Home > Health Resources > Menopause and Perimenopause
View Additional Section Content
Menopause is the point in a woman's life when she has not had her period for 1 year. It marks the end of the childbearing years. It's sometimes called "the change of life."
For most women, menopause happens around age 50. But every woman's body has its own time line. Some women stop having periods in their mid-40s. Others continue well into their 50s.
Perimenopause is the process of change that leads up to menopause. It can start as early as your late 30s or as late as your early 50s. How long perimenopause lasts varies, but it usually lasts from 2 to 8 years. You may have irregular periods or other symptoms during this time.
Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you. But it's a good idea to learn all you can about menopause. Knowing what to expect can help you stay as healthy as possible during this new phase of your life.
Normal changes in your reproductive and hormone systems cause menopause. As your egg supply ages, your body begins to ovulate less often. During this time, your hormone levels go up and down unevenly (fluctuate), causing changes in your periods and other symptoms. In time, estrogen and progesterone levels drop enough that the menstrual cycle stops.
Some medical treatments can cause your periods to stop before age 40. Having your ovaries removed, having radiation therapy, or having chemotherapy can trigger early menopause.
Common symptoms include:
Some women have only a few mild symptoms. Others have severe symptoms that disrupt their sleep and daily lives.
Symptoms tend to last or get worse the first year or more after menopause. Over time, hormones even out at low levels, and many symptoms improve or go away.
You don't need to be tested to see if you have started perimenopause or reached menopause. You and your doctor will most likely be able to tell based on irregular periods and other symptoms.
If you have heavy, irregular periods, your doctor may want to do tests to rule out a serious cause of the bleeding. Heavy bleeding may be a normal sign of perimenopause. But it can also be caused by infection, disease, or a pregnancy problem.
You may not need to see your doctor about menopause symptoms. But it is important to keep up your annual physical exams. Your risks for heart disease, cancer, and bone thinning (osteoporosis) increase after menopause. At your yearly visits, your doctor can check your overall health and recommend testing as needed.
Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you. But if your symptoms are upsetting or uncomfortable, you don't have to suffer through them. There are treatments that can help.
The first step is to have a healthy lifestyle. This can help reduce symptoms and also lower your risk of heart disease and other long-term problems related to aging.
If lifestyle changes aren't enough to relieve your symptoms, you can try other measures, such as breathing exercises and yoga.
If you have severe symptoms, you may want to ask your doctor about prescription medicines. Choices include:
All medicines for menopause symptoms have possible risks or side effects. A very small number of women develop serious health problems when taking hormone therapy. Be sure to talk to your doctor about your possible health risks before you start a treatment for menopause symptoms.
Remember, it is still possible to become pregnant until you reach menopause. To prevent an unwanted pregnancy, keep using birth control until you have not had a period for 1 full year.
Health Tools help you make wise health decisions or take action to improve your health.
Menopause is a natural part of aging. As you age, the number and quality of your eggs decline, hormone levels fluctuate, and your menstrual cycle becomes less predictable until it finally stops completely.
Certain lifestyle choices and medical treatments can cause or are linked to an earlier menopause, including:
The first sign that you are nearing menopause is a change in your menstrual periods. They may become less frequent. And they may be lighter or heavier than you're used to.
Menopause symptoms range from mild (or none) to severe. They include:
These symptoms usually go away after 1 or 2 years. But some women have them for several years longer.
Other conditions can cause similar symptoms. Examples include pregnancy; a significant change in weight; depression; anxiety; or uterine, thyroid, or pituitary problems.
Menopause caused by surgery, chemotherapy, or radiation therapy can cause more severe symptoms than usual. Preexisting conditions such as depression, anxiety, sleep problems, or irritability can also make symptoms worse.
After you stop having menstrual periods, you may get other symptoms, including:
In your late 30s, your egg supply begins to decline in number and quality. As a result, your hormone production changes. You may notice a shortened menstrual cycle and some premenstrual syndrome (PMS) symptoms that you didn't have before.
Gradually, your periods become irregular. This can start as early as your late 30s or as late as your early 50s. It continues for 2 to 8 years before menstrual cycles end.
During this time, your ovaries are sometimes producing too much estrogen and/or progesterone and at other times too little. Your progesterone is likely to fluctuate more than before. This can lead to heavy menstrual bleeding. (If you have heavy or unexpected vaginal bleeding, see your doctor to be sure it isn't caused by a more serious condition.)
About 6 months to a year before your periods stop, your estrogen starts to drop. When it drops past a certain point, your menstrual cycles stop. After a year of no menstrual periods, you are said to have "reached menopause."
During the next year or so, estrogen levels keep going down. This lowers your risk for certain types of cancers (estrogen is linked to some types of cancerous cell growth). But low estrogen also creates some health concerns, such as:
Although the reasons aren't well understood, a woman's risk of heart disease increases after menopause. Because heart disease is the number one killer of women, consider your heart risk factors when making lifestyle and treatment decisions.
Call your doctor if you have:
The following health professionals can help you manage menopause symptoms and evaluate menstrual period changes:
Your age, your history of menstrual periods, your symptoms, and the results of your pelvic exam will tell your doctor whether you are near or at menopause. If possible, bring a calendar or journal of your periods and symptoms.
If you have severe symptoms, if your doctor suspects another medical condition, or if you have a medical condition that makes a diagnosis difficult, your doctor may do one or more of the following blood tests:
If you have had no menstrual periods for 1 year, this is a good time to have a full physical exam, with particular focus on your heart health and risk factors for osteoporosis.
Menopause is a natural part of aging. But symptoms can be difficult for some women.
If you have trouble sleeping, mood swings, hot flashes, cloudy thinking, heavy menstrual periods, or other symptoms, treatment can help you get through this time more comfortably.
Treatment for menopause symptoms may include:
A healthy lifestyle can help you manage menopause symptoms. It can also help lower your risk for heart disease, osteoporosis, and other long-term health problems.
To manage hot flashes, try keeping your environment cool, dressing in layers, and managing stress.
To improve vaginal dryness and muscle tone, try using a vaginal lubricant and doing Kegel exercises regularly.
Medicines can help you cope with bothersome menopause symptoms. Some medicines contain hormones, and some don't.
Hormone therapy is sometimes used to treat menopause symptoms. But women who use it may have a higher risk of other health problems.
If your symptoms are the result of early menopause brought on by having your ovaries removed along with your uterus, you may consider estrogen therapy (ET). But ET may increase the risk of health problems in a small number of women.
Short-term, low-dose HT or ET can be taken for up to 4 to 5 years, with regular checkups. This may work well for many women, who will find that their menopause symptoms have subsided within this period of time.
Many women have turned to alternative medicine for menopause symptom relief. Before you try prescription medicines or hormones, you can think about using one or more of the following options for preventing or treating symptoms.
Remember that dietary supplements aren't regulated the way medicines are. It's important to be careful when taking supplements. Tell your doctor what you are taking.
Based on the latest research, some treatments aren't recommended, either because they don't work or because they can cause dangerous effects.footnote 7 These include:
Fritz MA, Speroff L (2011). Menopause and perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 673-748. Philadelphia: Lippincott Williams and Wilkins.
North American Menopause Society (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause, 19(3): 257-271. http://www.menopause.org/docs/default-document-library/psht12.pdf?sfvrsn=2. Accessed August 27, 2015.
North American Menopause Society (2015). The North American Menopause Society statement on continuing use of systemic hormone therapy after age 65. Menopause, 22(7): 693. http://www.menopause.org/docs/default-source/2015/2015-nams-hormone-therapy-after-age-65.pdf. Accessed August 24, 2015.
North American Menopause Society (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause, 19(3): 257-271. DOI: 10.1097/gme.0b013e31824b970a. Accessed April 18, 2016.
Cedars MI, Evans M (2008). Menopause. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 725-741. Philadelphia: Lippincott Williams and Wilkins.
Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749-857. Philadelphia: Lippincott Williams and Wilkins.
American College of Obstetricians and Gynecologists (2001, reaffirmed 2010). Use of botanicals for management of menopausal symptoms. ACOG Practice Bulletin No. 28. Obstetrics and Gynecology, 97(6, Suppl): 1-11.
Other Works Consulted
American Association of Clinical Endocrinologists Menopause Guidelines Revision Task Force (2006). American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice, 12(3): 315-337.
Daley A, et al. (2011). Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews (9).
Grady D, et al. (2016). Menopause. In L Goldman, A Shafer, eds., Goldman-Cecil Medicine, 24th ed., vol. 2 , pp. 1623-1629. Philadelphia: Saunders.
Levis S, et al. (2011). Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms. Archives of Internal Medicine, 171(15): 1363-1369.
Shifren JL, Schiff I (2007). Menopause. In JS Berek, ed., Berek and Novak's Gynecology, 14th ed., pp. 1323-1340. Philadelphia: Lippincott Williams and Wilkins.
U.S. Preventive Services Task Force (2012). Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf12/menohrt/menohrtfinalrs.pdf.
ByHealthwise StaffPrimary Medical ReviewerAnne C. Poinier, MD - Internal MedicineKathleen Romito, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineMartin J. Gabica, MD - Family MedicineSpecialist Medical ReviewerCarla J. Herman, MD, MPH - Geriatric Medicine
Current as ofOctober 6, 2017
Current as of:
October 6, 2017
Anne C. Poinier, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine
To learn more about Healthwise, visit Healthwise.org.
© 1995-2018 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Our interactive Decision Points guide you through making key health decisions by combining medical information with your personal information.
You'll find Decision Points to help you answer questions about:
Get started learning more about your health!
Our Interactive Tools can help you make smart decisions for a healthier life. You'll find personal calculators and tools for health and fitness, lifestyle checkups, and pregnancy.
Feeling under the weather?
Use our interactive symptom checker to evaluate your symptoms and determine appropriate action or treatment.
2700 Clay Edwards Drive, Ste 240, North Kansas City, MO 64116