relate to hormone changes and growing older.
  • The effects of early menopause are caused by bilateral oophorectomy (the surgical removal of both ovaries).

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.  

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