Menopausal Symptoms
Menopause is a natural life transition that occurs when menstrual periods stop permanently, typically between ages 45 and 55. While it’s a normal part of aging, the physical and emotional changes that come with shifting hormone levels can significantly affect daily life, relationships, and work for many women.
Table of contents
- What is menopause and when does it happen
- Common symptoms of menopause
- Physical symptoms
- Mental and emotional symptoms
- How long do symptoms last
- Treatment options
- Lifestyle changes that can help
- When to see a healthcare professional
What is menopause and when does it happen
Menopause is diagnosed after 12 consecutive months without a menstrual period, vaginal bleeding, or spotting[1]. It marks the permanent end of menstruation and the end of reproductive years. The average age of menopause in the United States is 51 years, though it can happen anywhere between ages 45 and 55[1][2].
The process happens gradually in three stages. Perimenopause, also called the menopausal transition, is the time leading up to menopause when your body begins changing. This stage can begin eight to ten years before menopause, usually when you’re in your 40s, and typically lasts about four years[1][2]. During perimenopause, your ovaries gradually produce less estrogen and progesterone, the hormones that regulate menstruation. This causes hormone levels to fluctuate, leading to irregular periods and various symptoms[9].
After you reach menopause itself—the point when periods have stopped for 12 months—you enter postmenopause, which lasts for the rest of your life[2]. While many symptoms ease during postmenopause, some can continue for several years.
Menopause that occurs before age 45 is called early menopause. When it happens at age 40 or younger, it’s considered premature menopause[2]. Menopause can also be induced by surgery to remove the ovaries or by medical treatments such as chemotherapy[6].
Common symptoms of menopause
About 75% of women worldwide experience symptoms during perimenopause and after menopause, with 25% having moderate to severe symptoms that affect their quality of life[12]. The changes occur because your ovaries stop producing the same levels of reproductive hormones, particularly estrogen[1].
Symptoms can vary widely from person to person. Some women experience many symptoms, while others have few or none. The symptoms you experience and how bothersome they are can change over time[5].
Physical symptoms
Changes in menstrual periods
The first sign of perimenopause is usually a change in the normal pattern of your periods. Menstrual periods often become irregular before they stop completely[5]. Periods may be heavier or lighter than usual, come more or less frequently, or be shorter or longer in duration[2]. It’s common to skip periods during perimenopause—you might skip a month and then have your period return, or skip several months before cycles resume for a while[1].
Hot flashes and night sweats
Hot flashes are the most common menopause symptom. As many as three out of four women experience them[3]. A hot flash is a sudden feeling of heat in the upper part of your body, particularly your face, neck, and chest[3][19]. Your face and neck may become red, and red blotches may appear on your chest, back, and arms. You may experience heavy sweating, and some women feel cold or have chills after the heat passes[2].
When hot flashes occur during sleep and cause sweating, they’re called night sweats[2]. Hot flashes can last anywhere from a few seconds to several minutes. Studies show that vasomotor symptoms (the medical term for hot flashes and night sweats) last on average seven to eight years total, including four to five years after the final menstrual period[15].
Sleep problems
Many women have difficulty sleeping during menopause, which may be related to night sweats, hot flashes, or the need to urinate frequently at night[2][3]. Over time, lack of sleep can lead to fatigue and memory problems[2].
Vaginal and urinary symptoms
Vaginal dryness is a common symptom that can cause discomfort or pain during sexual intercourse[2][3]. The vagina may also feel itchy or irritated. These changes can progress without treatment[6]. Many women also experience urinary problems, including urinary urgency (a pressing need to urinate more frequently), urinary incontinence (loss of bladder control), and recurrent urinary tract infections[2][5].
Other physical changes
Physical symptoms of menopause may also include joint aches and pains, muscle aches, headaches and migraines that may be worse than usual, heart palpitations (when your heartbeats suddenly become more noticeable), dry skin, dry eyes, dry mouth, and sensitive teeth or painful gums[2][5][7]. Many women experience weight gain and changes in body shape during menopause[5][7]. Some women also notice reduced sex drive and sore breasts[7].
Mental and emotional symptoms
Menopause commonly affects mental and emotional wellbeing. Many women experience mood changes, low mood, anxiety, mood swings, irritability, and low self-esteem[5][7]. Some women feel they can’t cope as well as they used to[7].
Problems with memory or concentration, often called brain fog, are also common[1][7]. These symptoms may be related to large swings in estrogen levels during perimenopause, though the precise mechanism isn’t fully understood[8].
How long do symptoms last
Symptoms can last for months or years, and they can change over time[5]. For example, hot flashes and night sweats may improve, and then you may develop low mood and anxiety. Many symptoms start during perimenopause and continue into postmenopause. Australian studies show that some women still experience symptoms like hot flashes and night sweats in their 60s[7].
Some symptoms, such as joint pain and vaginal dryness, can continue after periods stop[5]. While most symptoms of menopause ease up in postmenopause, you can continue to have mild symptoms for several years[2].
Treatment options
Menopause itself is a natural process that doesn’t require treatment. However, treatments are available to ease symptoms and help you maintain your quality of life[10].
Hormone replacement therapy
The main medical treatment for menopause symptoms is hormone replacement therapy (HRT), which replaces the hormones that are at low levels[11]. HRT involves using estrogen to replace your body’s own levels around the time of menopause[11]. Estrogen therapy works best for easing hot flashes and also helps with other menopause symptoms and slows bone loss[10].
If you still have your uterus, you’ll need to take progesterone along with estrogen to protect your uterine lining from the effects of estrogen. Taking both is called combined HRT[11]. Estrogen comes in several forms including skin patches, gels or sprays to put on the skin, implants, and tablets. Progesterone is available as patches, an intrauterine system (hormonal coil), or tablets[11].
HRT is a safe and effective treatment for most women going through menopause and perimenopause[11]. The benefits usually outweigh the risks, and starting hormone therapy around the time of menopause has shown benefits. Your healthcare professional will discuss any risks with you and help determine if HRT is right for you[10][11].
Vaginal estrogen
For vaginal dryness, painful sex, and urinary symptoms, your healthcare provider can prescribe estrogen treatments you insert directly into your vagina as a tablet, cream, or ring[11]. These vaginal estrogen treatments only work on the area where you put them and don’t get into your bloodstream. You can use them safely for the rest of your life, though symptoms usually return when you stop using them[11].
Nonhormonal medications
If you cannot or choose not to take HRT, there are nonhormonal treatments available. For hot flashes and night sweats, medicines such as certain blood pressure medications and epilepsy medications can help[11]. Antidepressants can help with mood symptoms if you’ve been diagnosed with depression or anxiety[11].
For vaginal dryness, nonhormonal vaginal moisturizers and lubricants are available without a prescription[11]. If you’re using condoms, avoid oil-based lubricants as they can damage condoms; use water-based lubricants instead[18].
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a talking therapy that can help with low mood and anxiety caused by menopause, some physical symptoms like hot flashes and joint pain, and sleep problems[11].
Lifestyle changes that can help
Many women find they can manage their symptoms with lifestyle changes. Eating well, exercising regularly, and looking after your mental wellbeing can help with symptoms and keep you as healthy as possible for the future[18].
Managing hot flashes
To reduce hot flashes, try wearing light, layered clothing that can be easily removed, keep your bedroom cool at night, take cool showers, use a fan, and have cold drinks available[18][19]. Avoid or reduce potential triggers such as spicy food, caffeine, hot drinks, smoking, and alcohol[18]. Reducing stress levels can also help[18].
Exercise and healthy eating
Exercise regularly, including weight-bearing activities where your feet and legs support your weight, like walking, running, or dancing, as well as resistance exercises[18]. Regular exercise can help you sleep better, improve your mood, maintain a healthy weight, and lower your risk for age-related health problems[6].
Eat a healthy diet that includes plenty of fruit, vegetables, and sources of calcium such as milk, yogurt, and leafy greens to keep bones healthy[18]. Maintaining a healthy weight is important, as being overweight can make hot flashes worse[6].
Sleep and stress management
Practice good sleep habits by keeping your bedroom dark, quiet, and cool[6]. Try relaxation techniques such as meditation, deep breathing, yoga, tai chi, or muscle relaxation exercises to manage stress[6][18].
Bone and heart health
Get some sunlight on your skin, as this triggers the production of vitamin D, which helps keep bones healthy[18]. Consider taking vitamin D supplements. If you smoke, try to quit—not only to help with symptoms but for your overall health. Limit or avoid alcohol[6][18].
When to see a healthcare professional
Keep seeing your healthcare professional for regular check-ups during this time[1]. You should see a doctor or nurse if you think you have perimenopause or menopause symptoms, especially if they’re affecting your daily life, relationships, social life, family life, or work[5][7].
Getting advice early can help reduce the impact that perimenopause and menopause have on your health, relationships, and work[5]. Many women reduce working hours or leave the workforce due to difficulty managing menopause symptoms at work[23]. A healthcare provider can help you find treatments that work for you.
Most people can tell by their symptoms that they’ve started menopause. Tests usually aren’t needed to diagnose menopause, but sometimes your healthcare professional may suggest blood tests to check hormone levels or rule out other conditions[10][21].
