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What is menopause? Understanding the transition

A deep dive into menopause, including when it starts, its stages, symptoms to look out for and some options for relief support.

Published: June 6, 2024 |13 minute read

Written by: Jessica Sebor

An illustration of a panicked person appears inside an illustration of a uterus.

Although menopause is a natural part of aging, it isn’t always easy.1 Despite being in good company — more than two million American people assigned female at birth experience menopause every year — the process can sometimes feel lonely.2,3 “Many women find this transition time scary, as their bodies are changing and they may feel out of control,” says Mary Dolan, MD, MPH, a professor in the Department of Gynecology and Obstetrics at Emory University School of Medicine.4

Of course, some people have no negative symptoms or worries at all.5 But no matter what your journey looks like, Dr. Dolan advises taking time to understand what’s happening with your body; to get the support you need; and, of course, to be sure to consult with your health care provider from day one.

Here's what to know about menopause so that you can stay informed during this stage of life.

In this article:

What is menopause?

Menopause happens when a person’s menstrual period stops for good.6 While menopause is technically a single moment in time, the word is often used to describe the menopausal transition, which can take many years. In medical terms, menopause happens when the menstrual period doesn’t happen for a full 12 months.7,8

Menopause can affect the entire body, but the process itself starts in the ovaries, which are small glands near the uterus. Ovaries are an integral part of the female reproductive system.9,10 During the menstrual cycle, ovaries release eggs into the fallopian tubes where the eggs can be fertilized by sperm, resulting in a pregnancy.11

Ovaries have another vital job: They produce the hormones estrogen and progesterone, which help the uterus prepare for pregnancy.12 These hormones also play important roles in other functions, including sex drive, metabolism, skin health, bone health and brain health.13

During the menopausal transition, the ovaries slow down.14 One result is that they gradually stop releasing eggs. They also no longer produce as much estrogen and progesterone.15

Menopause usually happens as part of the natural aging process, but it can also be brought on by a health issue.16 Medical treatments like chemotherapy, radiation in the pelvic area or surgical removal of the ovaries can induce menopause.17

No matter what brings it on, the result of fluctuating hormones can lead to a number of temporary symptoms,18 and it can raise the risk of a few longer-term medical issues.19 But for the most part, this transition shouldn’t stop a person from leading a full and healthy life.20

Nanette Santoro, MD, menopause expert and professor in the Department of Obstetrics and Gynecology at the University of Colorado School of Medicine, explains that there are several misconceptions surrounding menopause.21 One of the most prevalent is “the mistaken belief that ovarian hormones are essential for women’s health and keep them young.”22

Long and short, menopause doesn’t have to be an “end.” It can also be a brand-new beginning. As a general trend, people are living longer than they did a few decades ago, adds Dr. Dolan.23,24 With increasing life expectancy, many women may spend up to 40% of their lives postmenopause.25

What age does menopause start?

Because menopause is, by definition, a moment in time, it doesn't really start; it happens.26 The broader menopausal transition, however, usually begins in a person’s forties or fifties, as the ovaries slowly stop producing hormones and stop releasing eggs.27 In the United States, the average person reaches menopause at 5128 or 52 years old.29

Pamela Della Valle, MD, obstetrics and gynecological physician with Pardee OB/GYN Associates in Hendersonville, North Carolina, explains that it’s normal for the age of menopause to vary.30,31 “Some women can experience it as early as their thirties or as late as their sixties,” she says.32,33

Indeed, about 1 in 20 people assigned female at birth will go through menopause earlier in life.34 When menopause occurs before the age of 40, this is called premature menopause.35,36 Early menopause can be influenced by a number of factors, including:

  • Autoimmune conditions: A small number of cases of early menopause are due to an autoimmune condition called autoimmune oophoritis.37
  • Cancer treatments: In some cases, chemotherapy and radiation can damage the ovaries, which may lead to premature menopause.38 Not all people who go through cancer treatments will go through early menopause, and the younger a person is during treatment, the less likely early menopause is to occur.39
  • Genetics: People are more likely to experience early menopause if their mothers or grandmothers went through menopause at an early age.40
  • Health conditions: Other health conditions have been connected to early menopause. This includes acquired immunodeficiency syndrome (AIDS) and Turner’s syndrome (when the body is missing all or part of the X chromosome).41
  • Smoking: Some research shows that, on average, smokers may experience menopause earlier than nonsmokers.42
  • Surgery: People who have both ovaries removed (bilateral oophorectomy) will experience menopause right after surgery, as their periods will cease.43

Late-onset menopause (or delayed menopause), on the other hand, occurs when someone hasn’t experienced menopause by the age of 55. It may, in part, be due to genetics, lifestyle factors and weight.44,45

How long does menopause last?

Because menopause is a moment in time, it doesn’t “last.” It happens. However, the symptoms can vary in length and severity. The full transition — from the first signs of menopause to full menopause (the day your periods stop forever) — typically takes about 4 to 7 years, although it can take as long as 14 years in some cases.46,47

Again, the duration is different for everyone and depends on a number of factors.

Signs of menopause approaching

“The first sign is often a change in menstrual cycle length,” says Dr. Dolan.48,49

As the ovaries decrease in function, menstrual periods also become more irregular50 and unpredictable. Menstrual periods may change in length and flow, starting later or earlier, or skipping a period or two as the ovaries stop releasing eggs.51

Another sign of the onset of the menopausal transition is the arrival of symptoms. Other than irregular menses, hot flashes are the most common symptom of menopause approaching.52 (More on symptoms below.)

“The menopausal transition is when women may have the most bothersome symptoms,” says Dr. Dolan.53,54 For most people, uncomfortable symptoms last a few years, but one-third of them will experience menopausal symptoms for over a decade.55

If you think you may be entering the transition to menopause, it’s a good idea to make an appointment with your gynecologist or health care provider.56 They will review your medical history and symptoms to help you understand if you’ve started your menopause journey — and, if so, how best to manage the transition.

What is perimenopause?

The transition to menopause is known as perimenopause.57 From the root “peri,” which means “around,” perimenopause is the time around menopause.58 It begins when the hormones in your body start to shift and ends when the person reaches menopause.59

For more information on perimenopause — including signs, symptoms and coping strategies — check out the article on “What is perimenopause?”

Menopause symptoms

During menopause, about 85% of people will experience symptoms.60 “Some women have several symptoms, while others have few,” says Dr. Della Valle.61,62 Each person’s experience is different but, “in general, the hormonal change associated with menopause can affect physical, emotional, mental and social well-being.”63,64

Common symptoms include:

  • Bladder problems. Vaginal atrophy and relaxation of the pelvic floor muscles can lead to urinary incontinence.65 Pelvic floor exercises like Kegels may help combat bladder weakness.66 As such, people may want to consider using Kegel tools and incontinence underwear to assist them.
  • Decreased interest in sex. Dwindling sex hormones can also lead to diminished libido and more trouble achieving orgasms during intimacy.67 Health care providers may recommend a water-based lubricant to help make sex more comfortable and pleasurable.68
  • Headaches. Since hormones play a role in migraine headaches, people can experience this painful condition.69 People who suffer from migraines may experience an increase in frequency during the menopausal transition. Headaches can also be triggered by symptoms like increased stress, mood changes and lack of sleep.70 Over-the-counter (OTC) migraine medication may help, but talk to your doctor first.
  • Hot flashes and night sweats. Marked by a sudden, overwhelming feeling of heat in the chest and upper arms, up to three out of four people going through the menopausal transition deal with hot flashes.71 Hot flashes can also cause heavy sweating,72 especially at night, when you may wake up with your sheets soaking wet.73 Experts believe hot flashes are related to changes in the part of the brain responsible for regulating body temperature, known as the hypothalamus.74 Lifestyle changes like maintaining a healthy weight and avoiding alcohol, caffeine and cigarettes may help.75 Carrying a portable fan and dressing in layers that can be removed may also provide some relief.76
  • Mental clarity. About two out of three experience brain fog, subjective memory impairment and difficulty concentrating during the transition.77 While these symptoms can be scary, in most cases, this loss is temporary and will subside in postmenopause.78 “Studies of cognition show that there is a transient reduction in working memory that improves after a person has had their last menstrual period,” says Dr. Santoro.79,80 “This can cause a lot of worry but it is not a harbinger of dementia.”81
  • Mental health struggles. Menopause increases the risk of certain mental health conditions, including depression and anxiety.82 (More on menopause and mental health below.)
  • Mood shifts. People may notice shifts in mood that feel similar to the emotional rollercoaster of premenstrual syndrome (PMS).83 About 4 in 10 experience episodes of sadness, irritability and fatigue.84
  • Skin issues. As menopause approaches, people may notice dry, sagging skin due to a decrease in collagen.85 Other issues may include adult acne, rashes and fragile skin.86 (More on menopause and skin care below.)
  • Trouble sleeping. Nighttime hot flashes can make sleeping a challenge. Plus, some deal with insomnia and sleep-disordered breathing.87 If you still have trouble sleeping, ask your doctor whether an OTC or prescription medication could help.
  • Vaginal dryness. The hormone estrogen helps keep the vagina lubricated and its muscles able to stretch and contract.88 As estrogen decreases, people may notice feelings of dryness or tightness in and around the vagina.89 OTC vaginal moisturizers may be able to help.
  • Weight gain. Some may notice that the transition to menopause comes with physical body changes. The distribution of fat changes during menopause, which could be linked to decreasing estrogen as well as the natural slowing of metabolism as we age.90 (More about menopause and weight gain below.)

“A common misconception is that there is nothing you can do about these symptoms and you must ‘suffer’ through it since it’s a natural process,” says Dr. Dolan.91,92

But aside from lifestyle changes and OTC options, there are a number of prescription medications that may help. Talk to your health care provider about hormone therapy and medications specific to different symptoms.93

Dr. Della Valle adds that there is a lot of misinformation surrounding hormone therapy — both its risks and advantages.94,95 “Many women also believe that if they go to a doctor, they will be prescribed hormones and there is nothing else to reduce symptoms. That is not true,” she says.96,97 “These fears and confusion cause women to wait too long to have their symptoms addressed.”98

Another myth: People going through perimenopause can’t get pregnant.99 “Contraception is still needed until a woman has not had menses for a year,” says Dr. Dolan.100,101

If you’re engaging in sexual intercourse and do not wish to conceive, it’s a good idea to continue to use whatever form of contraception works best for you. And in postmenopause, you can still contract sexually transmitted infections, so protection is important at every stage of life.102 Check out our article for a deep dive into birth control options.

To learn more about common symptoms and how to manage them, explore the article about menopause symptoms.

What is postmenopause?

Postmenopause is the time after menopause has been reached — 12 months following the date of your last period.103 (Learn more about the stages of menopause.) Once you’re in postmenopause, this phase continues for the rest of your life.104

Like any life stage, it comes with its advantages and challenges.

Some good news: If your symptoms are flaring during the years before you reach menopause, postmenopause can provide some relief.105 “Most of the symptomatology is worse during perimenopause or the time leading up to menopause,” says Dr. Dolan.106,107 Issues like hot flashes, brain fog, trouble sleeping and mood shifts often relax or stop completely in postmenopause.108 However, some continue to grapple with these challenges in their postmenopausal years.109

While the troublesome symptoms of menopause may have died down, postmenopause can carry other health challenges. It’s important to stay aware of these increased risks:

  • Heart disease. Cardiovascular disease is the number one cause of death for women in the United States — and the risk increases in postmenopause.110 Keep up with healthy habits, including staying physically active, not smoking, getting regular checkups and eating a healthy diet full of fruits, vegetables and whole grains.111
  • Osteoporosis. With the loss of hormones, “there is an increased risk of bone loss, which may lead to osteoporosis,” says Dr. Dolan.112,113 Estrogen works to slow down the loss of bone, so when bodies stop producing this hormone, bone loss can accelerate.114 In fact, 50% of all people in postmenopause will have osteoporosis at some point in their lives. The condition is marked by porous, brittle bones, which can lead to painful breaks and fractures.115 A healthy diet — rich in calcium and protein and low in alcohol — can help stave off bone loss.116 Make time for weight-bearing exercise (like aerobics and walking) too, as well as strength training to keep bones strong.117
  • Urinary genital challenges. According to a study from the North American Menopause Society, up to 84% of postmenopausal people experience Genitourinary Syndrome of Menopause (GSM).118 This is a catch-all term to describe chronic genital, sexual and urinary issues. The same vaginal dryness and irritation that people experience in perimenopause can persist in postmenopause, as can a lack of interest in sex and pain during intercourse.119 Incontinence and urinary tract infections become more common during this life stage as well.120 If you’re experiencing any of these issues, it’s important to talk to your health care provider.

Menopause and mental health

Our hormones and mental health are closely linked.121 This is why experts call puberty, pregnancy and menopause “windows of vulnerability” when it comes to mental health.122

Phases in life when hormones go through major shifts can cause emotional upheaval, mood swings, depression and anxiety.123 “It is now well documented that depressive symptoms increase as women traverse menopause,” says Dr. Santoro. “Up to 40% of women will have an increase in depressive symptoms.”124,125

Furthermore, while menopausal people can experience depression for the first time, those who have a history of depressive episodes during a prior window of vulnerability are more likely to suffer during this period.126 Lack of sleep and hot flashes can up the risk as well.127

If you are experiencing mood changes that get in the way of your life, and they last for two weeks or longer, seek help from a medical professional as soon as you can.128 If you or someone you love is struggling with mental health, know that you are not alone. Call 988 any time of day or night if you or a loved one ever experience thoughts of suicide.129

In addition to dealing with hormones, menopause often falls at a time of social and physiological stress.130 “Menopause happens to coincide with many life changes,” says Dr. Della Valle.131 “It often occurs when children are moving out of the home or aging parents are starting to face health challenges.” People may also face other medical issues at the same time, and a change in mood and sexual desire can put marital relationships and partnerships under strain.132

Dr. Dolan adds that cultural pressures can also play a role:133,134 “Our culture doesn’t really embrace women’s aging. Depending on a person’s personal values and their self-perception, aging itself can be a challenging transition, associated with mental health concerns,” she says.135,136

Menopause and skin care

The menopausal transition can have a big impact on your skin.137 Falling estrogen levels mean skin has more trouble holding on to moisture and can therefore feel dry and patchy.138 Collagen, a protein that helps keep skin looking full, can drop by nearly one-third in the first five years following menopause. Some people can also experience unexpected skin issues like acne and rosacea.139

If you are noticing skin issues, consider updates to your routine.

Menopause weight gain

Whether or not menopause directly impacts weight gain, the transition can affect how weight is distributed in the body.140 As menopause approaches, people may notice more fat accumulation around the waist.141 More fat around the belly can also bring more serious concerns like increased risks of heart disease, hypertension and metabolic disorders.142

Help combat weight gain and belly fat by staying active and opting for a healthy diet.143 The Centers for Disease Control and Prevention recommends a minimum of 2 sessions of muscle-strengthening exercise and 150 minutes of moderate-intensity physical activity each week.144

Having some fitness and exercise equipment at home can encourage you to get moving, as can wearing a fitness tracker.145

A diet rich in fruit, vegetables and whole grains can also help. The Women’s Health Initiative has found that individual counseling and support groups may inspire you to stick to a diet and maintain a healthy weight.146

Supplements for menopause

“Regular exercise and a good diet are the best supplements for menopause,” says Dr. Dolan.147,148

With that in mind, certain supplements may also help alleviate discomfort and stave off health complications that can come with menopause.149 But talk to your health care provider before taking any OTC supplement.

Who experiences menopause?

Menopause is a transition that occurs within the female sex organs.150 Women experience menopause as well as people with ovaries who don’t identify as female, including trans people, non-binary people and gender-fluid individuals.151

The bright side of menopause

Menopause can be difficult, but there are many advantages to this life stage as well.

“Aging is a privilege,” says Dr. Dolan.152 She recommends speaking with other people who have gone through this transition to find community, wisdom and solace.

There may be relief for people who experienced difficult periods. “Many gynecological issues associated with menstrual cycles improve after menopause, such as pelvic pain associated with endometriosis, adenomyosis, fibroids and ovarian cysts,” adds Dr. Della Valle.153,154

The risk of unexpected pregnancy also disappears, and some people see their entry into this new life stage as a fresh start — giving them a sense of freedom.155

Just remember there’s no right way to feel when you’re experiencing menopause. “The experience of menopause is variable — there is not a ‘one size fits all’ when it comes to the transition,” Dr. Dolan says.156

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.