Menopause: Signs, Symptoms, Causes and Treatments

Often referred to as the “change of life,” menopause marks a significant change for women. As you approach your mid-40s, you may begin to notice subtle shifts in your body, such as irregular or unpredictable periods, hot flashes, difficulty sleeping, changes in metabolism, vaginal dryness and other symptoms, as estrogen levels decline.

While the process of menopause is universal and inevitable, you don’t have to suffer through it. By understanding what to expect as you approach menopausal age and getting to know effective strategies for navigating these changes, you can embrace this next chapter and continue to enjoy your life!

[Related:At-Home Menopause Tests: Pros and Cons, What They Test and When to See a Provider]

What Is Menopause?

Menopause is defined as the cessation of a woman’s menstrual cycle for 12 consecutive months. Before menopause, your ovaries release eggs during each menstrual cycle — a process called ovulation — and you can become pregnant. Your ovaries also produce most of your body’s estrogen.

As you get older, usually as you approach age 45 to 50, your ovaries gradually reduce their estrogen production. When your estrogen levels fall low enough, menstrual periods stop.

Menopause is a natural biological process, but it may also occur if you have had your uterus or ovaries surgically removed, if your ovaries have been damaged by radiation or chemotherapy, or if you take medication that lowers your estrogen levels.

Stages of menopause

Below are the phases of menopause:

Perimenopause, which is the transitional period leading up to menopause. During perimenopause, women may begin to experience irregular menstrual cycles and menopausal symptoms, like hot flashes or mood changes, due to fluctuations in estrogen and progesterone production. This process can range from two to 10 years.

Menopause, which is reached when a woman no longer has a menstrual cycle for 12 consecutive months, signifying the end of ovulation.

Postmenopause, which refers to the years following menopause. During postmenopause, symptoms related to hormonal changes can still occur, but they often gradually decrease in intensity.

[READ: Ways to Get Relief From Perimenopausal Symptoms.]

When Does Menopause Start?

Menopause officially starts 12 months after a woman’s final menstrual cycle. On average, women go through menopause between ages 45 and 55. However, it can occur either earlier or later.

Premature menopause occurs before age 40.

Early menopause occurs before age 45.

Late-onset menopause occurs after age 55.

How long does menopause last?

The onset and duration of menopause vary greatly among individuals. The entire menopausal transition, from the onset of perimenopause to postmenopause, can span several years.

Perimenopause itself can last an average of four years, but this transition can range between two to 10 years. However, the symptoms associated with menopause can persist into the postmenopausal phase.

[See: 16 Health Screenings All Women Need.]

Menopause Symptoms

Understanding what to expect can help you manage symptoms and prepare for the changes, no matter when menopause begins or how long it lasts.

Common symptoms of menopause include:

Bladder problems like urgency, frequency, and waking at night to empty your bladder

— Cognitive issues, such as forgetfulness or brain fog

— Hot flashes

— Insomnia and other sleep problems

— Low libido

Mood swings

— Night sweats

— Severe tiredness

Sleep disturbance

Stiff joints or joint pain

— Vaginal dryness

— Weight gain or slowed metabolism

The severity of symptoms can vary greatly from one individual to another. While some women don’t experience any symptoms or mild symptoms that only require simple lifestyle modifications, others may experience severe enough symptoms that can impact everyday life.

These symptoms may disappear within a few months, but they can persist for several years after the last menstrual period.

[READ: Can a Plant-Based Diet Help With Hot Flashes?]

Menopause Diagnosis

If you’re experiencing common menopausal symptoms, your doctor can confirm if you’re in menopause by reviewing your symptoms, your age, personal medical history and family history.

While lab testing is generally not necessary to diagnose menopause, some doctors may suggest a blood test to check certain hormone levels. For example, blood tests can measure the level of follicle-stimulating hormone, or FSH, in your blood because high levels is a normal sign that your body is in menopause.

At-home menopause testing is also available, but they can be expensive and possibly unreliable due to hormone fluctuations.

[READ: The Menopause Diet: The best diet plan for mitigating symptoms and weight gain.]

Hormone Therapy for Menopause

Hormone replacement therapy, or HRT for short, is the most effective treatment to alleviate vasomotor menopausal symptoms, commonly referred to as hot flashes and night sweats. HRT uses estrogen, progestin (synthetic progesterone) or a combination of both to replenish the hormones that decline during or after menopause.

“Hormone replacement therapy is most effective within five years of onset of menopause because after five years, a woman tends to lose her estrogen receptors,” says Dr. G. Thomas Ruiz, a board-certified OB-GYN and lead OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

Types of hormone therapy

Because symptoms of menopause are primarily caused by decreasing estrogen, one approach to managing these symptoms is to replace the estrogen the body no longer naturally produces.

The two main types of estrogen therapy are:

Systemic hormone therapy. Systemic estrogen typically contains higher doses of estrogen that is absorbed throughout the body and is prescribed to address a wide range of common menopausal symptoms, such as hot flashes and night sweats. These therapies are available in various forms, including creams, gels, patches, pills and sprays.

Local hormone therapy. Local hormone therapy delivers low doses of estrogen that can be absorbed by a specific region of the body to treat urinary and vaginal symptoms of menopause, such as vaginal itching, dryness and discomfort during sex. These therapies, which can be used long term, are available in the form of vaginal suppositories, rings and creams.

For women with an intact uterus, progestin is often combined with estrogen to protect the uterine lining, whereas someone without a uterus would likely only need estrogen. If you’re sexually active, oral contraceptives containing estrogen and progestin may also be recommended.

Hormone therapy duration

In general, a majority of people take HRT for up to five years. However, the duration of hormone therapies depends on many factors, including an individual’s medical history and specific symptoms being treated.

“(Local vaginal therapy) is very safe, and I let patients use that for the rest of their life, depending upon their symptoms,” says Dr. Adi Davidov, the associate chair of obstetrics and gynecology at Staten Island University Hospital, a New York-based Northwell Health facility.

On the other hand, Davidov adds, systemic hormone therapies may be reevaluated on a yearly basis. As your body adjusts to menopause, certain symptoms — like hot flashes and night sweats — can smooth out over time, so you don’t need to be on hormone therapies forever.

Hormone therapy risks

The safety of hormone therapy depends on several factors, including the woman’s age, duration of time since menopause and any preexisting conditions.

Increased risks associated with hormone therapy may include:

Heart disease or heart attack for older women

— Deep-vein thrombosis (blood clots in the veins), which increases with age and factors, like obesity, heart disease or kidney disease

Gallbladder disease

Stroke

— Skin irritation with patches or topical formulations

— Certain types of cancer

Estrogen therapy alone, if you have a uterus, can cause uterine lining to thicken and increase endometrial cancer risk. However, progestogen therapy, a category of hormones including both natural and synthetic hormones that have effects similar to progesterone, is used to avoid an increased risk of endometrial cancer.

Although there’s no increased risk of breast cancer within the first five years of using combined hormone therapy, there’s a slight increased risk of breast cancer if used for more than five years.

Is hormone therapy right for me?

Hormone therapy isn’t suitable for everyone. There are some women who should avoid hormone therapy, such as those who have:

— A history of blood clots or stroke

— A history of hormone-dependent cancer such as breast or uterine cancer

— Deep vein thrombosis

— A history of heart disease

— Significant liver disease

— Undiagnosed uterine bleeding

Talk to your doctor about your medical history and individual risk factors before considering hormone therapy.

Ultimately, every case is different, so it’s important to communicate with your doctor.

“This puts the onus on the patient to be her own advocate as well,” says Dr. Octavia Cannon, a board-certified osteopathic physician and provider at Alliance Obstetrics and Gynecology in East Lansing, Michigan. “If she’s not able to advocate for herself or doesn’t feel comfortable doing that, then that’s when she may need to bring someone with her — a friend, a sister, (a) partner — to try to describe the things that she’s been going through.”

Nonhormonal Treatment for Menopause

You can work with your doctor to incorporate a combination of hormonal and nonhormonal approaches to manage menopausal symptoms effectively.

Nonhormonal approaches include antidepressants, blood pressure medications and other treatments.

Antidepressants

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), are sometimes prescribed to alleviate vasomotor symptoms associated with menopause.

“It’s generally half the dose,” Cannon says. “However, I often see patients who I start on the half dose for the vasomotor symptoms who say, ‘I just feel better. I feel less anxious. I feel my mood is better,’ and they want to go on the full dose, which is absolutely fine.”

While these drugs were originally developed to treat depression, they have been found to reduce the frequency and severity of hot flashes for many women. Additionally, they may help alleviate problems with irritability or mood swings.

Side effects of antidepressants may include:

— Headache

— Dry mouth

Nausea

— Difficulty sleeping

Sexual dysfunction

Other nonhormonal treatments

There are other nonhormonal treatments that can be used to treat menopausal symptoms. These include:

Blood pressure medications to help reduce hot flashes

Medications for seizures and neuropathic pain to help reduce hot flashes

Medications for osteoporosis to prevent bone loss and prevent fracture risk

Vaginal moisturizers and lubricants to relieve vaginal dryness and discomfort

It’s essential to discuss the potential benefits and side effects of therapy options with your health care provider to determine the most appropriate treatment plan for your individual needs.

Lifestyle Changes to Relieve Menopause Symptoms

Lifestyle factors also play a major role in getting relief from menopause symptoms, as well as improve feelings of anxiety or depression that may occur during menopause.

Here are five lifestyle changes you can make to help manage menopause symptoms naturally and reduce health risks:

1. Modify triggers

Many women notice that certain habits can trigger or worsen hot flashes.

Paying attention to what is happening before and during your hot flashes can help you identify the causes or contributing factors so you can avoid them.

Common triggers include:

Alcohol

— Caffeine

Cigarette smoking

— Hot drinks

— Hot or spicy foods

— Hot weather or a warm room

Stress

“Don’t underestimate how caffeine, spicy foods and not drinking enough water everyday can affect the vasomotor symptoms,” Cannon says.

2. Follow a well-balanced diet

Maintaining an overall healthy diet during menopause can help balance symptoms.

For example, the Galveston diet, Nutrisystem’s Complete 50 diet and the menopause diet created by registered dietitian nutritionists Elizabeth Ward and Hillary Wright are all nutrition plans tailored to women’s hormonal changes during menopause, designed to support hormone balance and alleviate associated symptoms.

Because menopausal women typically lose a significant amount of bone mass, which sets the stage for osteoporosis later in life, this makes it all the more important to start adding an extra dose of calcium and vitamin D to your daily diet.

In general, before menopause, you need about 1,000 milligrams of calcium per day. After menopause, you need 1,500 milligrams per day. Good sources of calcium include milk, yogurt, leafy greens, almonds and fortified foods.

Vitamin D helps the body absorb calcium and stimulates bone formation. The government’s recommended daily amount is 400 international units, though the National Osteoporosis Foundation recommends 400 to 800 IU of vitamin D daily for adults under 50 and 800 to 1,000 IU of vitamin D daily for adults 50 and over. If you get 15 minutes of sunlight a day, that might be enough, at least in the summer months. Talk to your health care provider to see if a vitamin D supplement is right for you.

3. Get moving

Many women find that working out for an hour three or more times a week provides relief from hot flashes. Although available studies are limited, existing research — including research published in 2019 and 2023 — have shown that engaging in moderate-intensity aerobic exercises may be effective in reducing hot flashes. Walking, jogging, swimming, dancing and bicycling are good mild aerobic exercise options.

Not only does staying active benefit your physical health, but exercise promotes mental health as well: It reduces stress and helps stave off the blues, which can both result from hot flashes.

“If you exercise at a certain level, you do create endorphin release,” Ruiz says, explaining that endorphins can help to modulate many symptoms.

What’s more, weight-bearing exercises, resistance training, yoga, aerobics and cardio help build muscle and reduce bone loss and fractures, which become more common as estrogen production falls.

Increasing your heart rate every day is cardioprotective, which is especially important for those with preexisting heart disease if you’re on hormone replacement therapy.

Even just getting out and taking a walk can make a difference, Cannon says.

4. Prioritize sleep

With age, women and men often experience increased sleep issues. For women going through menopause, certainly hot flashes can disrupt sleep. Hormonal changes can play a role in difficulty getting adequate shuteye, and anxiety frequently increases around the time of menopause, which can disrupt sleep.

Improving sleep requires prioritizing good sleep hygiene practices, including:

Creating a comfortable sleeping environment. Keeping the bedroom dark and cool is important for anyone, but it’s especially important for women experiencing hot flashes.

Having a routine sleep and wake time. Establishing a regular sleep schedule helps regulate the body’s internal clock and mitigate fluctuations in hormones that often disrupt sleep for women in menopause.

Keeping the TV out of the bedroom. The bedroom should be reserved for sleep, rather than brain-stimulating activities like scrolling on your phone or watching TV. Screens emit blue light which can interfere with melatonin production, a hormone that regulates your sleep-wake cycle.

Not drinking caffeine or alcohol before bed. Alcohol and caffeine can both disrupt the sleep cycle, leading to poorer sleep.

If you still have trouble sleeping, you may want to consider cognitive behavioral therapy, or CBT for short. In fact, a randomized clinical trial demonstrated that cognitive behavioral therapy for insomnia improved sleep in women with menopausal sleep disturbances.

If you’re experiencing persistent sleeping difficulties, it’s important to discuss your concerns with a doctor.

5. Talk about it

It’s nearly impossible to get help if you’re not talking about it — whether to your doctor or among friends and loved ones.

“Start talking to your daughter who’s 25, about what you’re going through at 55 in terms of menopause,” Cannon says. “Not to complain, but to inform them.”

This can help those around you gain a better understanding and more compassion if you’re not in the greatest mood.

“Help your family and people who love you. Understand what you’re going through so that they can help you and support you,” she urges.

It’s also important to recognize that symptoms of menopause may overlap with other conditions. Talking with your doctor to ensure you’re getting appropriate care will help address concerns.

“The symptoms are so vague and so vast that you could be suffering from something else,” Cannon says.

Therefore, make sure you’re communicating with your health care provider to rule out any other health conditions and get the appropriate care you need for menopause symptom relief.

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Menopause: Signs, Symptoms, Causes and Treatments originally appeared on usnews.com

Update 02/04/25: This story was previously published at an earlier date and has been updated with new information.

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