What Is Menopause? | National Institute on Aging

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Larissa is experiencing the menopausal transition, a normal part of aging for women. Menopause is not a disease or disorder. This time in a woman’s life is often full of other transitions in addition to physical ones: Women may be caring for aging parents or relatives, supporting their children as they move into adulthood, or taking on new responsibilities at work.

Some women don’t have any trouble with menopausal symptoms and may even feel relieved when they no longer need to worry about painful periods or getting pregnant. For other women, the menopausal transition can bring hot flashes, trouble sleeping, pain during sex, moodiness and irritability, depression, or a combination of these symptoms. Some may decide to talk with their doctor about lifestyle changes or medications to treat their symptoms.

Understanding the menopausal transition

Menopause is a point in time 12 months after a woman’s last period. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause.

The menopausal transition most often begins between ages 45 and 55. It usually lasts about seven years but can be as long as 14 years. The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity. During perimenopause, the body’s production of estrogen and progesterone, two hormones made by the ovaries, varies greatly.

The menopausal transition affects each woman uniquely and in various ways. The body begins to use energy differently, fat cells change, and women may gain weight more easily. You may experience changes in your bone or heart health, your body shape and composition, or your physical function.

Is it menopause?

If you are having symptoms that are common during menopause, your doctor may ask questions about your age, symptoms, and family history to determine if it really is the menopausal transition causing your problems. In some cases, your doctor may suggest a blood test to check your follicle-stimulating hormone (FSH) and estradiol (E2) levels to rule out any other causes for the changes you’re experiencing.

Read and share this infographic about staying healthy during and after menopause.

While the menopausal transition may commonly be referred to as “menopause,” true menopause doesn’t happen until one year after a woman’s final menstrual period. For that reason, a woman who does not want to get pregnant should continue to use birth control for at least a full 12 months after her last period.

Menopause can also be triggered by a hysterectomy or surgical removal of the ovaries, which produce hormones. If you have surgery to remove your uterus or ovaries and are not taking hormones, you will experience symptoms of menopause immediately.

After menopause, women enter postmenopause. Postmenopausal women are more vulnerable to heart disease and osteoporosis. During this time, it is important to continue to eat a healthy diet, be active, and make sure you get enough calcium for optimal bone health.

What are the signs and symptoms of menopause?

Estrogen is used by many parts of a woman’s body. As levels of estrogen decrease, you could have various symptoms. Many women experience mild symptoms that can be treated by lifestyle changes such as avoiding caffeine or carrying a portable fan. Some women don’t require any treatment at all, but for others, symptoms can be more severe. The severity of symptoms varies greatly around the world and by race and ethnicity.

Here are the most common changes you might notice at midlife. Some may be part of aging rather than directly related to menopause.

Change in your period. This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed more or less than usual. These are all normal changes, but to make sure there isn’t a problem, see your doctor if:

• Your periods happen very close together.
• You have heavy bleeding.
• You have spotting.
• Your periods last more than a week.
• Your periods resume after no bleeding for more than a year.

Hot flashes. Many women have hot flashes, which can last for many years after menopause. They may be related to changing estrogen levels. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck may become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Hot flashes can be very mild or strong enough to wake you up (called night sweats). Most hot flashes last between 30 seconds and 10 minutes. They can happen several times an hour, a few times a day, or just once or twice a week. Find information on managing hot flashes in Hot Flashes: What Can I Do?

Bladder control. A loss of bladder control is called incontinence. You may have a sudden urge to urinate, or urine may leak during exercise, sneezing, or laughing. The first step in treating incontinence is to see a doctor. Bladder infections also can occur in midlife.

Sleep. Around midlife, some women start having trouble getting a good night’s sleep. Maybe you can’t fall asleep easily, or you wake too early. Night sweats might wake you up. And if you wake up during the night, you might have trouble falling back to sleep. Learn how to improve your sleep during the menopausal transition and beyond in Sleep Problems and Menopause: What Can I Do?

Vaginal health and sexuality. After menopause, the vagina may become drier, which can make sexual intercourse uncomfortable. Read about options for addressing vaginal pain during sex in Sex and Menopause: Treatment for Symptoms. You may also find that your feelings about sex are changing. You could be less interested, or you could feel freer and sexier because after one full year without a period, you can no longer become pregnant. However, you could still be at risk for sexually transmitted diseases (STDs), such as gonorrhea or HIV/AIDS. Your risk for an STD increases if you have sex with more than one person or with someone who has sex with others. If so, make sure your partner uses a condom each time you have sex.

Mood changes. You might feel moodier or more irritable around the time of menopause. Scientists don’t know why this happens. It’s possible that stress, family changes such as growing children or aging parents, a history of depression, or feeling tired could be causing these mood changes. Talk with your primary care provider or a mental health professional about what you’re experiencing. There are treatments available to help.

Your body seems different. Your waist could get larger. You could lose muscle and gain fat. Your skin could become thinner. You might have memory problems, and your joints and muscles could feel stiff and achy. Researchers are exploring such changes and how they relate to hormones and growing older.

In addition, for some women, symptoms may include aches and pains, headaches, and heart palpitations. Follow up with a doctor. Because menopausal symptoms may be caused by changing hormone levels, it is unpredictable how often women will experience symptoms and how severe they will be.

• My Menoplan Tool

  My Menoplan is an evidence-based online resource developed by NIA-funded researchers to help people learn about the symptoms and treatments of menopause and create a personalized plan. Learn more on the My Menoplan website.

Treating menopause symptoms: What’s right for me?

Deciding whether and how to treat the symptoms of menopausal transition can be complicated and personal. Discuss your symptoms, family and medical history, and preferences with your doctor. No matter what you decide, see your doctor every year to talk about your treatment plan and discuss any changes you want to make.

Learn about options to help you manage hot flashes, sleep problems, and sex problems during the menopausal transition.

For more information on menopause

Office on Women’s Health                                             
Department of Health and Human Services
800-994-9662
www. womenshealth.gov

American College of Obstetricians and Gynecologists
800-673-8444 
[email protected]
www.acog.org

North American Menopause Society
440-442-7550
[email protected]
www.menopause.org

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
September 30, 2021

Predicting the Age at Which You’ll Reach Menopause, Length of Transition

“Is this normal?” has to be one of the most common questions posed to doctors about a host of health-related signs and symptoms, from the crackling sound your knees make when you take the stairs to the number of times your sleep is interrupted each night.

And it’s often the question women pose to their ob-gyn when they begin to notice changes in their monthly period or have their first hot flash. When it comes to the menopause transition, what’s the normal age, and more importantly, why does it matter?

The average age of menopause is 51, and it does matter, in part because the timing of menopause can be predictive of other health issues, according to Stephanie S. Faubion, MD, the director of the Office of Women’s Health at the Mayo Clinic in Jacksonville, Florida, and the medical director of the North American Menopause Society (NAMS).

Are You Headed Toward Early Menopause?

“There are many negative health consequences linked to early menopause, including a higher risk of osteoporosis and fracture, heart disease, cognitive impairment and dementia, and early death,” says Dr. Faubion.

If you have questions about when you’ll experience menopause and if you can do anything to change it, keep reading for answers.

1. At What Age Do Most Women Reach Menopause?

The medical definition of menopause is no menstrual bleeding for a year, according to Lauren Streicher, MD, a clinical professor of obstetrics and gynecology and the medical director of the Northwestern Center for Menopause and the Northwestern Center for Sexual Medicine in Chicago.

Most women experience menopause between age 40 and 58, and the average age at menopause is 51, according to the North American Menopause Society.

Many women are surprised when they go through menopause in their forties because they think they’re too young, but it’s not unusual, says Dr. Streicher.

2. What Age Is Considered Early for Menopause?

If you reach menopause before age 40, that is considered premature menopause, says Faubion. “This occurs in about 1 to 2 percent of women,” she says.

“Experiencing menopause at 40 to 45 years of age is called early menopause, and that occurs in about 5 to 7 percent of the population, so it’s safe to say that at least 7 percent of women are going to go through menopause early or prematurely,” says Faubion. Menopause at age 46 or older is considered normal, she says.

3. How Long Will Menopausal Transition Symptoms Last?

Menopause is technically one full year without bleeding, and perimenopause is the stage before the final menstrual period, also known as the menopausal transition. Puberty and perimenopause are similar in that they both involve hormonal changes, and the transitions can take place over several years. Some medical organizations, such as the American Osteopathic Association, refer to perimenopause as “reverse puberty” in women.

According to NAMS, this phase can last four to eight years, and it comes with symptoms caused by hormone fluctuations, such as mood swings, poor sleep, and hot flashes.

The age at which a woman begins perimenopause can help predict how long the transition to menopause will last, according to research published in the journal Menopause in February 2017. The authors found that perimenopause lasted longer in women who started the transition at a younger age, and the women had more symptoms, such as hot flashes.

4. Does the Age My Mother Reached Menopause Mean Anything?

Most likely your mom’s age at menopause will provide a clue. “When we look at the things that are the greatest determinants for when someone is going to go through menopause, genetics seems to be one of the most important things,” says Streicher.

A woman’s race or ethnicity can influence when she goes through menopause, too, she says. Findings from the Study of Women’s Health Across the Nation (SWAN) indicate that women of color tend to begin perimenopause and menopause at earlier ages than white women.

“The question I always ask women when they ask when they’re going to go through menopause is, ‘When did your mom go through menopause?’ because that is very often predictive,” says Streicher.

“There’s a lot of truth in that. You may follow what happened with your mother; if she went through menopause early or late, you may, too,” she says.

Certain medical conditions, such as autoimmune problems, thyroid issues, and lupus, can make a woman go through menopause earlier, Streicher adds.

5. Could Alcohol Consumption or Cigarette Smoking Influence When Menopause Occurs?

Although it can be difficult for scientists to tease out specific factors that impact when a woman goes through natural menopause, there is a growing body of research in this area.

One such study, published online in April 2021 in Menopause, the journal of NAMS, looked at several aspects of women’s health and lifestyle, while also controlling for different variables in an attempt to zero in on what could be influencing the timing of the transition.

“They found that there are factors that do seem predictive of when a woman will approach menopause, such as higher estradiol and follicle-stimulating hormone (FSH) levels, which we’ve known for a while,” says Streicher. “Irregular menstrual bleeding and hot flashes were also indicators of earlier menopause,” she adds.

One new finding concerned alcohol consumption. Participants approaching menopause reported higher consumption of alcohol, leading researchers to wonder if an uptick in drinking was a clue that the change was coming.

That makes sense, says Streicher. “This can be a time of added stress for women, and we know that any stressful situation can cause someone to drink more,” she says.

Although this study didn’t find a strong association with smoking, other research has indicated that smoking is related to early onset of menopause, says Streicher.

6. Does Menstrual Cycle Length or Menopause Symptoms Influence the Timing of Menopause?

Women with shorter menstrual cycles, defined as less than 25 days, are more likely to reach menopause early than women with normal-length cycles (26 to 34 days), according to a study of 634 women published in Menopause on August 23, 2022.

Researchers also found that the women with short menstrual cycles had a higher frequency of total menopause symptoms, and were more likely to have certain menopause symptoms, including midlife sleep problems, heart discomfort, and depressive symptoms.

More research is needed to confirm these findings, especially studies that separately evaluate women with a usual cycle length of fewer than 21 days, according to the authors.

7. Does Having More Children Delay Menopause?

Because pregnancy puts menstruation and ovulation on “pause,” it’s been theorized that a high number of pregnancies may delay menopause, but the findings of a Norwegian study published in Human Reproduction in February 2020 belie that assumption.

After analyzing data on close to 300,000 women, investigators found that women with three childbirths had the highest average age at menopause, at 51.36 years old, and that women who had never given birth had the lowest, at an average of 50.55 years of age.

But women who had had more than three childbirths didn’t go through the menopause transition later, which is what would be expected if pregnancies truly delay menopause, according to the researchers. The authors concluded that the results “question the assumption that interrupted ovulation during pregnancy delays menopause.”

8. Is There a Link Between Trauma and the Timing of the Menopause Transition?

In a study published in March 2022 in Menopause, researchers found that a mother’s own childhood physical abuse and her child’s own sexual abuse both were associated with an earlier age of menopause: mothers who were physically abused in childhood and had a child who experienced regular sexual abuse reached menopause 8. 78 years earlier than mothers without a history of personal abuse or abuse of their child.

The authors attribute this association to “allostatic load,” which refers to how stress experienced over one’s life course can accumulate and eventually exceed a person’s coping resources, says the lead author, Holly Foster, PhD, a professor of sociology at Texas A&M University in Brazos County, Texas.

It’s thought that this chronic stress buildup can impact the release of certain hormones and potentially suppress the immune system. “Over time this can lead to accrued wear and tear on one’s body, known metaphorically as the ‘weathering hypothesis.’ This finding is illustrative of how violence, both to oneself, but also to one’s children, contributes to maternal allostatic load, accelerating their reproductive aging,” says Dr. Foster.

This study is important because it investigates the cumulative impact of intergenerational violence on reproductive aging, says Faubion. “That intergenerational violence accelerates reproductive aging should come as no surprise. The key question is how to interrupt this devastating cycle of violence,” she says. Addressing the issue will require multiple sectors, including social change, policy and education, adds Faubion.

9. What Else Affects When a Woman Will Finally Stop Having Menstrual Periods?

Researchers continue to explore a number of factors that may influence the timing of menopause.

The level of education a woman has completed is one thing that seems to correlate with menopause timing, says Faubion. “Women who have more education tend to go through menopause later,” she says.

A study published in January 2020 in JAMA Network Open found that pregnancy and breastfeeding may reduce the risk of early menopause.

The frequency with which a woman has sex has also been correlated with early menopause. A study published January 15, 2020, in Royal Society Open Science found that frequent sexual activity was associated with a higher age of natural menopause.

10. I Got My First Period Early. Does That Mean I’ll Go Through Menopause Early?

“I have many patients tell me, ‘I know I’m going to go through menopause earlier because I started my period really early,’” says Streicher. “The reason women think that is because they think menopause occurs when you run out of eggs. This isn’t going to happen; we’re born with millions of eggs and many of those are never used. When you go through menopause is really about the aging of eggs and what causes them to age more quickly,” she says.

The average age of menarche (the onset of menstruation) in the United States has gotten younger for a variety of reasons, but that hasn’t made women go through menopause earlier, she says.

11. Are Women Who Aren’t Experiencing Menopausal Symptoms Still Fertile?

“No matter when you experience natural menopause, your chances of getting pregnant after the age of 40 are low,” says Faubion. But you can still become pregnant as you’re transitioning to menopause, and you still need to use birth control if you don’t want to conceive, she says.

Streicher confirms this, saying, “Fertility and menopause are not the same thing; there are plenty of women who are pumping out estrogen and menstruating and are not fertile.” If you’re sexually active, it’s important to consult with your doctor before making any decisions about birth control to avoid unwanted pregnancy.

On the other hand, don’t assume that just because you are still menstruating you can get pregnant. Women who are concerned that they may have trouble conceiving or think they may experience menopause early and still want children should discuss options such as egg freezing with their doctor, says Streicher.

12. Will Being Super Healthy Delay Menopause?

Although maintaining good overall health is important for a variety of reasons, it won’t necessarily translate to later menopause, says Streicher. “I have women who tell me, ‘I have a healthy diet, I’m thin, I work out all the time, and I look young. I’m sure I’m not going to go through menopause early, and when I do, I won’t have hot flashes and other symptoms. ’ I wish I could say that was true, but it’s not,” she says.

Body weight might matter, though. “We do know that the extremes of weight, in someone who is very obese or someone with very low body weight, may impact the onset of menopause, but for the majority of women in the middle it doesn’t seem to have a big impact,” says Streicher.

13. Predicting Natural Menopause: Why Does Age Matter?

If there’s not a lot that women can do to change when they’ll experience menopause, why does predicting it even matter?

It would be helpful for every woman to know exactly when menopause will arrive. Beyond recognizing and addressing issues such as increased cardiovascular disease risk and risks related to bone health, if a woman knows her age of menopause and how long the perimenopause transition will last, it could help her make important health decisions, says Faubion.

“If you’re bleeding like crazy it would be helpful to know,” she says.

As of now, research hasn’t uncovered a way to determine when a woman will go into menopause, but that information could be useful in making decisions such as whether to have a hysterectomy or other invasive procedures, says Faubion. “If menopause is going to be a few months or a year from now, you may choose to wait it out; if it’s going to be five years from now, you might want to go ahead and have an invasive procedure,” she says.

The ability to predict when menopause will occur could also help with managing menopause symptoms or deciding which type of birth control to use, adds Faubion.

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Fomin Clinic — a network of multidisciplinary clinics

During menopause, serious changes occur in the body, about which women usually know very little. In this article, we will debunk the most popular myths, and at the same time explain what menopause is, what to expect from it, and whether it is necessary to endure the unpleasant symptoms associated with it.

Age of onset of sexual activity does not affect the rate of menopause. The timing of menopause is determined by genetics. You will most likely go through menopause around the same age as your mother.

To date, scientists know of only one external, heredity-independent factor that can bring menopause closer in otherwise healthy people – this is smoking. On average, smokers stop menstruating 2 years earlier than non-smokers.

This is not true. The menopause is a smooth physiological restructuring associated with a decrease in the level of sex hormones until the complete disappearance of menstruation. Changes in the hormonal background begin at about 40-50 years old, can last up to 8-10 years and take place in three stages.

Perimenopause . Normally, it begins at the age of 40-45 years and can last from 4 years to several months. At this time, a woman produces less and less female sex hormones – estrogens. At this time, menstruation becomes irregular, sometimes their character changes – the discharge becomes either unusually plentiful, or, conversely, scarce.

In the last year or two of perimenopause, the fall in estrogen levels accelerates. Approximately 40% of women experience menopausal symptoms for the first time at this time – due to biochemical and hormonal changes, they may become more irritable, experience hot flashes (an unexpected feeling of hotness and sweating), sleep disturbances, or even fall into depression.

Menopause . At this time, menstruation stops. However, it is possible to assert that this is menopause, and not a cycle failure, only after a woman has lived without menstruation for a whole year. At this time, menopause symptoms appear in 60-80% of women.

Postmenopausal . Comes after a year of menopause. At this time, for many women, menopausal symptoms subside. Unfortunately, at this stage, health problems associated with a lack of estrogens, such as osteoporosis, can appear.

With age, the level of sex hormones decreases in both women and men, so the term “male menopause” has the right to exist. At the same time, age-related hormonal changes in women occur differently than in men.

In women during the last period of perimenopause, the level of estrogen drops quite sharply in just 1-2 years, so that this leads to a complete cessation of menstruation, that is, menopause. Although this is a natural physiological process, due to the gradual “turning off” of the usual hormonal background, women often experience unpleasant symptoms.

In men, testosterone levels begin to decline gradually from the age of 30. After this age, testosterone levels drop by about 1-2% each year. A sharp decrease in the level of sex hormones in men does not occur, so the “male menopause” most often goes without noticeable physical symptoms.

However, there are exceptions to every rule. In about 2.1% of men, the age-related decrease in the level of sex hormones leads to changes resembling the female menopause. True, “male menopause” is not usually considered a natural part of aging. According to British doctors, the age-related decline in testosterone levels is a disease that must be treated with hormone therapy.

Not really. Although the ability to have children decreases in perimenopause, the chance still remains. In order to definitely not get pregnant, you need to use contraceptives until a “guaranteed” menopause occurs, that is, at least a year must have passed since the last menstruation.

However, condoms should not be completely abandoned even after menopause. Although it is no longer possible to become pregnant, there is still a risk of getting a sexually transmitted disease through unprotected sex with a new/non-regular partner.

Indeed, there is evidence that estrogen improves learning and memory in healthy women. But it is not a fact that the lack of estrogen is to blame for the forgetfulness of older women. Memory problems may be associated with age-related changes in the cardiovascular system. Because of this, the blood supply to the brain worsens in older people of both sexes.

As for hysteria, some menopausal women sometimes experience mood swings, may become more irritable and experience unreasonable anxiety. But sudden mood swings depend not only on hormones, so you can’t write them off solely on menopause.

The only menopausal symptom unequivocally associated with a decrease in the synthesis of sex hormones is hot flashes, which are experienced by 80% of women of different cultures. Fortunately, hot flashes that are too strong and too frequent can be managed with menopausal hormone therapy or non-hormonal treatment, which can be prescribed by your gynecologist.

Tooth decay is not associated with menopause but with the normal aging process. Unfortunately, the lack of estrogen leads to other problems, such as hair loss and dry skin, and in some people, menopause provokes muscle and joint pain. If you are faced with such manifestations, it is not necessary to endure them – you need to contact a gynecologist who will select the appropriate treatment for you.

43% of menopausal women lose interest in sex. But despite their age, more than half of women continue to do it! Another thing is that due to the lack of estrogen, sex may not be as pleasant as before.

According to a large American study, 39% of menopausal women complained of a lack of lubrication, 34% noted an inability to climax, 23% experienced no pleasure from sex, and 17% experienced pain during sex.

Fortunately, these problems can be overcome. To regain interest in sex, you can try to have it more often and do Kegel exercises to strengthen the muscles of the pelvic floor – this will help increase blood flow to the vagina and strengthen the muscles involved in orgasm.

Lack of lubrication can be compensated with lubricants, and interest in sex is often restored in women who start taking menopausal hormone therapy.

True, it must be taken into account that menopausal hormone therapy is not indicated for everyone. For example, there is evidence that hormone therapy harms rather than helps women over 60 years of age. Before starting treatment, you must always consult with your doctor.

The benefits of proper menopausal hormone therapy (MHT) far outweigh the risks. MHT relieves the discomfort of hot flashes, helps avoid osteoporosis-related fractures, and generally improves quality of life.

When hormone therapy was first introduced to relieve menopausal symptoms, there was evidence that it increased the risk of breast cancer and coronary heart disease.

However, subsequent studies have shown that if MHT is started immediately after the onset of menopause, it, on the contrary, reduces the risk of death from coronary heart disease and other causes, and also relieves menopausal symptoms and reduces the risk of fractures due to osteoporosis.

However, MHT is not suitable for everyone: for example, it is not suitable for women with severe liver disease, venous thrombosis, and breast cancer. However, this does not mean that women who have contraindications to MHT are doomed to endure the symptoms of menopause. In addition to hormone therapy, the doctor can also choose non-hormonal treatments that can significantly improve the quality of life.

The benefits of plant estrogens have not been proven: it is still unknown whether phytoestrogens can “cancel” hot flashes and improve well-being. But they are quite capable of harm: some doctors believe that due to their similarity with estrogens, plant hormones can be dangerous for women suffering from breast cancer.

• Menopause is not a disease, but a natural stage in a woman’s life. It is impossible to write off all health and mood problems only on menopause.
• Not all menopausal women experience unpleasant symptoms. But if there are symptoms, it is not necessary to endure them: hot flashes, mood swings and other “companions” of menopause can and should be treated.
• Do not self-medicate with menopause. In order for the treatment to help, it must be selected individually, and this should be done by a doctor.

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[ii] United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Aging 2019: Highlights (ST/ESA/SER.A/430). https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf

[iii] UNAIDS. The Gap Report 2014: People aged 50 years and older. Geneva, Switzerland. (2014). UNAIDS. https://www.unaids.org/sites/default/files/media_asset/12_Peopleaged50yearsandolder.pdf

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Basic Facts

• Menopause is one of the stages in a woman’s life cycle that marks the end of reproductive age. After menopause, a woman cannot become pregnant except in rare cases when special fertility treatments are used.
• Most women go through menopause between the ages of 45 and 55 as a natural part of biological aging.
• Menopause occurs as a result of the decline in ovarian follicular function and a decrease in circulating estrogen levels.
• The menopausal transition can be gradual. It usually starts with changes in the menstrual cycle. “Perimenopause” means the period that begins with the onset of the first signs and ends one year after the last menstrual period.
• Perimenopause can last for several years, affecting physical, emotional, mental and social well-being.
• Symptoms of perimenopause can be alleviated with various non-hormonal and hormonal agents .
• Menopause may result from surgical or medical procedures.
  

How does menopause proceed?

For most women, menopause is associated with the cessation of monthly periods (also known as “periods”) due to the decline of ovarian follicular function. This means that the ovaries stop releasing eggs for fertilization.

The regularity and length of the menstrual cycle varies throughout a woman’s reproductive life, but the age of natural menopause for women worldwide is typically between 45 and 55 years of age.

Natural menopause is considered to occur after the absence of menses for 12 consecutive months without any other obvious physiological or pathological causes and in the absence of clinical intervention.

Some women experience menopause earlier (before age 40). This “premature menopause” may be due to certain chromosomal abnormalities, autoimmune disorders, or other unknown causes.

It is impossible to predict when a woman will go through menopause, although there are associations between the age of menopause and several demographic, medical and genetic factors.

Menopause may also occur as a result of surgery to remove both ovaries or medical interventions that suppress ovarian function (eg, radiation therapy or chemotherapy).

Many women stop menstruating before menopause, such as those who have had certain surgeries (hysterectomy or surgical removal of the lining of the uterus) and those who are taking certain hormonal
contraceptives and other medicines that lead to infrequent or no periods. However, they may experience other changes associated with the menopausal transition.

Changes associated with menopause

Hormonal changes associated with menopause can affect physical, emotional, mental and social well-being. The symptoms experienced during and after the menopausal transition vary significantly from woman to woman. Some have symptoms
practically absent. Others may experience severe symptoms that can affect daily activities and quality of life. Some may experience symptoms for several years.

Symptoms associated with menopause include the following:

• hot flashes and night sweats. Hot flashes are a sudden sensation of heat in the face, neck, and chest, often accompanied by reddening of the skin, sweating (sweating), rapid heartbeat, and an acute sense of physical discomfort.
  which may last several minutes;
• changes in the regularity and course of the menstrual cycle, ending in the cessation of menstruation;
• vaginal dryness, pain during intercourse and urinary incontinence;
• difficulty sleeping/insomnia; and
• mood changes, depression and/or anxiety.

These changes may also affect the composition of body tissues and increase the risk of cardiovascular disease. The advantage of women over men in terms of the risk of developing cardiovascular diseases is gradually decreasing.
not with a significant drop in estrogen levels after menopause. Menopause can also lead to weakening of the pelvic floor structures, which increases the risk of pelvic organ prolapse. Loss of bone density during menopause is significant
a factor contributing to an increase in the incidence of osteoporosis and fractures.

There are a number of non-hormonal and hormonal agents that can help relieve menopausal symptoms. Symptoms that affect health and well-being should be discussed with a healthcare professional to determine available options
their relief, taking into account medical history, values ​​and preferences.

Pregnancy is still possible during perimenopause. To avoid unwanted pregnancy, it is recommended to use contraceptives for 12 consecutive months after the last menstrual period. Pregnancy after menopause without fertility treatment,
involving the use of donor eggs or previously frozen embryos is unlikely.

During perimenopause and after menopause, sexually transmitted infections (STIs), including HIV, can still be contracted through unprotected sex, including oral, anal, and vaginal sex. Thinning of the walls of the vagina after
menopause increases the chance of damage and ruptures, which increases the risk of HIV transmission through vaginal sex.

The importance of understanding menopause

It is very important to consider menopause as one of the life cycle stages. The state of health of a woman entering the perimenopausal period is largely determined by the previous state of health, reproductive history, lifestyle and factors
environment. Perimenopausal and postmenopausal symptoms can be devastating to personal and professional life, and the changes brought about by menopause impact a woman’s health as she ages. Therefore rendering
Perimenopausal health care plays an important role in promoting healthy aging and improving quality of life.

Menopause can be an important transition period, both socially and biologically. Socially, how a woman experiences menopause can be influenced by gender norms, family and sociocultural factors, including how aging
women and the menopausal transition are accepted in her culture.

The global population of postmenopausal women is growing. In 2021, women aged 50 and over made up 26% of all women and girls in the world. This figure has increased from 22% 10 years earlier[i]. In addition, women’s life expectancy is longer
than in men. In 2019d. women aged 60 worldwide could expect to live an average of 21 more years[ii].

Menopause can be an important opportunity to reassess your health, lifestyle, and goals.

Menopause-related public health issues

Perimenopausal women need access to quality health care and communities and systems that can support them. Unfortunately, awareness of and access to menopause services remains serious.
problem in most countries. Often, menopause-related issues are not discussed in families, communities, workplaces, and health care settings.

Women may not know that the symptoms they experience are related to menopause and that there are counseling and treatment options available to help relieve discomfort. Women experiencing menopausal symptoms may feel uncomfortable
or shame that prevents them from drawing attention to their experiences and asking for support.

Health care providers may not be trained to recognize perimenopausal and postmenopausal symptoms and counsel patients about treatment and health options after the menopausal transition. Currently in programs
The training of many medical professionals has given limited attention to the problem of menopause.

In many countries, the sexual well-being of menopausal women is neglected. This means that common gynecological effects of menopause, including vaginal dryness and pain during intercourse, may remain.
without attention. Similarly, older women may not consider themselves at risk of contracting sexually transmitted infections, including HIV[iii], and may not receive safe sex or testing advice from their doctors.

Many governments do not have the health policy and funding to include diagnostic, counseling and treatment services for menopause as part of the routinely provided services. Menopause services are
presents a particular challenge in the presence of other urgent and competing health financing priorities.

WHO activities

WHO believes that social, psychological and physical health support during the menopausal transition and after menopause should be an integral part of health care. WHO aims to improve understanding of menopause through
following events:

• raising awareness of menopause and its impact on women at the individual and community levels, and on the health and socioeconomic development of countries;
• advocacy for the inclusion of diagnostic, treatment and counseling services for menopausal symptoms in the universal health coverage package;
• promoting the inclusion of menopause education and treatment options in pre-service training programs for health workers; and
• promoting a lifelong approach to health and well-being (including sexual health and well-being) by ensuring that women have access to relevant health information and services to promote healthy
  aging and a high quality of life before, during and after menopause.

Notes:

and self-identify as women), transgender men and some individuals who do not identify as either male or female are also going through menopause.

In this fact sheet, “women” are referred to according to available data, which usually does not specify gender identity. There is little data available on the experience of menopause among transsexuals and individuals with
gender identity. Transgender people and individuals with different gender identities have their own age-related health needs that clinicians should consider, including referral to specialized
services.

2) Although menopause is not a disease, in this fact sheet what women experience during perimenopause and postmenopause is
called symptoms because it can cause discomfort that affects quality of life.

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[i] United Nations, Department of Economic and Social Affairs. (2021) World Prospects 2021. https://population.un.org/wpp/Download/Standard/Population/

[ii] United Nations, Department of Economic and Social Affairs, Population Division (2019).