Menopause refers to the time in a woman's life when she stops having a menstrual period and is no longer fertile. The time leading up to menopause is called the menopausal transition, or perimenopause.

During perimenopause, a woman's ovaries start to produce less estrogen and progesterone. Changes in these hormones cause symptoms of menopause. Periods occur less often and eventually stop. Although this typically is a gradual process that happens over time, in some cases, a woman's periods will stop suddenly. Throughout perimenopause, ovulation—the release of eggs from the ovaries—also occurs less and less frequently.

Menopause is the point at which a woman has not had a period in 12 consecutive months. The time after menopause is called postmenopause, a phase that lasts for the rest of a woman’s life.

All women experience menopause, usually between ages 45 and 55. The average age of menopause is 51, but it occurs earlier in some women. Women who smoke may go through menopause earlier than women who don't smoke.

However, perimenopause can begin several years earlier when levels of estrogen and progesterone first begin to fluctuate. Surgical or medical menopause is the term for a decrease in estrogen that is a result of surgery to remove the ovaries or uterus, or medical treatments such as chemotherapy or hormone therapy to treat breast cancer.

Symptoms of menopause may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time once they begin, or they may happen only once in a while. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome (PMS). Others may be new to you. For example:

• Your menstrual periods may not come as regularly as before. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.
• Your periods might be heavier or lighter than before.
• You might have hot flashes and problems sleeping.
• You might experience mood swings or be irritable.
• You might experience vaginal dryness. Sex may be uncomfortable or painful.
• You may have less interest in sex. It may take longer for you to get aroused.

Other possible changes are not as noticeable. For example, you might begin to lose bone density because you have less estrogen. This can lead to osteoporosis, a condition that causes bones to become weak and break easily. Changing estrogen levels can also raise cholesterol levels and increase your risk for heart disease and stroke.

Talk to your doctor about possible treatment for your menopause symptoms if they bother you.

After menopause, your ovaries make very little estrogen. Women who have gone through menopause have very low estrogen levels. Low levels of estrogen and progesterone raise your risk for certain health problems after menopause. Other health problems may happen naturally as you age.

Examples of common health problems in the years after menopause include:

• Heart disease. Before age 55, women have a lower risk of heart disease than men. Estrogen helps keep blood vessels relaxed and open and helps the body maintain a healthy balance of good and bad cholesterol. Without estrogen, cholesterol may start building up on artery walls leading to the heart. By age 70, women have about the same risk for heart disease as men of the same age.
• Stroke. Your risk for stroke doubles every decade after age 55. The lower levels of estrogen in your body may play a role in cholesterol build-up on artery walls leading to the brain.
• Osteoporosis. Having less estrogen after menopause causes you to lose bone mass much more quickly than you did before, which puts you at risk for osteoporosis. Osteoporosis is a condition that causes your bones to become brittle and weak and break easily. A recent large study found that women who have severe hot flashes and night sweats during the years around menopause usually have more bone loss and are at higher risk for hip fractures than women who do not have severe symptoms.
• Lead poisoning. Lead that you are exposed to over your lifetime gets stored in your bones. Because bone begins to break down much more quickly after menopause, that lead is more likely to be released into the blood. Older women can have blood lead levels 30% higher than before they reached menopause. This lead increases your risk for high blood pressure and atherosclerosis (sometimes called hardening of the arteries). This lead in your blood can also cause your kidneys to not work as well. It can also cause symptoms similar to dementia, affecting your memory and ability to think.
• Urinary incontinence. About half of postmenopausal women have trouble holding in their urine. Lower estrogen levels may weaken the urethra. Learn about treatment options for incontinence.
• Oral issues. Dry mouth and an increased risk for cavities are more common after menopause. Learn more about oral health.
  

What is menopause?

Menopause is a normal, natural change in a woman’s life when her period stops. That’s why some people call menopause “the change of life” or “the change.” Your period may start to change as your body moves into menopause. You may have irregular or heavier periods. Speak with your health care provider about any changes in your periods or bleeding.

During menopause, a woman’s body slowly produces less of the hormones, estrogen and progesterone. This often happens between ages 45 and 55. A woman has reached menopause when she has not had a period for 12 months in a row.

What are the symptoms of menopause?

Every woman’s period will stop at menopause. Some women may not have any other symptoms at all. As you near menopause, you may have:

• Changes in your period—time between periods or flow may be different.

• Hot flashes (“hot flushes”)—getting warm in the face, neck, or chest, with and without sweating.

• Night sweats that may lead to problems sleeping and feeling tired, stressed, or tense.

• Vaginal changes—the vagina may become dry and thin, and sex may be painful.

• Thinning of your bones, which may lead to loss of height and bone breaks (osteoporosis).

Speak with your health care provider to discuss whether treatment is right for you if your menopause symptoms are interfering with your usual activities or get worse.

Treatments for menopausal symptoms include hormone therapy and non-hormonal therapy. In addition, hormone therapy can be used to prevent bone loss in some situations.

Hormone therapy

What is hormone therapy for menopause?

Lower hormone levels in menopause may lead to hot flashes, vaginal dryness. To help with these problems, some women choose to treat their symptoms with hormone medicines, sometimes called menopausal hormone therapy (MHT). Women may be prescribed estrogen or estrogen with progestin (another hormone).

Menopause hormone therapy is not for everyone. Like all medicines, hormone therapy has benefits and risks. Talk with your health care provider about hormone therapy. If you decide to use hormone therapy, use it at the lowest dose that helps. Also use hormones for the shortest time that you need them.

Who should not take hormone therapy for menopause?

Women who:

• Think they are pregnant.
• Have problems with vaginal bleeding.
• Have certain kinds of cancers.
• Have had a stroke or heart attack.
• Have had blood clots.
• Have liver disease.

What are the benefits of using hormone therapy for menopause?

• Hormone therapy may help relieve hot flashes, night sweats, vaginal dryness, or dyspareunia (pain with sexual activity).
• Hormones may reduce your chances of getting osteoporosis—thin, weak bones that break easily.

What are the risks of using hormone therapy?

For some women, hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, breast cancer, and gall bladder disease. For a woman with a uterus, estrogen increases the chance of getting endometrial cancer (cancer of the uterine lining). Adding progestin lowers this risk.

How long should I use hormone therapy for menopause symptoms?

Treatment of menopausal symptoms should be decided with your health care provider, as there are many different FDA-approved hormones for treatment of the symptoms of menopause.

Does it make a difference what form of hormones I use for menopause?

Yes. FDA recommends that women use hormone therapies that are FDA-approved. FDA-approved hormone therapies are evaluated for safety and effectiveness.

Are compounded “bioidentical hormones” safer or more effective than FDA-approved hormone therapy for menopause?

Many marketed products that are called “bioidentical hormones” are compounded drugs, which are not FDA-approved. FDA does not have evidence that compounded “bioidentical hormones” are safe and effective, or safer or more effective than FDA-approved hormone therapy.

FDA has approved drugs containing hormones that are identical to the hormones made naturally by women in their reproductive years.

Is the hormone estriol a “safer form of estrogen”?

FDA does not have evidence that drugs containing estriol are safe and effective, or are “safer forms of estrogen.” There are no FDA-approved drugs containing estriol. Marketed drugs that contain estriol are compounded drugs, which are not FDA-approved.

Non-hormone treatments

Some women use non-hormonal medicines for their menopause symptoms. FDA has approved:

• A medicine used to reduce moderate to severe hot flashes associated with menopause.
• A medicine used to reduce moderate to severe vasomotor symptoms due to menopause. Vasomotor symptoms are the feelings of warmth in the face, neck, and chest, or sudden intense feelings of heat and sweating (“hot flashes” or “hot flushes”).
• A medicine used to treat and prevent postmenopausal osteoporosis, and reduce the risk of invasive breast cancer in post-menopausal women, including postmenopausal women at high risk for invasive breast cancer.
• A medicine used after menopause for women with or without a uterus to treat moderate to severe pain during sexual intercourse due to changes in and around the vagina.

Are herbs and other "natural" products useful in treatment symptoms of menopause?

Some women may decide to use products marketed as dietary supplements or over-the-counter “natural” hormone creams to help them deal with their menopausal symptoms. At this time, FDA does not know if herbs or other “natural” products are helpful or safe. These products may also have health risks. Don’t get scammed by products making false claims about miracle cures for weight gain, hair loss, wrinkles, or other changes that can happen during or after menopause. Get the facts.

• Check with your health care provider for information about using these products.
• Learn more about dietary supplements.

Living with menopause

Women often spend many years of their lives in the postmenopausal period.

• Work with your health care provider to develop a plan to build and maintain a healthy life during and after menopause.
• Be sure to learn about how to protect your heart and prevent bone loss as you get older.
• Always tell your health care provider if you have any vaginal bleeding after menopause. This may be a sign of an urgent medical problem.

All women need regular checkups and screening tests throughout their lives. Most women can help take care of their health with:

• Regular mammograms after age 50 through age 75
• Regular Pap tests, even after menopause. You should get a Pap test and HPV test together every five years if you have a cervix, until you are 65 and have had three clear tests in a row.
• Regular height measurements to detect loss of height due to bone loss
• Blood, urine, and other tests to screen for risk of diabetes and heart disease
• Blood pressure, cholesterol, and other tests your doctor recommends

Ask your doctor or nurse about flu shots and other vaccines. Besides the flu shot, vaccinations are available for pneumonia, shingles, and other diseases.

Your doctor or nurse might also recommend other tests, depending on your health. For example, you might need to see a specialist for some specific problems, like urinary incontinence.

Maybe. Many women gain an average of 5 pounds after menopause. Lower estrogen levels may play a role in weight gain after menopause. But weight gain may be caused by your metabolism slowing down as you age. You may also not eat as healthy or be as active as when you were younger. You also lose muscle mass as you age (muscle burns more calories at rest than other types of tissue in the body).

Weight gain can raise your risk for high blood pressure, cholesterol, diabetes, heart attack, and stroke. The risk is greater if you are already overweight or are not active or eating healthy. Learn about the effects of overweight and obesity on heart health.

The best way to lose weight, if you are overweight or obese, is to eat fewer calories each day. Exercise or physical activity is also important for good health, but works better to keep weight off than it does to help you lose weight. Researchers think this might be because people who are physically active are usually hungrier. Eating healthy and getting at least 30 minutes of exercise on most days is the best way to keep a healthy weight.

As women transition into menopause, they may experience changes in their menstrual cycles, hot flashes, night sweats, vaginal dryness, urinary changes and other physical symptoms. This transition into menopause is called perimenopause. Perimenopause begins when menstrual cycles first change and ends a year after the last menstrual cycle, when a woman enters menopause. During perimenopause, a woman’s risk of feeling depressed is double what it is before or after. Women also may experience increased anxiety. This is due in part to fluctuating hormones and midlife stress. Many women experience major life changes in middle age, such as retirement, children leaving home, divorce, widowhood, caring for elderly parents and coping with chronic medical concerns in themselves and loved ones.

Do you think you might have depression or anxiety affected by menopause or perimenopause? Complete the screening checklist to learn more.

Checklist for depression or anxiety related to menopause or perimenopause

(Adapted from the North American Menopause Society)

Is there a recent change in how often you have periods?

Is there a recent change in how many days you bleed?

Has your period recently become very heavy?

Do you have any of these symptoms?

• Hot flashes
• Night sweats
• Increased difficulty sleeping
• Increased fatigue
• Irritability
• Anxiety
• Depressed mood
• Crying spells
• Increased urination
• Leaking urine
• Dry or itchy vagina
• Pain during sexual intercourse

If you answered yes to at least three questions, consider speaking with your primary care provider or mental health clinician about assessment and treatment options.

Menopause may cause changes in your sex life, or you may not notice any changes at all. Here are some possible changes:

• Lower hormone levels can make your vaginal tissue drier and thinner. This condition, called vaginal atrophy, can make sex uncomfortable or painful.

• Lower hormones may lower your sex drive. It may take you longer to get aroused.

• Night sweats can disturb your sleep and make you tired.

• Emotional changes can make you feel stressed or irritable.

Being less interested in sex as you get older is not a medical condition that requires treatment. But if changes in your sexual health bother you, talk to your doctor or nurse about ways to help, such as treatments to relieve vaginal dryness.

The years of the menopausal transition are often a time when there are other changes in a woman’s life. You may be caring for aging parents, supporting children as they move into adulthood, taking on more responsibilities at work, and reflecting on your own life journey. Add symptoms of menopause on top of all this, and you may find yourself having trouble sleeping at night.

Hot flashes, especially night sweats, and changes in mood — depression in particular — can contribute to poor sleep. Managing these issues may help to manage sleep symptoms as well.

Some women who have trouble sleeping may use over-the-counter sleep aids such as melatonin. Others use prescription medications to help them sleep, which may help when used for a short time. But these are not a cure for sleep disturbances, such as insomnia, and should not be used long term.

Not getting enough sleep can affect all areas of life. Lack of sleep can make you feel irritable or depressed, might cause you to be more forgetful than normal, and could lead to more falls or accidents. And research now suggests that waking from sleep itself may trigger hot flashes, rather than the other way around.

Developing healthy habits at bedtime can help you get a good night’s sleep.

Getting a good night’s sleep during the menopausal transition

To improve your sleep through the menopausal transition and beyond:

• Follow a regular sleep schedule. Go to sleep and get up at the same time each day.
• Avoid napping in the late afternoon or evening if you can. It may keep you awake at night.
• Develop a bedtime routine. Some people read a book, listen to soothing music, or soak in a warm bath.
• Try not to watch television or use your computer or mobile device in the bedroom. The light from these devices may make it difficult for you to fall asleep.
• Keep your bedroom at a comfortable temperature, not too hot or too cold, and as quiet as possible.
• Exercise at regular times each day but not close to bedtime.
• Avoid eating large meals close to bedtime.
• Stay away from caffeine (found in many coffees, teas, and chocolate) late in the day.
• Remember, alcohol won’t help you sleep. Even small amounts make it harder to stay asleep.

Talk to your doctor if you are having trouble sleeping. If these changes to your bedtime routine don’t help as much as you’d like, you may want to consider cognitive behavioral therapy for insomnia. This problem-solving approach to therapy has been shown to help improve sleep in women with menopausal symptoms. Cognitive behavioral therapy can be found through a class or in one-on-one sessions. Be sure that your therapy is guided by a trained professional with experience working with women during their menopausal transition. Your doctor may be able to recommend a therapist in your area.

Osteoporosis is a disease that causes very weak bones that break easily.

Who is at risk?

Anyone can get osteoporosis, but women are more likely to get it than men. You may be more likely to get it if you:

• Are over age 50
• Smoke
• Have a low body weight
• Have family members who had osteoporosis or broken bones
• Do not get enough exercise
• Drink alcohol (more than 3 drinks/day)
• Take certain medicines for a long time like seizure medicines or steroids

How do I know if I have osteoporosis?

There are tests that use either x-rays or sound waves to measure bone density. These tests are painless. Ask your doctor if you should be tested.

• X-ray tests, called DXA scans, examine your spine, hip, or wrist. DXA scans use very few x-ray waves.
• Newer sound wave tests, called ultrasounds, test your heel.

How is it treated?

There is no way to cure osteoporosis. There are things you can do to slow it down.

Talk to your doctor to make a plan to keep your bones healthy.

Prescription Medicines

There are prescription medicines that you can take. These medicines come as a pill, a patch, or a shot (injection). Talk to your doctor, nurse, or pharmacist before you stop taking your medicine.

Bisphosphonates are a common type of drug given to slow bone loss. Your doctor may offer you other drugs.

• Talk to your doctor about how long you should take these medicines.
• Tell your doctor if you start having side effects like new pain in your hip or thigh. Some people who take these medicines had broken thigh bones.
• Some of these medicines may irritate your throat.
• Severe jaw bone problems may also be caused.

Dietary Supplements

Dietary supplements are products that people add to their diets. They include vitamins, powders, energy bars, and herbs.

Talk to your doctor before you take any dietary supplements. These may affect your other medicines and make you sick.

Lifestyle Changes

There are lifestyle changes you can make to lower your risk for osteoporosis.

• Stay physically active. Do weight bearing exercise like walking.
• Do not smoke.
• Limit alcohol use.
• Get enough calcium and vitamin D in your diet. Your doctor may suggest taking calcium and vitamin pills.

You may think heart disease only affects men. This is not true. Heart disease is the leading cause of death for women in the United States. FDA has tips to help you make good decisions about your heart health.

1. Eat a heart healthy diet.
2. Manage your health conditions.
3. Get the facts about aspirin.
4. Know the signs of a heart attack.

1. Eat a heart healthy diet.

The nutrition facts on the food label can help you make healthy food choices.

• Choose foods that are ‘low salt’ or ‘low sodium.’
• Limit foods that have ‘trans fat.’ Too much trans fat can cause heart attacks.
• Cut back on sugar. Sugar is also labeled as ‘glucose’, ‘fructose’, ‘sucrose’, and ‘corn syrup.’
• Get tips on how to use the nutrition facts label.

2. Manage your health conditions.

Common health problems like diabetes, high blood pressure, and high cholesterol can increase your risk of heart disease.

• Download a booklet to help you talk to your doctor about medicines for diabetes or high blood pressure.
• Take your medicines as directed. Do not stop taking your medicines until your healthcare provider says that it is OK.
  • Consider using less costly generics as safe and effective alternatives to your more costly brand-name medicines. Discuss with your healthcare provider if this is an option for you and get your questions answered.
• If you have diabetes, check your blood sugar level.
• Ask your healthcare provider how you should manage your health conditions during pregnancy.
• Some women need a device to help their heart work. Talk to your healthcare provider about what device is best for your heart problem.
• Talk to your healthcare provider about getting your blood pressure and cholesterol tested.

3. Get the facts about aspirin.

Daily use of aspirin to prevent a heart attack or stroke is not right for everyone.

• Ask your healthcare provider if you should use aspirin.
• If aspirin is right for you, find out:
  • how much you should take.
  • how often you should take it.
  • how long you should take aspirin. Some products combine aspirin with other ingredients and are not meant for long-term use.
• Tell your healthcare provider about all medicines and supplements you take. Your risk of bleeding may be higher if you use aspirin while also taking certain medicines, vitamins, or herbs.
• Get the facts on using aspirin to prevent heart attack and stroke.

4. Know the signs of a heart attack.

The signs of a heart attack can be different for women than they are for men.

• Heavy ache in your chest or back between your shoulder blades
• Sharp pain in your upper body
• Shortness of breath
• Breaking out in a cold sweat
• Unusual or unexplained tiredness
• Feeling dizzy or light-headed
• Feeling sick to your stomach

While the most common symptom for both women and men is chest discomfort, you can have a heart attack without experiencing chest pain or pressure. Women are more likely to have other symptoms such as back pain, jaw pain, shortness of breath, indigestion, and nausea or vomiting.

Call 9-1-1 if you think you are having a heart attack.

Make a Difference

Clinical trials help researchers learn about heart health and how treatments work. People of all ages, racial and ethnic groups, healthy women, and those with a variety of health conditions should be included.

The risk of heart disease increases for everyone as we age. For women, the risk goes up after menopause, but younger women can also develop heart disease. Protect your heart!

There are many important steps you can take to build your health in the years around menopause.

• Quit smoking. Quitting smoking is the most important step you can take to be healthier. Smoking hurts your health in many ways, including by damaging your bones and causing heart disease and as many as 12 types of cancer in women. Stay away from secondhand smoke and get help quitting if you need it. Visit Women.Smokefree.gov for woman-specific information, tips, and tools.
• Be active. Getting at least 30 minutes of physical activity on most days of the week is one of the best ways you can be healthier. Physical activity can help your bones, heart, and mood. Exercise doesn't have to be complicated. Brisk walking and regular household chores are good for your health. Ask your doctor about what activities are right for you. Aim to do:
  • At least 2 hours and 30 minutes a week of moderate aerobic physical activity or 1 hour and 15 minutes of vigorous aerobic activity or some combination of the two
  • Exercises that build muscle strength on two days each week
• Eat well. Getting vitamins, minerals, fiber, and other essential nutrients is just as important as when you were younger. But older women usually need fewer calories for energy. Find out how many calories you need each day, based on your age, height, weight, and activity level.
• Talk to your doctor or nurse about dietary supplements.
  • Women older than 50 need 2.4 micrograms of vitamin B12 and 1.5 milligrams of vitamin B6 each day. Ask your doctor or nurse if you need a vitamin supplement.
  • After menopause, calcium needs go up to maintain bone health. Doctors recommend that women 51 and older get 1,200 milligrams of calcium each day. Vitamin D also is important to bone health. Doctors also recommend that women 51 to 70 get 600 international units (IU) of vitamin D each day and women ages 71 and older get 800 IU of vitamin D each day. Ask your doctor or nurse if you need a calcium supplement or if you need more vitamin D.
• Practice safe sex. After menopause, you can’t get pregnant. But you can still get a sexually transmitted infection (STI, or STD). Condoms are the best way to prevent STIs when you have sex. After menopause the vagina may be drier and thinner, leading to small cuts or tears during sex. Vaginal cuts or tears put you at higher risk for STIs.

Healthy aging involves good habits like eating healthy, avoiding common medication mistakes, managing health conditions, getting recommended screenings, and being active. FDA has tips to help you age fabulously.

1. Eat a Healthy Diet

Good nutrition and food safety are especially important for older adults. As you age, you may be more susceptible to foodborne illness and food poisoning. You also need to make sure you eat a healthy, balanced diet. Follow these tips to help you make wise food choices and practice safe food handling.

2. Avoid Common Medication Mistakes

Medicines can treat health problems and help you live a long, healthy life. When used incorrectly, medicines can also cause serious health problems. Use these resources to help you make smart choices about the prescription and over-the-counter medicines you take.

3. Manage Health Conditions

It is important that you work with your healthcare provider to manage health conditions like diabetes, osteoporosis, and high blood pressure. Learn more about the medicines and devices used to treat these common health problems.

4. Get Screened

Health screenings are an important way to help recognize health problems -- sometimes before you show any signs or symptoms. Ask your healthcare provider which health screenings are right for you and find out how often you should get screened.

5. Be Active

Exercise and physical activity can help you stay fit and strong. You don't have to go to a gym to exercise. Talk to your healthcare provider about safe ways that you can be active.