Menopause is the time when a woman’s menstrual periods stop for good, and she can no longer get pregnant. You’ve reached menopause when you haven’t had a period for one year. It’s a normal part of aging. But the transition to menopause affects every woman differently.

The menopausal transition often begins between ages 45 and 55. It can last for many years. During this time, women may notice changes to their periods. They may have hot flashes, sleep problems, and mood changes. They may also have problems with bladder control or weight gain. Sex may be uncomfortable. Body changes during this transition can also raise the risk for certain health problems, like heart disease or osteoporosis.

For some women, symptoms are mild and need no treatment. Lifestyle changes can help to relieve certain symptoms. But if symptoms are severe or bothersome, it’s a good idea to talk with a doctor about treatment.

After menopause, symptoms may continue for years. Deciding whether and how to treat these symptoms can be complicated and personal. The benefits and risks of some treatments may vary, depending on your medical and family history.

Perimenopause (PER-ee-MEN-oh-pawz), or the menopausal transition, is the time leading up to your last period. Perimenopause means “around menopause.”

Perimenopause is a long transition to menopause, or the time when your periods stop permanently and you can no longer get pregnant. As your body transitions to menopause, your hormone levels may change randomly, causing menopause symptoms unexpectedly. During this transition, your ovaries make different amounts of the hormones estrogen (ES-truh-jin) and progesterone (proh-JES-tuh-RONE) than usual.

Irregular periods happen during this time because you may not ovulate every month. Your periods may be longer or shorter than usual. You might skip a few months or have unusually long or short menstrual cycles. Your period may be heavier or lighter than before. Many women also have hot flashes and other menopause symptoms during this transition.

Perimenopause, the transition to menopause, usually starts in a woman's mid- to late 40s. On average, women are in perimenopause for four years before their periods stop.

Sometimes it can be hard for you and your doctor to tell whether you are in perimenopause, the transition to menopause:

• Symptoms: Tell your doctor or nurse about any menopause symptoms, such as hot flashes or trouble sleeping.
• Irregular periods: Track your periods. Irregular periods may be your first sign of menopause.
• Hormone levels: Your doctor may test the amount of hormones in your blood if your periods stopped at an early age (before 40). Doctors don’t usually recommend this test unless there is a medical reason to do so. This is because, for most women, hormone levels go up and down in an unpredictable way during the transition to menopause. So it is difficult to tell for sure whether you have gone through menopause or are getting close to it based on this blood test.

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.

Perimenopause, the transition to menopause, can last between two and eight years before your periods stop permanently. For most women, this transition to menopause lasts about four years. You will know you have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.

As you approach menopause, certain levels of hormones in your body begin to change. This initial transition to menopause when you still get a period is called perimenopause. During perimenopause, some women begin to feel symptoms such as intense heat and sweating (“hot flashes”), trouble sleeping, and changing moods.

As you get closer to menopause, you may notice other symptoms, such as pain during sex, urinary problems, and irregular periods. These changes can be stressful on you and your relationships and cause you to feel more extreme emotions.

Women with mental health conditions may experience more symptoms of menopause or go through perimenopause differently than women who do not have mental health conditions.

• Women with depression are more likely to go through perimenopause earlier than other women. Studies show that women with depression have lower levels of estrogen.
• Bipolar disorder symptoms may get worse during perimenopause.
• Insomnia affects up to half of women going through menopause. Insomnia may be more common in women with anxiety or depression.
• Menopause can cause a relapse of obsessive-compulsive disorder (OCD) or a change in symptoms.

Yes. You can still get pregnant during perimenopause, the transition to menopause, even if you miss your period for a month or a few months. During perimenopause you may still ovulate, or release an egg, on some months.

But it is impossible to know for sure when you will ovulate. If you don’t want to get pregnant, you should continue to use birth control until one full year after your last period. Talk to your doctor about your birth control needs. Learn more about different birth control methods.

You can’t get pregnant after menopause, but anyone who has sex can get sexually transmitted infections (STIs, or STDs). If you are not in a monogamous relationship in which you and your partner have sex with each other and no one else, protect yourself by using a male condom or dental damcorrectly every time you have vaginal, oral, or anal sex. After menopause you may be more likely to get an STI from sex without a condom. Vaginal dryness or irritation is more common after menopause and can cause small cuts or tears during sex, exposing you to STIs.

Menopause happens when you have gone 12 months in a row without a period. The average age of menopause in the United States is 52. The range for women is usually between 45 and 58. One way to tell when you might go through menopause is the age your mother went through it.

Menopause may happen earlier if you:

• Never had children. Pregnancy, especially more than one pregnancy, may delay menopause.
• Smoke. Studies show smoking can cause you to start menopause up to two years earlier than women who don’t smoke.

Certain health problemscan also cause you to start menopause earlier.

Menopause usually happens on its own. However, you may enter menopause earlier than you normally would if you have had chemotherapy or surgery to remove both ovaries.

After menopause you will no longer be able to get pregnant and you will no longer get a period. If you have any type of vaginal bleeding after menopause, you should see a doctor as soon as possible. Vaginal bleeding after menopause is not normal and can mean that you have a serious health problem.

You may experience any of the following after menopause:

• Low hormone levels. With menopause, your ovaries make very little of the hormones estrogen and progesterone. Because of changing hormone levels, you may develop certain health risks, including osteoporosis, heart disease, and stroke.
• Menopause symptoms instead of period problems. After menopause, most women get relief from period problems or menopause symptoms. However, you may still experience symptoms such as hot flashes because of changing estrogen levels. One recent study found that hot flashes can continue for up to 14 years after menopause.
• Vaginal dryness. Vaginal dryness may be more common post-menopause. 

During midlife, a woman’s menstrual periods grow further and further apart. At some point, they stop completely, and she can no longer get pregnant.

This is because the ovaries aren’t releasing eggs and making hormones like estrogen anymore. After 12 months without a period, a woman can say she’s gone through menopause.

In the years before menopause, women may experience skipped and unpredictable menstrual periods. This phase is called the midlife transition, perimenopause, or the change of life. Some women go through the transition faster than others. It lasts between 1 and 10 years.

Midlife Transition

Typically, menopause occurs between ages 45 and 55. This means women can expect less frequent periods and other symptoms at some point during their 40s. But it’s different for every woman. There’s no lab test to predict when in life it will start or how easy it will be.

Along with unpredictable periods, a woman may have other symptoms—both physical and emotional. Hot flashes, poor sleep, and mood changes are common. Some women have vaginal dryness, weight gain, and thinning hair. Bone density may also start to decrease.

“Most people don’t have severe symptoms. Most people have mild or less frequent symptoms,” says Dr. Hadine Joffe, an NIH-supported menopause researcher and psychiatrist at Brigham and Women’s Hospital.

NIH is funding studies looking into how to relieve menopause symptoms. There are medicines and lifestyle changes that can help.

“No two people are going to go through menopause in exactly the same way,” explains Dr. Chhanda Dutta, who oversees clinical aging research at NIH. “Different women go through menopause with different kinds of symptoms, and we’re trying to give them options for how they can manage them.”

Waves of Heat

Hot flashes are a common symptom during the midlife transition. Many women have these for several years after menopause. Some experience hot flashes for 10 or more years.

A mild hot flash feels like being embarrassed, Joffe says. “There’s a wave of heat sensation that rises to your head and chest, and sometimes you look red, feel hot, and then it’s gone.”

A not-so-mild hot flash can make your skin appear very red. Your head, neck, and chest may become hot and sweaty.

“It’s particularly disruptive at night,” Joffe says. “People are waking up, feeling very hot and sweaty, and they have weird, disrupted sleep.”

NIH-supported studies have found some medicines that reduce hot flashes. The most effective FDA-approved treatment is low-dose hormone therapy. Some women are given estrogen or estrogen with another hormone, progestin. Women take hormone therapy for the shortest time that they need it.

Not every woman can take hormone therapy. Another option is an antidepressant that is FDA-approved for treating moderate to severe hot flashes.

A doctor can help determine which medicine might work best. See the Wise Choices box for other ways to outsmart hot flashes.

Restless Nights

During midlife, women may start having trouble sleeping because of changes in hormone levels. Hot flashes and night sweats can also cause women to wake up.

“In people who have hot flashes at night, their sleep is disrupted throughout the entire night. It’s like a ripple of a sleep irritation throughout the whole night,” Joffe says. A woman may feel tired the next day as a result.

The medicines that help with hot flashes may also help ease sleep issues. But other things can help, too.

If a hot flash or anything else wakes you up, avoid looking at a clock. “It’s much easier to fall back to sleep if you don’t know what time it is,” Joffe advises.

She also says to avoid tossing and turning. If you wake up, get out of bed briefly to read and then get back into bed to go back to sleep.

Exercise can also help women sleep better at night. It’s best to avoid caffeine and alcohol for several hours before bedtime, too. Both can disrupt sleep.

For women who have a hard time falling asleep, relaxation breathing can help. Slowly breathe in through your nose. With a hand below your ribs, feel your stomach push your hand out. Slowly exhale through your mouth. You can do this for several minutes to relax.

Rollercoaster Moods

During perimenopause, many women become irritable or feel moody. Some may feel sad and anxious and unable to enjoy things as much as they used to.

If a woman has these symptoms day after day for at least 2 weeks, she may be dealing with a clinical depression. “There is a two- to three-fold risk of depression during perimenopause,” says NIH psychiatrist and researcher Dr. Peter J. Schmidt.

Although most women don’t have a problem with depression during this transition, he explains, changes in hormones can bring a negative mood for some women. Researchers are studying how to counteract the effects of shifting hormone levels.

Schmidt and his colleagues found that women who were at risk of depression and taking estrogen therapy were less likely to become depressed during perimenopause. The medicine prevented dips in estrogen and seemed to prevent mood plunges as well.

“If you think you’re at a higher risk of depression, you should proactively touch base with your doctor, says Schmidt. “Talk about what kind of symptoms you should be looking for and be concerned about as you age.”

He advises that you set up a plan for how to look for symptoms of depression. That way, you can enter midlife prepared to act. Schmidt encourages anyone who has a depressed mood to seek help from a primary care doctor or mental health professional.

Midlife Well-Being

The midlife transition is a phase of life that brings gradual changes. Many women don’t have problems during this transition.

You can make midlife your time for optimizing well-being by eating well, exercising, and getting quality sleep. The healthier you are at midlife, the more successful you’ll be combating age-related changes and diseases.

“We see it almost like a window of opportunity where people want to be entering midlife as healthy as possible,” Joffe says. “It’s really important for people to do the right thing now. And protect their health over time.”

How to Live With Hot Flashes

• Wear light clothing.
• Keep your room cool.
• Use a fan.
• Drink cold water.
• Avoid smoking, caffeine, spicy foods, and alcohol.
• Maintain a healthy weight.
• Take several slow and deep breaths when you feel a hot flash coming on.
• Ask your doctor about medicines that can help.