If you menstruate (have periods), menopause is when your menstrual cycle ends for 12 consecutive months. It is a natural stage of life that happens because your ovaries reduce or stop producing the hormones estrogen and progesterone. Estrogen and progesterone regulate female reproductive health, including fertility and pregnancy.

Here’s what to expect when entering menopause, how you can manage symptoms, and how it affects your overall health.

When does menopause begin, and how long does it last?

Menopause usually begins naturally, most often between the ages of 45 and 55. If you had an oophorectomy (surgery to remove the ovaries), or a hysterectomy with an oophorectomy, and are not taking hormones you may experience menopause symptoms sooner.

Menopause has different phases that may overlap. The entire process usually lasts about seven years but can take as long as 14 years. These phases include:

1. Perimenopause. This is when hormone levels first start to change and hot flashes or other symptoms may begin. You may also have irregular periods during this phase. For some people, perimenopause begins as early as age 40.
2. Menopause. This is when the ovaries slow their hormone production. You are officially in menopause 12 months after your final menstrual period. It occurs on average around age 51.
3. Postmenopause. This phase follows menopause and lasts for the rest of your life. Your symptoms may continue during this phase.

The start of the menopausal transition and how long it lasts depends on many factors. These include genetics, the age it begins, your medical history or medications (such as chemotherapy drugs), and lifestyle habits (such as smoking). Race, ethnicity, and social factors such as stress and socioeconomic status may also impact your menopause experience.

Although fertility declines in perimenopause, it is still possible to become pregnant until you have gone 12 consecutive months without a period. If you do not want to become pregnant, birth control or other types of contraceptives (such as condoms) are still recommended until that point. You can still get sexually transmitted infections (STIs) throughout your life.

What are the symptoms of menopause?

Hormone changes during menopause can cause a range of symptoms. These symptoms vary by intensity and frequency, which makes it difficult to know whether the transition has begun. Common symptoms include:

• Hot flashes and night sweats (if they occur late in the evening)
• Trouble sleeping
• Mood swings, depression, or anxiety
• Difficulty concentrating or memory issues
• Abnormal uterine bleeding
• Vaginal pain or dryness
• Pain during, or loss of interest in, sex
• Headaches
• Body aches and pains
• Heart palpitations
• Incontinence
• Weight gain or muscle loss

Everyone’s experience is different—you may have many symptoms or hardly any. Communicate with your health care provider about any symptoms or concerns related to menopause. Some symptoms can be caused by other health conditions as well, so they may suggest some tests to rule out any other causes for the changes you're experiencing.

Tell your doctor if your periods happen very close together, last more than a week, are heavy, or return after a year of no bleeding.

Can menopause affect my health in other ways?

Yes. Hormone changes during menopause can increase the risk of heart disease and osteoporosis (a condition that weakens bones and makes them vulnerable to breaking), so it’s important to maintain healthy lifestyle habits.

You are also at greater risk for vaginal and urinary tract infections. Dyspareunia (pain during sexual intercourse) due to vaginal irritation from the lack of hormones can also have an emotional effect on you and your partner.

What can I do to manage my symptoms?

Menopause is a natural process, but there are many safe methods to relieve symptoms that disrupt your daily life.

Some tips from the National Institute on Aging for better sleep 💤 and managing hot flashes 🔥 include:

• Carry a portable fan 🔥 💤
• Avoid alcohol, spicy foods, and caffeine (especially close to bedtime) 🔥 💤
• Avoid smoking 🔥
• Maintain a healthy weight and exercise regularly, but avoid strenuous activity close to bedtime 🔥 💤
• Dress in layers that can be easily removed 🔥
• Keep your bedroom a cooler temperature 🔥 💤
• Drink small amounts of cold water before bed 🔥
• Adjust the number of layers of your bedding 🔥 💤
• Use mindfulness exercises such as meditation, yoga, or tai chi 🔥
• Follow regular sleep schedule and avoid naps in the late afternoon or evening 💤
• Take prescription or over-the-counter sleep medications such as melatonin 💤

Medications are also available to treat hot flashes and prevent bone loss that can occur throughout menopause. These medications may include menopausal hormone therapy. They could have health risks for certain people with risk factors such as high blood pressure or a history of certain cancers. Talk to your doctor about whether these are right for you.

Pain during sex may be treated with over-the-counter vaginal lubricants and moisturizers, or your doctor may prescribe medication.

Complementary health practices such as natural products or mind and body practices can help manage your menopausal symptoms. However, talk to your doctor before using natural products (such as black cohosh or soy isoflavones) as they may cause other side effects, including liver damage.

Menopause—it’s a transition that looms large in the minds of many women as they approach age 50. It’s sometimes called the “change of life.” Menopause marks the end of menstrual periods and fertility.

It can be a challenging time, physically and mentally. Familiar concerns include hot flashes, trouble sleeping and mood changes, but symptoms can vary greatly for each woman. Many women don’t need treatment. For those bothered by symptoms, choosing the best treatment can be confusing. Different therapies have benefits and risks that need to be weighed carefully.

Knowledge about menopause has grown significantly over the last 2 decades. Large NIH-funded studies of women before, during and after menopause have given new insights into how menopause proceeds. New treatment options are being developed, and long-standing therapies are under more thorough evaluation.

“This ongoing research is necessary because there are 40 million menopausal or postmenopausal women right now in this country, and a growing number are entering menopause each year,” says Dr. Howard N. Hodis, a cardiovascular and menopause researcher at the University of Southern California.

Menopause is defined as the final menstrual period. On average, women have their last period around age 51, but it can also occur in their 40s or late 50s. Symptoms usually begin to appear several years before menopause. This time of change—called the menopausal transition, or perimenopause—extends to 1 year after your final period.

During perimenopause, levels of estrogen and progesterone—2 female hormones made in the ovaries—go up and down irregularly. This leads to changes in menstrual periods. The fluctuation in hormone levels that begins during perimenopause can affect many different parts of the body.

Dr. Gail Greendale of the University of California, Los Angeles, is one of the lead researchers in an NIH-funded study that’s looking at the many shifts women face during the transition. The study’s been following more than 3,000 women for over 15 years, from before menopause to well after. The researchers are monitoring bone health, the heart and blood vessels, the brain, cancer and a variety of symptoms.

“Part of our mission is to let women know what’s coming—the range of common experiences—because it can help them understand what’s going on during the transition,” says Greendale.

Among the study’s many findings, the researchers discovered that thinking can become temporarily muddled during perimenopause. “Our study found that women were not learning information as efficiently as they had before. There was a subtle decline in cognitive performance during the transition,” says Greendale. But the learning deficits went away once women hit postmenopause. “So there’s light at the end of the tunnel,” she says.

Another part of the study looked at mood and found that depressive symptoms—such as feelings of hopelessness, loss of appetite and a persistent sad mood—increase during the transition and continue into postmenopause. During that same period, hot flashes and night sweats also tend to increase.

“Hot flashes can be severe and highly disruptive. We used to think that they lasted for 2 or 3 years, but our studies have shown that for some women they can last a lot longer—up to 7 or 10 years,” says Dr. Sherry Sherman, who oversees the menopause research programs funded by NIH’s National Institute on Aging.

For some women, hot flashes and other symptoms can become so troubling that they interfere with daily activities. If this happens, check with your doctor. There are many ways to seek relief. Lifestyle changes, such as exercise or reducing stress, might help. Some women turn to medications—especially menopausal hormone therapy—to reduce symptoms. The therapy may include different hormone combinations and is available in a variety of forms and doses. Some studies, though, have raised questions about the safety of hormone therapy.

Back in the 1990s, hormones were recommended for most women for the rest of lives. Hormones not only relieved symptoms; they were also thought to help prevent heart disease and other conditions. Things changed in 2002, when a large NIH-funded study called the Women’s Health Initiative concluded that the overall risks of hormone therapy outweighed the benefits. The therapy—a particular type of estrogen plus progestin—led to fewer bone fractures and less risk for colon and rectum cancer. But it also raised the risk for breast cancer, heart attack, stroke and blood clots in the legs and lungs. In 2004, the study found a lower risk of bone fractures in women using only estrogen, but an increased risk of stroke.

Further analysis suggested that some health risks may depend on when a woman begins menopausal hormone therapy. “Multiple lines of evidence suggest that if we put women on hormones at a time that is early or close to menopause, there tends to be a benefit to heart health and a reduction in mortality (death rate),” Hodis says. He’s heading an NIH-funded study to explore the idea that vascular health might be improved in women close to menopause. Results are expected by 2013.

Today, estrogen remains the most effective medicine approved by the U.S. Food and Drug Administration for treating menopausal symptoms such as hot flashes and night sweats. Because of safety concerns, some experts recommend that physicians prescribe the lowest effective dose for the shortest period necessary.

NIH-funded researchers are evaluating alternatives to hormones, too. “We’re looking at mind-body approaches, exercise, different medications, behavioral and alternative medicine approaches,” says Sherman. To learn more about NIH-funded studies of menopause, visit ClinicalTrials.gov.

If you’re nearing or in the midst of menopause, learn what you can about the transition, consult with your doctor and make an informed decision about what treatment—if any—is best for you. “Each woman is different, and so therapies must be personalized to each and every woman,” says Hodis.

Menopause affects every woman differently. Some women have no symptoms, but some women have changes in several areas of their lives. It's not always possible to tell if these changes are related to aging, menopause, or both.

Some changes that might start in the years around perimenopause and menopause include:

• Irregular menstrual periods
• Vaginal dryness
• Hot flashes
• Night sweats
• Sleep problems
• Mood changes
• Weight gain and slowed metabolism
• Thinning hair and dry skin
• Loss of breast fullness

Hot flashes, also called hot flushes, are the most common menopause symptom. As many as three out of four women experience hot flashes. Some women begin having hot flashes before menopause, when they are still getting a period.

Hot flashes are a sudden feeling of heat in the upper part of your body. Your face and neck may become red. Red blotches may appear on your chest, back, and arms. You may also get heavy sweating during hot flashes or cold chills after the hot flashes. Some women get more cold chills (also called cold flashes) than hot flashes.

Hot flashes are most common in women in the year before their period stops and in the year after their period stops. However, recent studies show that hot flashes can continue for up to 14 years after menopause. Doctors and researchers do not know why hot flashes are so common during menopause. There are medicines that can prevent some hot flashes, and there are ways you can try to manage hot flashes when they do happen.

What you can do

• Consider using hormones. If you still have menstrual periods, ask your doctor about low-dose hormonal birth control. This may help your symptoms. For women who have gone through menopause, menopausal hormone therapy helps relieve hot flashes and night sweats. There are risks to menopausal hormone therapy. Ask your doctor whether it may help you. If you decide to use menopausal hormone therapy, take it for the shortest amount of time possible in the lowest dose that helps your symptoms.
• Consider other medicines. If hormone treatments are not an option for you, ask your doctor about prescription medicines used for other health problems. Certain antidepressants, epilepsy medicine, and blood pressure medicines may help with hot flashes, even if you don’t have these specific health problems.
• Track your hot flashes. Write down what triggers your hot flashes and try to avoid those things. Possible triggers might include spicy foods, alcohol, caffeine, stress, or being in a hot place.
• Drink cold water. Keep ice water close by to drink when you feel a hot flash coming on.
• Take off a layer of clothing. Dress in layers as much as possible.
• Use a fan. Turn on a fan at night by your bed and keep one at work if possible.
• Take deep breaths. Try taking slow, deep breaths when a hot flash starts. Slow, deep breaths tell your body that it is time to relax and be calm. This might make hot flashes shorter.
• Lose weight. Hot flashes may be worse in women who have overweight or obesity. A recent study found that losing weight may help improve hot flashes.

Vaginal problems, such as vaginal dryness, may start or get worse in the time around menopause. Low levels of the hormone estrogen may cause your vaginal tissue to get drier and thinner. This can cause itching, burning and pain or discomfort. It also can make sex painful and cause small cuts and tears in your vagina during sex.Vaginal cuts or tears put you at higher risk for sexually transmitted infections (STIs, or STDs).

What you can do

• Vaginal moisturizer. An over-the-counter vaginal moisturizer can help keep your vagina lubricated and can make sex more comfortable. You use this every few days.
• Vaginal lubricant. A water-based, over-the-counter vaginal lubricant can help make sex more comfortable. You use this before or during sex.
• Prescription medicine. You can also talk to your doctor about other ways to treat your vaginal dryness, including hormonal birth control, menopausal hormone therapy, or a prescription estrogen cream, gel, or ring that is inserted into your vagina. Learn more about menopause treatments. All medicines have risks so talk to your doctor first.

Your periods may come more often or less. They may last more days or fewer, and be lighter or heavier. Missing a few of periods does not always mean you are in perimenopause or the transition to menopause.

What you can do

• See your doctor to make sure there are no other reasons for your missed periods, like pregnancy or a health problem.
• See your doctor also if you have not had a period for a year and start bleeding or spotting. In women who have gone through menopause, spotting or light bleeding could be caused by cancer or another serious health problem.

Many women in menopause find it hard to sleep through the night. Low levels of progesterone can make it hard to fall and stay asleep. Low estrogen levels can also cause hot flashes that make you sweat while you sleep. This is sometimes called night sweats. Many menopausal women get urinary symptoms that make them get up several times during sleep to urinate. You may also feel more tired than usual during the day.

What you can do

• Exercise. One of the best ways to get a good night’s sleep is to get regular physical activity. But you may need to work out earlier in the day. Too much activity close to bedtime can make you more awake. Even if you have not exercised regularly in the past, starting to exercise during menopause may help you feel better. Studies show that certain exercises, such as yoga and stretching, may help improve hot flashes.
• Do not eat, drink alcohol, or smoke before bed. Avoid large meals, smoking, and drinking alcohol right before bedtime. Avoid caffeine after noon.
• Drink warm drinks. Try drinking something warm before bedtime, such as caffeine-free tea or warm milk.
• Limit screen-time near bedtime. Limit TV, phone, or computer use near bedtime, especially in your bedroom. The bright light of the screens tell your brain to wake up instead of sleep.
• Practice good sleep habits. Keep your bedroom dark, quiet, and cool. Use your bedroom only for sleep and sex, if you can.
• Don’t nap during the day. Try to go to bed and get up at the same times every day.
• Train your brain. If you wake during the night and can’t get back to sleep, get up and do something relaxing until you’re sleepy again.
• Talk to your doctor or nurse. Talk to your doctor or nurse about your sleep problems, as it could be something serious. Many women develop sleep apnea or insomnia. Treating sleep problems can also help improve chronic pain.
• Consider treatment for hot flashes. Talk to your doctor or nurse about treatment for your hot flashes if they are causing your sleep problems. This will usually improve your sleep.
• Treat bladder problems. Talk to your doctor or nurse about treatment for urinary problems. Urinary or bladder incontinence is not a normal part of the aging process. There are treatments that work.

You might become forgetful or have trouble focusing. As many as two-thirds of women going through perimenopause say they have problems with memory or trouble focusing. Menopausal hormone therapy does not treat or prevent memory loss or brain diseases, including dementia and Alzheimer’s disease. In a recent study, memory problems were linked to depression and loss of sleep but not to levels of the hormone estrogen.

What you can do

• Get enough sleep and physical activity, eat healthy and don’t smoke. This may improve memory.
• Stay socially active. Join a group or club that focuses on activities you enjoy, such as a hiking club or a quilting bee. Social interaction may help delay memory loss and prevent diseases such as dementia and Alzheimer’s disease.
• Stay mentally active. You may be able to boost your memory and focus by doing mental activities like crossword puzzles, taking a class, or learning a new skill like a foreign language.
• Talk to your doctor if forgetfulness or other mental problems affect your daily life.

Many women develop bladder or urinary problems during menopause. Lower estrogen levels may weaken the urethra. Some women find it hard to hold their urine long enough to get to the bathroom. This is called urinary urge incontinence. Urine might also leak out when you sneeze, cough, or laugh. This is called urinary stress incontinence. Some women have disrupted sleep during menopause because of the need to urinate during sleep. Urinary problems after menopause are not a normal part of aging and can be treated.

What you can do

• Treatment for urinary incontinence can include limiting or avoiding caffeine, taking medicine, using special medical devices, physical therapy, or having surgery, depending on the cause of the condition.
• If you have urine leakage, you can try urinary incontinence products such as pads, a urethra cap, or a pessary. A urethra cap fits over your urinary opening. It is reusable. A pessary is a round disk that is inserted into your vagina to support your bladder. Your doctor or nurse will fit you for your pessary, but you can remove, wash, and reinsert it yourself.
• Talk to your doctor or nurse about things you can do at home to help treat urinary incontinence. These may include a special kind of exercise for your pelvic floor muscles called Kegel exercises. Your doctor or nurse may also suggest losing weight, since extra weight puts more pressure on your bladder and nearby muscles.

You might feel irritable or have crying spells. If you had mood changes with your monthly periods or depression after giving birth, you may be more likely to have mood changes with menopause, too. Even if you never experienced mood changes during your monthly periods or after giving birth, you may still get mood changes during menopause. Mood changes at this time also could be from stress, family changes, or feeling tired. Mood changes are not the same as depression.

What you can do

• Try to get seven to eight hours of sleep.
• Get active to help you feel your best. Find ways to get active.
• Avoid taking on too many duties as much as possible. Look for positive ways to ease your stress.
• Join a support group online or in your community with women who are also going through menopause.
• Talk to your doctor or nurse about menopausal hormone therapy, which can help with mild mood changes. All medicines have risks, including menopausal hormone therapy. Mood changes that happen during menopause are usually not the same as depression, which is a different, serious illness that also needs treatment.

Your risk for depression and anxiety is higher during the time around menopause. This may be caused by changing hormones, menopausal symptoms, or both. You may experience sadness or depression over the loss of fertility or the changes in your body. If you have symptoms of depression or anxiety, see your doctor. Your doctor may recommend therapy or medicine or both to treat depression or anxiety.

What you can do

• Sleep. Try to get enough sleep. Most adults need between seven and eight hours of sleep each night. Lack of sleep is linked to depression.
• Exercise. Get at least 30 minutes of physical activity on most days of the week. Exercise is proven to help with depression. See our Fitness section for tips on how to get active.
• Limit alcohol. Limit how much alcohol you drink, if any. A moderate amount of alcohol for women is one drink a day, and no more than seven drinks in a week. More than four drinks at a time is considered binge drinking.
• Lower stress. Set limits for how much you take on. Look for positive ways to unwind and ease daily stress. Try relaxation techniques, reading a book, spending some quiet time outdoors, or other healthy ways to unwind.

Some women feel more comfortable with their sexuality after menopause. Others may feel less aroused. You may feel less interested in sex if it is uncomfortable or painful. This can happen because of drier or thinner vaginal tissue.

What you can do

• If you are bothered by vaginal dryness, there are safe over-the-counter and prescription treatments to improve vaginal lubrication. Learn more about menopause and your sexuality.
• Some women are less interested in sex during menopause because of other menopause symptoms such as depression, anxiety, or lack of sleep. Talk with your doctor or nurse about possible treatments if your menopause symptoms bother you.

• Remember that you are not alone. All women go through menopause after a certain age.
• Mention that you are dealing with menopause symptoms and would like to talk about it.
• Ask questions and talk about your experiences.

If any of your menopause symptoms bother you, talk with your doctor or nurse. When you talk about treatments, you might discuss:

• Your symptoms and how much they bother you
• Your health risks based on your age and your health
• Whether you have used a treatment like menopausal hormone therapy before
• Whether menopausal hormone therapy is an option for you, based on your past health and family history
• Whether you have already reached post-menopause and, if so, how long ago