What is menopause?
Menopause is a normal part of aging and is when you stop getting your period. You have reached menopause when it has been a full year since your last period. The time leading up to menopause may take several years. This is known as perimenopause. Menopause happens when your ovaries stop making the hormone estrogen.2
When does menopause start?
The natural transition to menopause usually starts in your mid– to late–40s. The average age for menopause is 51.3 Black women are more likely to start menopause earlier.4
Premature menopause happens before age 40. Early menopause occurs before age 45. Menopause may start earlier due to:5, 6
- Autoimmune disorders
- Chemotherapy or radiation to treat cancer
- Genes
- Primary ovarian insufficiency (POI)
- Smoking
- Surgery to remove the ovaries
- Surgery to remove the uterus and ovaries
What are the stages of menopause?
Menopause is a gradual process that happens in 3 stages.
Perimenopause
Perimenopause is the time before your last period when your body starts making less estrogen. It may start in your 30s or 40s. Periods may be shorter or longer than usual or skip a month. You may also have lighter or heavier bleeding.3 During perimenopause, you may still ovulate. You can still get pregnant during the transition to menopause.2 Changes to your period are normal during perimenopause. You should still report them to your health care provider.3
Menopause
You have reached menopause after going a full year without a period. Once you’ve reached menopause, your ovaries no longer release eggs. This means you can no longer get pregnant. Your body also produces less estrogen.3, 6
Postmenopause
Postmenopause is the time in your life after menopause. Most symptoms lessen in postmenopause, but some may continue for several years. People in the postmenopausal phase are at an increased risk for osteoporosis and heart disease. If you have vaginal bleeding after menopause, see a health care professional as soon as possible.
What are the symptoms of perimenopause and menopause?
Each person has a different experience with perimenopause. You could have a few symptoms or many.
You may notice changes to your period before other symptoms. Changes may include:4
- Irregular periods
- Periods that are lighter than usual
- Worsening premenstrual syndrome (PMS)
- Periods that are shorter or longer than usual
Some reasons to see your doctor include if you notice:4
- Spotting or bleeding between periods or after sex
- Periods that last more than a week
- More frequent periods
- Heavier periods
Hot flashes and night sweats are called vasomotor symptoms. They are some of the most common symptoms of menopause. A hot flash is a sudden feeling of heat in your face and upper body. It may last a few seconds or several minutes. They can happen a few times a month or daily.
Hot flashes that happen while you’re sleeping are called night sweats.7
The vagina and the vulva may change during perimenopause. Changing estrogen levels may cause less lubrication in the vagina. Sexual intercourse may be uncomfortable. This may cause some people to avoid sex. Some people also experience lower libido.4
These changes are called genitourinary syndrome of menopause.8
Our brains have estrogen receptors that help certain functions. They help our memory, mood and emotions, among other things. Having less estrogen may affect these functions.9
During perimenopause, some people notice changes in:9
- Memory, such as brain fog
- Emotions, such as anxiety, depression and irritability
- Sleep, which may cause poor memory
Difficulty sleeping or insomnia are common symptoms of perimenopause. Lower progesterone levels can make it hard to sleep. Lower estrogen levels can cause night sweats. Changing hormones may also cause you to wake up with the urge to urinate more often.2
Some physical symptoms are also common, including:6
- Breast tenderness
- Dry skin, dry eyes or dry mouth
- Racing heart
- Headaches
- Weight gain
- Hair loss or thinning
Menopausal symptoms are caused by changing hormone levels. Symptoms may begin up to 10 years before reaching menopause.6 They may range from mild to very noticeable. Research shows different races report varying degrees of symptoms. For example, Black women report more symptoms and have them for longer than White women. Asian women are less likely to have symptoms.4
Talk with your doctor about ways you can help manage symptoms. Some may be addressed through lifestyle changes. For some women, hormone replacement therapy (HRT) might be a good choice to help manage symptoms.
Hormone replacement therapy (HRT)
Hormone therapy (HT) is a broad term for any type of treatment involving hormones. Hormone replacement therapy (HRT) means you are replacing the hormones your body no longer makes.10
The 2 main types of HRT are estrogen therapy and combination therapy. Estrogen therapy may come in a pill, topical patch, gel or spray, or vaginal ring, cream or tablets. Combination therapy has estrogen and progesterone.
Potential benefits of HRT may include:10
- Less vaginal dryness
- Fewer hot flashes and night sweats
- Better sleep
- Improved mood
- Irregular bleeding11
- Lower risk for developing osteoporosis or breaking a bone
- Lower risk of colon cancer
- Lower risk of diabetes
HRT may not be right for everyone. Possible increased health risks of HRT include:10
- Uterine cancer (if you have your uterus and aren’t taking combination therapy)
- Heart disease (if using HRT 10 years after menopause starts)
- Blood clots and stroke
- Gallbladder disease
- Breast cancer (with long-term use in some people)
Nonhormonal menopause symptom remedies
Some people may want to manage menopause symptoms without hormones. These options may help ease certain symptoms, but it’s important to talk with your health care provider about what may be right for you.
Herbal supplements
Many herbal supplements are marketed for ease of menopausal symptoms. Black cohosh and red clover are herbs marketed for menopause symptoms. Research continues on these and other alternative remedies.12
The U.S. Food and Drug Administration (FDA) does not manage supplements. Also, many supplements can cause problems with medicines. Talk to your health care provider before taking any supplement.
Medication
Several types of antidepressants can be used to treat hot flashes. Gabapentin and clonidine may also help reduce hot flashes and improve sleep. Selective estrogen receptor modulators (SERMs) target tissues that respond to estrogen. They may help with hot flashes and painful intercourse caused by vaginal dryness.3
Vaginal moisturizers and lubricants
Over-the-counter vaginal moisturizers and lubricants can help with dryness and painful intercourse. You may use vaginal moisturizers every 2–3 days, if needed. Lubricants should be applied when you engage in intercourse.
Frequently asked questions about menopause
Menopause is the point in time when you haven’t had a period for one year. The time leading up to this is perimenopause. The symptoms of perimenopause may start up to 10 years before your period ends. The average length of symptoms is 7 years. Most women say their symptoms stop after menopause.6
Early menopause happens before age 45. The symptoms of early menopause are mostly the same as other menopause symptoms.5
Gaining weight during menopause is common. As your estrogen levels decline, your metabolism may slow. Poor sleep, another symptom of perimenopause, can also add to weight gain.13
Accepting and embracing your changing body may help your mental health. It’s important not to push your body too hard with extreme diets. If you want to start eating better, you can try the Mediterranean diet. It focuses on lean proteins, whole grains and plant-based foods.14
Exercise may also help maintain a healthy weight. Getting different types of exercise each week may be helpful. This may include:
- Cardiovascular exercise (jogging, biking or swimming) for heart health
- Strength training with weights to prevent muscle loss
- Yoga or Pilates for flexibility, metabolism and strength
Talk with your doctor before significantly increasing your activity level. This is especially important if you have an underlying medical condition. Ask about the amounts and types of activities that may be best for you.
HRT may support weight management by balancing hormones. This can lead to improved metabolism. It may also help redistribute weight gain around the belly. Having weight around this area may make you more likely to have heart problems. HRT may provide ease from hot flashes, night sweats and poor sleep. Without these symptoms, it may be easier to exercise and eat well.15
Tips for life after menopause (postmenopause)
Changing hormones may cause health problems. For example, low estrogen can cause a loss in bone density, which may lead to osteoporosis. Research shows that up to 20% of bone loss can happen during perimenopause and postmenopause.16 Lower estrogen levels can also raise cholesterol levels and raise your risk for heart disease and stroke.17 To care for your health, focus on:18
How do I find a provider to help with menopause?
If you’re a member with UnitedHealthcare health insurance, use our provider search. This tool can help you find an OB/GYN or other health care provider who has special training in providing care for women. They can provide guidance on how to live with your symptoms. Be sure to come ready with a list of your symptoms and questions.