When does menopause typically begin. What are the common symptoms of menopause. How can women manage menopausal symptoms. What lifestyle changes can help during menopause. Is hormone therapy safe for menopausal women. How does menopause affect bone and heart health. What are the long-term health considerations after menopause.

The Menopausal Transition: Timing and Duration

Menopause is a natural biological process marking the end of a woman’s reproductive years. But when does this transition typically begin? The menopausal transition, also known as perimenopause, usually starts between ages 45 and 55. However, it’s important to note that this can vary widely among women.

The duration of perimenopause is not set in stone. On average, it lasts about seven years, but it can extend up to 14 years in some cases. Factors influencing the length of this transition include:

• Lifestyle choices (e.g., smoking)
• Age at onset
• Race and ethnicity

During this time, the body’s production of estrogen and progesterone fluctuates significantly, leading to various physical and emotional changes.

Recognizing the Signs: Common Symptoms of Menopause

As estrogen levels decline, women may experience a range of symptoms. The severity and combination of these symptoms can vary greatly from one individual to another. Some common signs of menopause include:

1. Irregular periods
2. Hot flashes and night sweats
3. Mood changes
4. Sleep disturbances
5. Vaginal dryness
6. Changes in libido
7. Weight gain and slowed metabolism

Are these symptoms always indicative of menopause? Not necessarily. If you’re experiencing these changes, it’s advisable to consult with your healthcare provider. They may suggest a blood test to check your follicle-stimulating hormone (FSH) and estradiol (E2) levels to confirm menopause or rule out other potential causes.

Managing Menopausal Symptoms: Effective Strategies

While some women sail through menopause with minimal discomfort, others may find the symptoms challenging. Fortunately, there are various ways to manage these symptoms and improve quality of life during this transition.

Lifestyle Modifications

Simple changes in daily habits can often provide significant relief:

• Maintaining a healthy diet rich in fruits, vegetables, and whole grains
• Regular exercise to boost mood and energy levels
• Stress-reduction techniques like meditation or yoga
• Avoiding triggers for hot flashes (e.g., spicy foods, caffeine, alcohol)
• Keeping the bedroom cool and comfortable for better sleep

Medical Interventions

For more severe symptoms, medical treatments may be necessary. These can include:

• Hormone therapy (estrogen and/or progesterone)
• Non-hormonal medications for specific symptoms
• Vaginal estrogen for localized symptoms

Is hormone therapy safe for all menopausal women? While it can be effective for many, it’s not suitable for everyone. The decision to use hormone therapy should be made in consultation with a healthcare provider, considering individual health history and risk factors.

The Impact of Menopause on Bone and Heart Health

Menopause affects more than just reproductive health. The decline in estrogen levels can have far-reaching effects on a woman’s overall health, particularly concerning bone density and cardiovascular function.

Bone Health

Estrogen plays a crucial role in maintaining bone density. As levels drop during menopause, the risk of osteoporosis increases. How can women protect their bone health during and after menopause?

• Ensuring adequate calcium intake (1200 mg daily for women over 50)
• Getting sufficient vitamin D (600-800 IU daily)
• Engaging in weight-bearing and resistance exercises
• Avoiding smoking and excessive alcohol consumption

Heart Health

The risk of cardiovascular disease increases after menopause. To maintain heart health, women should:

• Monitor and control blood pressure
• Maintain healthy cholesterol levels
• Exercise regularly
• Eat a heart-healthy diet
• Manage stress effectively

Body Changes and Weight Management During Menopause

Many women notice changes in their body composition and weight during menopause. The body’s energy utilization shifts, and fat cells undergo changes, often making weight gain more likely. How can women maintain a healthy weight during this transition?

• Adjusting calorie intake to match changing metabolic needs
• Increasing physical activity, particularly strength training
• Focusing on nutrient-dense foods
• Staying hydrated
• Getting adequate sleep

By adopting these strategies, women can better manage their weight and overall health during menopause.

Sexual Health and Intimacy During Menopause

Menopause can bring changes to a woman’s sexual health and intimate relationships. Decreased estrogen levels may lead to vaginal dryness, discomfort during intercourse, and changes in libido. How can women maintain a healthy and satisfying sex life during and after menopause?

• Using water-based lubricants or moisturizers
• Communicating openly with partners about changes and needs
• Exploring new ways to enhance intimacy
• Considering pelvic floor exercises to improve muscle tone
• Discussing options like localized estrogen therapy with a healthcare provider

Remember, sexual health is an important aspect of overall well-being, and there’s no need to suffer in silence if issues arise.

Long-term Health Considerations After Menopause

As women enter the postmenopausal phase, certain health considerations become increasingly important. What should women focus on to maintain optimal health in the years following menopause?

Regular Health Screenings

Postmenopausal women should prioritize regular health check-ups, including:

• Mammograms for breast cancer screening
• Bone density scans to monitor for osteoporosis
• Colonoscopies for colorectal cancer screening
• Regular blood pressure and cholesterol checks

Mental Health

The hormonal changes of menopause can impact mental health. Women should be aware of potential mood changes and seek support if needed. Strategies for maintaining good mental health include:

• Engaging in regular physical activity
• Practicing mindfulness or meditation
• Maintaining social connections
• Seeking professional help if experiencing persistent mood changes or depression

Cognitive Function

Some women report changes in memory or cognitive function during menopause. While mild changes are normal, significant cognitive decline is not a typical part of menopause. To support brain health, women can:

• Engage in mentally stimulating activities
• Maintain a healthy diet rich in omega-3 fatty acids
• Stay physically active
• Ensure adequate sleep

By focusing on these areas, women can promote overall health and well-being in the postmenopausal years.

Navigating the Emotional Aspects of Menopause

Menopause is not just a physical transition; it can also be an emotional journey. Many women experience mood swings, irritability, or feelings of loss related to the end of their reproductive years. How can women navigate these emotional changes?

• Practicing self-compassion and patience
• Seeking support from friends, family, or support groups
• Exploring new interests or hobbies
• Considering counseling or therapy if emotions become overwhelming

It’s important to remember that these emotional changes are normal and temporary for many women. However, if mood changes persist or interfere with daily life, it’s crucial to seek professional help.

Redefining Identity

Menopause often coincides with other life transitions, such as children leaving home or changes in career. This can be an opportunity for women to redefine their identity and explore new aspects of themselves. Some women find this time liberating, while others may struggle with the changes. How can women embrace this new phase of life?

• Reflecting on personal goals and aspirations
• Engaging in activities that bring joy and fulfillment
• Connecting with other women going through similar experiences
• Celebrating the wisdom and experience gained over the years

By viewing menopause as a new chapter rather than an ending, women can approach this transition with positivity and hope.

Alternative and Complementary Therapies for Menopausal Symptoms

While conventional medical treatments are effective for many women, some may prefer to explore alternative or complementary therapies to manage menopausal symptoms. What options are available in this realm?

Herbal Remedies

Some women find relief from menopausal symptoms through herbal supplements. Common options include:

• Black cohosh
• Red clover
• Evening primrose oil
• Ginseng

Are these herbal remedies safe and effective for all women? It’s important to note that the efficacy of these supplements can vary, and they may interact with other medications. Always consult with a healthcare provider before starting any new supplement regimen.

Acupuncture

Some studies suggest that acupuncture may help alleviate certain menopausal symptoms, particularly hot flashes. While more research is needed, some women report positive results from this traditional Chinese medicine practice.

Mind-Body Practices

Techniques that focus on the mind-body connection can be beneficial for managing stress and improving overall well-being during menopause. These may include:

• Yoga
• Tai chi
• Meditation
• Biofeedback

These practices can help reduce stress, improve sleep quality, and enhance overall quality of life during the menopausal transition.

The Role of Diet in Managing Menopausal Symptoms

Nutrition plays a crucial role in managing menopausal symptoms and promoting overall health during this transition. What dietary changes can help women navigate menopause more comfortably?

Phytoestrogen-Rich Foods

Phytoestrogens are plant compounds that can mimic the effects of estrogen in the body. While research on their effectiveness is mixed, some women find that including phytoestrogen-rich foods in their diet helps alleviate menopausal symptoms. These foods include:

• Soy products (tofu, tempeh, edamame)
• Flaxseeds
• Legumes
• Whole grains

Foods for Bone Health

As the risk of osteoporosis increases after menopause, it’s crucial to focus on foods that support bone health. These include:

• Calcium-rich foods (dairy products, leafy greens, fortified foods)
• Vitamin D sources (fatty fish, egg yolks, fortified foods)
• Magnesium-rich foods (nuts, seeds, whole grains)

Heart-Healthy Choices

To support cardiovascular health, women should emphasize:

• Omega-3 fatty acids (found in fatty fish, walnuts, chia seeds)
• Fiber-rich foods (fruits, vegetables, whole grains)
• Lean proteins
• Healthy fats (olive oil, avocados)

By focusing on a balanced, nutrient-dense diet, women can support their overall health and potentially ease some menopausal symptoms.

Menopause in the Workplace: Challenges and Solutions

Many women experience menopausal symptoms during their working years, which can present unique challenges in the workplace. How can women navigate these challenges, and what role can employers play in supporting menopausal employees?

Common Workplace Challenges

Menopausal symptoms that may impact work performance include:

• Hot flashes and sweating
• Difficulty concentrating
• Fatigue
• Mood changes

Strategies for Women

To manage these symptoms at work, women can:

• Dress in layers to adjust for temperature changes
• Keep a small fan at their workstation
• Take short breaks for relaxation or stretching
• Stay hydrated
• Communicate with supervisors about any necessary accommodations

Employer Support

Employers can create a more supportive environment for menopausal women by:

• Providing flexible work arrangements when possible
• Ensuring adequate ventilation and temperature control
• Offering wellness programs that address menopausal health
• Training managers on menopause awareness
• Creating a culture of open communication about health concerns

By addressing menopause in the workplace, both employees and employers can benefit from improved well-being and productivity.

The Future of Menopause Research and Treatment

As our understanding of menopause continues to evolve, what does the future hold for menopause research and treatment? Several exciting areas of study are emerging:

Personalized Medicine

Researchers are exploring ways to tailor menopause treatments to individual women based on their genetic profiles, symptoms, and risk factors. This could lead to more effective and targeted interventions.

Non-Hormonal Therapies

Scientists are investigating new non-hormonal treatments for menopausal symptoms, which could provide alternatives for women who cannot or prefer not to use hormone therapy.

Brain Health

There is growing interest in understanding the impact of menopause on brain health and cognitive function. This research could lead to new strategies for maintaining cognitive health in postmenopausal women.

Long-Term Health Implications

Ongoing studies are examining the long-term health implications of different menopausal experiences and treatments. This research could help inform preventive strategies for postmenopausal health issues.

As research progresses, women can look forward to more comprehensive and personalized approaches to managing menopause and promoting long-term health.

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

When does menopause start? Signs, stages and what to expect

Menopause is a normal part of aging. As normal as it may be, menopause can feel anything but. Changes to your body and mood may have you flashing back to memories of puberty: Is this normal? What comes next? Do I need to do something?

Your experience with menopause will be unique to you – from when it starts to the types of menopause symptoms you’ll feel as you age. But there are usually some signs to tell you where you‘re at in the process.

Knowing what stage of menopause you’re in can help you know what to expect and how to best manage your symptoms. It can also help you understand what’s normal, and when it’s a good idea to talk with a women’s health specialist.

We’re here to help. Read on to learn about the three stages of menopause, the symptoms you may experience at different ages, and when to seek care for menopause symptoms.

What are the three stages of menopause?

There are three stages of menopause: perimenopause, menopause and post-menopause. In everyday terms, those names can be translated to: when changes begin, when your menstrual cycle stops, and your new normal afterward. Here’s a closer look at what happens during each one.

Perimenopause: The beginning of menopause

Perimenopause – or pre-menopause – is a word that means “around menopause” and it’s when symptoms begin, leading up to menopause. This stage typically starts about 4-8 years before menopause. The age at which perimenopause begins varies – some women notice it in their 40s, but others can experience it as early as their mid-30s.

When you enter perimenopause, you’ll probably start to notice some early menopause symptoms, like changes to your period or mood shifts. These changes happen because your body’s estrogen and progesterone levels are starting to naturally decline. As your ovaries produce lower amounts of these hormones, your body adapts. It’s basically the reverse of what happened to your hormones as a teenager.

Menopause: The end of your menstrual cycle

Menopause refers to a specific point in time when your periods stop. You’re only in the menopause phase for one year, because when you’ve gone 12 consecutive months without a period, you enter post-menopause.

Reaching menopause means that you’re no longer able to bear children (become pregnant). Every woman – except for those who’ve had their ovaries removed before puberty – will go through menopause.

At what age does menopause start?

The average age for menopause is around 51. But some women experience menopause in their 40s – with a small percentage experiencing signs of menopause earlier. Some women may not reach menopause until their 60s.

There’s no way to know your exact menopause age until it happens, but genetics seems to play a strong role. You may get a general idea of when to expect menopause based on when your family members went through it, particularly your mother.

Genetics isn’t the only thing that can impact when menopause starts. Medical factors can also influence menopause timing. For example, if someone’s ovaries are removed, symptoms will begin to show immediately.

Certain medical conditions like autoimmune diseases have also been associated with early menopause. Women who’ve undergone treatments like radiation therapy or chemotherapy are also more likely to show symptoms earlier.

Post-menopause: After menopause

Post-menopause simply means “after menopause”, and you reach this point when it’s been 12 months since your last period. Post-menopause signals the end of your reproductive years, and you’ll be in this stage for the rest of your life. While your ovaries are still making low levels of the hormones estrogen and progesterone, you are no longer ovulating (releasing eggs), so you can’t become pregnant.

You’ll continue to experience menopause symptoms for about 2-7 years after your final menstrual cycle (it can be longer for some people), but after that time, symptoms often get milder or completely go away.

Women in post-menopause are at a higher risk for certain health conditions like heart disease and postmenopausal osteoporosis. You and your primary care doctor can work together on a plan to prevent or manage those conditions.

Menopause symptoms by age

Menopause symptoms evolve over time as your body slowly decreases the levels of reproductive hormones it’s making. Here’s a breakdown of menopause symptoms you may experience by age.

Menopause symptoms at age 40

For the majority of women, menopause symptoms don’t start this early. If menopause happens before age 40, it’s called premature menopause. If it happens between ages 40-45, it’s known as early menopause. Fewer than 10% of women experience premature or early menopause.

But if you’re in your early 40s and are regularly experiencing symptoms such as changes to your period’s timing or flow, hot flashes, mood changes or sleep problems, don’t ignore them. Talk with a women’s health specialist.

A specialist like an OB-GYN or certified nurse-midwife (CNM) can work with you to determine whether your symptoms are related to menopause, or another reason such as hormonal disorders or other health conditions.

Menopause symptoms at age 45

Around the age of 45, many women enter pre-menopause and start to notice the first signs that menopause is coming. For some women, the symptoms are mild and short-lasting. For others, menopause symptoms can be disruptive and long-lasting.

Some of the earliest signs of menopause may include:

Changes to your period

Period changes are usually the first signs of menopause. For example, your period may start to happen every 6-8 weeks. Or you may miss a couple months before it comes back again. You may also have a heavier flow or a lighter flow from time to time.

That said, it’s important to know you can still get pregnant during perimenopause. So, continue to use birth control in the lead up to menopause as you normally would. Also, if you’ve missed your period and you’re not sure whether perimenopause has started, consider taking a pregnancy test as a first step.

Mood changes

As your hormone levels change, you may find yourself feeling more irritable, anxious, sad or forgetful than usual. Your sex drive (libido) can also decrease or increase.

These changes are very typical as your body approaches menopause. So be kind to yourself, practice self-care and ask for help if you’re having trouble.

Sleeping problems (insomnia)

You may find it difficult to fall asleep, or you may wake up in the middle of the
. Sleep trouble can contribute to a persistent feeling of tiredness, which can also affect your mood.

The good news is that sleep issues like insomnia can be treated. Lifestyle changes such as cutting back on caffeine, limiting screen time before bed and exercise can be extremely helpful. There are over-the-counter medications and supplements like melatonin that can help – but ask your doctor for a recommendation before you start taking something. Sleep medicine is an option, too.

Ready to talk menopause? We’re here for you at any age and any stage.

Menopause symptoms at age 50

Most women will have their last period around the age of 50. After 12 months without a period, menopause is complete and post-menopause begins.

As menopause gets closer, your estrogen and progesterone levels start to decline more rapidly. As a result, your symptoms will likely become more intense.

Your periods will probably become more irregular until they finally stop. You may experience greater mood swings and an increase in insomnia. And you’ll likely start experiencing new symptoms that are common right around, or right after, reaching menopause, including:

Hot flashes and chills

Hot flashes are sensations of heat that develop around your face, neck and chest, and may spread to other areas of your body. They usually last for just a few minutes.

Alongside the feeling of heat, your skin may redden, you may sweat, your heart rate might increase, and your mood may change. Afterward, you may feel chills.

Doctors aren’t sure why hot flashes happen, but there are ways to lessen their impact. Some tips include:

• Try to stay in cooler environments
• Dress lightly or wear layers you can remove
• Find effective ways to manage stress
• Monitor your diet (foods that are spicy, processed or fatty can trigger hot flashes)
• Reduce how much caffeine or alcohol you drink

Hot flashes can happen during pre-menopause, but they’re most often reported right around menopause and in the first few years of post-menopause.

Night sweats (hot flashes during the night)

When hot flashes occur at night, they’re called night sweats. Night sweats can prevent you from getting a good night’s sleep and make you more irritable the next day. Sleeping with fewer blankets, in lighter clothing and with a fan can be helpful to stay more comfortable.

Weight gain

Some people find that, even without changing their diet or lifestyle, they begin to gain weight during menopause. This is because the drop in estrogen levels also lowers your ability to maintain muscle mass, which can slow down your metabolism. This means that during and after menopause, you won’t need as many calories to maintain your current weight.

Menopause symptoms at age 55 and above

Around age 55, most women have entered their post-menopausal years. After menopause, your body adjusts to the lower amount of estrogen and progesterone, and many women feel more productive, alert and free – now that they don’t have to worry about birth control or managing a period.

Post-menopausal years do bring some new symptoms with them, however. Some things to expect include:

Dryer or thinner skin and hair

Estrogen plays a role in collagen production. Collagen makes up your skin, hair, bones and many other tissues around your body. Because your estrogen levels are lower after menopause, your skin or hair may become dryer or thinner.

Vaginal dryness or sensitivity

Lower estrogen levels can also cause vaginal tissue to become dryer and thinner. This may result in discomfort or pain during sex.

Vaginal dryness or sensitivity usually happens after menopause, but it isn’t unusual to notice it earlier. A moisturizer or lubricant can often relieve these symptoms and help you feel more comfortable.

Pelvic floor muscle problems

Did you know that estrogen also helps support the sides of your bladder? Less estrogen can lead to weaker pelvic floor muscles. That’s why urinary incontinence and frequent urination can be common after menopause. Your doctor can help you identify the best treatment options to improve your symptoms, including lifestyle changes, pelvic floor therapy or medication.

When should I see a doctor for menopause help?

The way you experience each stage of menopause will be unique. For example, maybe you don’t get hot flashes, but insomnia leaves you feeling tired and irritable. Or perhaps the first sign of change is vaginal dryness.

Menopause symptoms can often be managed by maintaining a healthy diet, exercising regularly and taking advantage of home remedies or over-the-counter medications.

But if your symptoms are intense enough to affect daily activities or keep you from doing the things you love, it may be time to seek advice and care for menopause symptoms.

OB-GYNs and certified nurse-midwives, along with experienced nurse practitioners and other women’s health experts, can listen to your concerns and symptoms, and work with you to create a personalized care plan. Care options might include lifestyle changes, hormone replacement therapy (HRT), and supplements or medications.

Some menopause symptoms might be harder to talk about than others – but don’t wait. Women’s health specialists have heard it all, and they have the expertise needed to help you manage menopause symptoms. The sooner they know what’s bothering you, the sooner they can help you find the right way to manage your symptoms.

Ready to talk menopause? We’re here for you at any age and any stage.

Menopause

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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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Key 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 experience 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 during 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 links 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 undergone certain surgeries (hysterectomy or surgical removal of the lining of the uterus) and those who take 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 sudden sensations of heat in the face, neck, and chest, often accompanied by reddening of the skin, sweating (sweating), rapid heart rate, and intense 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 transitional 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 to 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 be aware that the symptoms they experience are associated with 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 options and health care 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 routine 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, as well as 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). 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

Women’s Health

Sexual and Reproductive Health and Research (English)

Aging

Sexual health

Early menopause. How to recognize and what to do

. We sort out painful issues and look for a solution together with a specialist

Updated March 29, 2023, 16:17

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Menopause is an inevitable event in the life of every woman. On average, it begins in the age range from 45 to 55 years, but there are times when a woman learns from her own experience what an early menopause is, having just celebrated her thirtieth birthday. How do you know if menopause is coming early? And what strategy of behavior in this case to follow? RBC Life found out what are the causes of early menopause, whether it can be delayed and what measures to take so that it does not lead to a decrease in the quality of life.

Physiological Menopause: What You Need to Know

The average age at which most women go through menopause is 51 years. However, this does not change the fact that the transition period with accompanying symptoms can begin much earlier. After all, the age at which the first signs of menopause appear varies significantly from woman to woman. Menopause most often occurs between the ages of 45 and 55. However, some experience this much earlier: before they reach the age of forty, and sometimes even at the tender age of 20-25 years.

Menopause has several stages, and its onset is preceded by a long process.

If we consider in more detail the meaning of the concept of “menopause”, it is worth referring to the Greek origin of this word, which in translation into Russian means “monthly cessation”. Menopause itself is just one point on a timeline that spans the premenopausal and postmenopausal periods.

It is possible to say with confidence that menopause has come only when there are no periods for exactly 12 months.

As defined by the World Health Organization (WHO), the following terms are distinguished:

• menopause is the last spontaneous menstruation, the so-called starting point, which can be discussed if menstruation is absent for more than a year;
• premenopause — the period from the onset of “failures” of the menstrual cycle to the onset of menopause;
• perimenopause – the period of menstrual irregularities preceding the cessation of the cycle and lasting one more year after the last menstruation;
• post-menopause – period after menopause.

When can menopause be considered early

If a woman under 40 has not had a period for at least four months and her hormonal levels have changed significantly, this can be considered as a sign of premature menopause. In this case, ovulation no longer occurs and the level of estrogen hormones begins to decline rapidly. At the same time, the levels of other hormones, such as FSH (a hormone that stimulates the growth of follicles) and LH (luteinizing hormone that stimulates the production of progesterone), are determined above normal.

Early menopause is also referred to as “primary ovarian failure” or “premature ovarian failure” (POF). These terms indicate the stoppage of ovarian function, the absence of growing follicles and therefore the absence of ovulation, making pregnancy impossible.

A doctor can confirm early menopause with a blood test.

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What are the causes of early menopause?

1. Natural early menopause

At birth, every woman has an individual ovarian reserve of 1 million to 2 million eggs. This number decreases throughout life, and by the time of menopause, about 1 thousand eggs remain. If there are not enough of them, the menstrual cycle stops. Early menopause can occur due to the depletion of egg reserves at a young age.

2. Chromosomal abnormalities

In some chromosomal abnormalities, such as Turner syndrome or Fragile X Syndrome, the egg reserve may also be reduced from birth.

3. Genetic features

The cause may also be genetic, and therefore premature menopause may be hereditary. For example, if the mother had an early menopause, then the chances of a similar development of events increase in the daughter. Abnormalities in the structure of the X chromosome can cause the ovaries to stop producing estrogen earlier.

4. Endometriosis

Endometriosis (or an overgrowth of the lining of the uterus) can also be a cause of early menopause.

5. Spatula

This surgery causes immediate and consequently early menopause.

6. Thyroid gland dysfunctions

Sometimes early menopause is associated with autoimmune thyroid disease.

“There are a number of factors that can provoke and hasten the onset of early menopause. First, it’s genetics. If we talk about other risk factors, then menopause can be brought closer by smoking (including past experience), low body weight, excessive exercise and the absence of a sexual partner.

Tatyana Petrovna ZefirovaMenopause expert

What are the symptoms of approaching menopause?

The symptom complex can be quite wide. It is wrong to focus only on the cessation of menstruation. Many of the events associated with menopause occur even before the end of the cycle. As a result, most often women do not associate this with the approaching menopause at all.

The following symptoms should alert you.

• Dryness of mucous membranes – and not only dryness of the vaginal mucosa and associated pain during intimacy. This is also dry mouth, dry eyes.
• Cracking and pain in the joints, especially if there were no such symptoms before, but then suddenly they appeared. All this is due to a decrease in the synthesis of the hormone estrogen, which is involved in the synthesis of collagen, which is so important for the health of the musculoskeletal system.
• Nighttime urge to urinate.
• Urinary incontinence. Initially, it often occurs in everyday situations: a few drops leak during laughter, sneezing, coughing or jumping – that is, with any increase in intra-abdominal pressure.
• Gain in weight and volume of the body. When nutrition did not change significantly, but after 38–40 years, there was a tendency to gain weight.
• An increase in blood pressure that has never bothered me before.
• Decreased sex drive (libido), especially with weight gain.
• Decreased motivation, ease of climbing and the appearance of unusual laziness.

In addition to the symptoms listed above, there are several more common symptoms that make it clear that menopause is fast approaching.

1. Loop failure

Irregular menstruation, which may vary in duration and be more or less heavy than usual. During premenopause, bleeding is normal. However, during perimenopause, women are more likely to have irregular discharges, either lighter or heavier, earlier or later than usual. During this period, women may also experience brownish discharge.

2. Hot flashes and night sweats

About 80% of women suffer from hot flashes and night sweats. Hot flushes are irritating hot flashes that rise from the chest to the face. They are often accompanied by redness, increased heart rate, and excessive sweating. Chills may follow after a severe attack of heat. Hot flashes can occur up to 30 times a day and last for several minutes.

Why is this happening? A certain part of the brain regulates temperature, and the hormone estrogen has a big influence on this. When the level of estrogen in the blood decreases, the work of the thermoregulatory center of the brain is disturbed. As a result, this internal “thermostat” receives an erroneous signal from time to time that the body is “too hot.”

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This means that the body temperature should rise only slightly, for example due to a cup of coffee, stress or emotional events – while the body reacts as if its temperature is too high. The blood vessels in the skin then dilate to bring more blood to the skin. For this reason, you start to sweat: in fact, in this way the body tries to get rid of excess heat.

3. Mood swings

Mood swings are caused by hormonal imbalances. The body begins to produce less and less “hormones of happiness”, such as serotonin and endorphin. This can make a woman restless, irritable, gloomy, provoke depression.

Even if you are under 40, but you observe all these signals and note something not quite typical from the side of health, this is an occasion to pay a visit to the endocrinologist and gynecologist.

How to get rid of the discomfort of early menopause?

This diagnosis can be difficult to accept and psychologically and emotionally difficult to bear. Therefore, it is very important to be able to talk about it – and increase the level of literacy about how to prolong the quality of life if early menopause does occur. After all, there are still many years of life ahead, and it would be a crime to spend these years dissatisfied with oneself, with a feeling of inner trouble and poor health.

In the case of menopause, we are not talking about a cure, because it is not a disease, but a natural process. However, the symptoms associated with it can cause discomfort and take away the zest for life. To reduce their negative impact on the quality of life, you should first contact a specialist. Your doctor will be able to check if you have indeed entered menopause by taking a blood test.

“If there are no unpleasant symptoms, such as hot flashes, sleep disturbance or decreased performance, then it is enough to undergo an annual medical examination. It does not require any special analysis. If a woman older than 40 is at risk of premature menopause, her doctor may be able to suggest the right medications to reduce her symptoms and support her health. For women themselves, the main thing is to pay attention to risk factors and their prevention, as well as to monitor the appearance of characteristic symptoms, in the presence of which you should immediately contact a specialist. ”

Tatyana Petrovna ZefirovaMenopause expert

What strategy to follow to keep the beauty and vitality when menopause came early?

1. Healthy lifestyle

A very important point for all its obviousness. Enough physical activity, quitting smoking, moderate consumption of alcohol, salt and unhealthy fats will serve as a significant help in maintaining youth, activity and strong self-esteem.

2. Vitamin D intake

Decreased estrogen production is associated with a higher risk of osteoporosis. Therefore, women with early menopause are advised to maintain adequate levels of vitamin D, in particular by taking supplements such as Calcium-D3-Nycomed.

3. Hormone replacement therapy

When you are in menopause, your doctor may prescribe medications to relieve your discomfort. As a rule, these are hormonal drugs that mimic the production of estrogen. This is called “hormone replacement therapy” (HRT).

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Medicines containing hormones are purchased only by prescription, as they can only be used after consultation with a specialist. In addition, women who are or have been treated with hormonal or chemotherapy are advised not to use hormones to relieve menopausal symptoms. This is because hormones can interact with the therapy being taken, which can reduce the effectiveness of the treatment.

However, there are also safe alternatives to relieve menopausal symptoms through a non-hormonal mechanism of action, such as natural dietary supplements.

4. Non-hormonal natural supplements

Mabelle is a natural herbal complex to support the health of women during menopause. It is a non-hormonal product based on a combination of flax flavolignans and red clover isoflavones, whose mechanism of action is well understood. These herbal extracts are, in fact, natural phytoestrogens that have a beneficial effect on a woman’s hormonal background and help make the menopause easier and calmer. Together, they help maintain hormonal balance. As a result, the Mabelle complex will help preserve and increase female beauty and vitality, despite all the difficulties of the menopause period.