What Is Menopause?

Each year, about 1.5 million women go through the menopausal transition, a natural biological process that marks the end of the reproductive years. Menopause typically occurs around the age of 51, though the transition leading up to it, known as perimenopause, often begins in the mid-40s. During this phase, the ovaries gradually produce less estrogen, causing menstrual cycles to become irregular and eventually cease.⁽¹⁾

Many women experience symptoms such as hot flashes, sleep disturbances, and mood swings. Hormonal changes that occur during this phase can also impact other aspects of health, including bone density and cardiovascular function.⁽¹⁾ 

This natural transition is not a disease. However, there are various treatment approaches that can help restore hormonal balance and alleviate menopausal symptoms. Embracing menopause with knowledge and awareness can foster a healthier, more empowered experience.

What are the three stages of menopause? 

Menopause occurs in three stages: perimenopause, menopause, and postmenopause. Each stage involves different changes, and while the experience varies for each individual, understanding these stages can help women navigate the process with greater confidence.⁽²⁾

Perimenopause

Perimenopause is the stage leading up to menopause, often beginning in the mid-40s, though it can start earlier or later. Changes in the menstrual cycle are often the first signs of perimenopause. Periods may become less predictable in timing, duration, or flow. Hot flashes and night sweats are also common during this phase.⁽³⁾

The duration of perimenopause can vary widely, lasting anywhere from a few years to nearly a decade. While some women may experience mild or no symptoms, others may face more challenging changes. Research shows that this stage tends to last longer for women with an earlier onset, with some experiencing perimenopause symptoms for up to 10 years.⁽³⁾

Menopause

Menopause is officially defined after 12 consecutive months without a period. This phase usually occurs around the age of 51. Unlike perimenopause, which is characterized by irregular periods, menopause marks the complete cessation of menstrual cycles, signaling the end of the reproductive phase.⁽¹⁾

As estrogen levels decline during menopause, many women continue to experience symptoms like hot flashes, sleep disturbances, and mood swings. While these symptoms often become less intense over time, they may still impact daily life. This stage also highlights the importance of focusing on long-term health, including bone and heart health. 

Postmenopause

Postmenopause begins 12 months after a woman’s final menstrual period and lasts for the rest of her life. While many women find that hot flashes and mood swings diminish, some may continue to experience other symptoms like vaginal dryness or trouble sleeping.⁽⁴⁾

Although some individuals may find relief from certain symptoms during postmenopause, maintaining overall health remains essential. The decline in estrogen can lead to a decrease in bone density, increasing the risk of osteoporosis. Low estrogen levels may also affect heart health. By adopting healthy habits, staying active, and seeking medical support, women can manage these risks and maintain a vibrant, healthy life in postmenopause.

Main Causes and Symptoms of Menopause

As the body prepares for menopause, it undergoes significant hormonal changes that influence various systems. These changes impact reproductive functions and other areas of health. Understanding the main causes of menopause helps explain why certain symptoms arise and why they can vary from person to person.

What causes menopause?

Menopause is a natural biological process marked by hormonal changes in the body. As the body transitions toward menopause, the ovaries gradually produce fewer eggs, causing a decline in key hormones such as estrogen, estradiol, inhibin B, and anti-müllerian hormone (AMH).⁽²⁾ 

AMH plays a crucial role in regulating the development of ovarian follicles. As AMH levels decrease, so does the body’s ability to regulate the menstrual cycle.⁽²⁾

Inhibin B and estrogen help keep the levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) under control by inhibiting their production. Fluctuating levels of inhibin B and estrogen can thus cause an increase in the production of FSH and LH.⁽²⁾ 

All these changes can disrupt the hypothalamic-pituitary-ovarian axis, which regulates the menstrual cycle, causing irregular periods and eventually leading to the cessation of menstruation.⁽²⁾ In perimenopause, many people experience changes in their menstrual cycle. Initially, the follicular phase may shorten, causing periods to occur more frequently. 

Over time, the cycle length may increase, and menstrual cycles may become anovulatory (meaning ovulation does not occur), resulting in abnormal uterine bleeding. Eventually, menstrual periods stop completely. Early in menopause, testosterone levels generally remain stable, which increases the relative ratio of testosterone to estrogen. 

Common Menopausal Symptoms

The changes during menopause can cause symptoms ranging from hot flashes to mood changes. Menopausal symptoms can vary significantly between individuals. Factors like genetics, overall health, and lifestyle choices influence how a person experiences this transition. For some, symptoms are mild and manageable, while others may experience more significant effects. Stress, diet, and sleep patterns can also impact how the body responds, making the menopause experience uniquely personal.

Some common menopausal symptoms include the following:⁽²⁾

• Hot flashes

• Night sweats

• Irregular periods

• Sleep disturbances

• Mood swings

• Vaginal dryness

• Decreased libido

• Memory problems

• Fatigue

• Weight gain

How does someone know they’re in menopause?

Determining if someone is in the menopausal transition can be challenging. Common symptoms such as hot flashes, irregular periods, and sleep disturbances may indicate the transition, but confirmation often requires a detailed evaluation.⁽²⁾ 

Healthcare providers typically consider the individual’s age, symptoms, and family history to assess whether menopause is the likely cause. In certain cases, such as cessation of periods at an unusually early age, blood tests may be conducted to measure hormone levels.

Menopause is confirmed only after 12 consecutive months without a menstrual period. Individuals who do not wish to conceive are advised to continue using contraception until the age of 50.

Taking this free menopause quiz online offers a cost-effective and efficient alternative to blood tests for determining if you're entering menopause. Save time and money by accurately assessing your symptoms, as blood tests may not only be unreliable but often unnecessary.

How to Treat Menopause

Treatment approaches for managing menopausal symptoms are broadly classified as hormonal and non-hormonal. However, there is no one-size-fits-all solution. Other treatment approaches, including counseling and lifestyle modifications, may be required depending on the symptoms.⁽²⁾

Hormonal Treatments for Menopause

Hormone replacement therapy (HRT) is commonly used to manage menopausal symptoms by addressing hormonal imbalances. As menopause causes a decline in estrogen, HRT supplements the body with this essential hormone, significantly alleviating symptoms such as hot flashes, night sweats, and mood swings. For women with an intact uterus, progesterone is included in the therapy to help protect the endometrium and prevent the risk of endometrial hyperplasia, a condition that can occur with estrogen alone.⁽²⁾

There are two main types of HRT: synthetic and bioidentical. Synthetic HRT uses manufactured hormones, while bioidentical HRT uses hormones that are chemically identical to those produced naturally by the body. While both types can be effective, bioidentical HRT is considered a more natural option.⁽²⁾

HRT is available in systemic and local forms:

• Systemic HRT: This type of HRT is used to treat more widespread menopausal symptoms, such as hot flashes, mood swings, and sleep disturbances. It’s available in various forms, including tablets, patches, gels, and creams.
  

• Local HRT: This type of treatment is used to target one area and treat specific symptoms. Vaginal estrogen is an example of localized HRT that is used to treat vaginal dryness and urinary issues. Local estrogen therapy is available as creams, tablets, or vaginal rings to target vaginal health and reduce symptoms like dyspareunia (pain during sex). HRT can also come in the form of skincare for the face to address specific concerns like collagen-loss, skin dryness, and fine lines and wrinkles.

It’s important to start HRT within 10 years of the final menstrual period or before the age of 60 for optimal benefits. The decision to continue HRT should be tailored to the individual's needs based on symptoms and overall health.

Non-Hormonal Treatments for Menopause

Non-hormonal options like selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and gabapentin can be used to treat vasomotor symptoms, such as hot flashes.⁽²⁾

• SSRIs/SNRIs: Antidepressants like paroxetine, escitalopram, and venlafaxine can help alleviate hot flashes. Paroxetine is the only FDA-approved medication specifically for this use, with symptoms often improving within a week of treatment.
  

• Neurokinin B Antagonists: Fezolinetant, an NK3R antagonist, is approved by the FDA for moderate to severe vasomotor symptoms. Studies suggest it may be more effective than SSRIs and SNRIs for managing hot flashes. The most common side effect is headaches.

Understanding the Menopausal Transition

Menopause is a natural phase that brings significant hormonal changes, with each stage — perimenopause, menopause, and postmenopause — presenting its own unique experiences and challenges. While symptoms can vary significantly among individuals, understanding the causes and effects of menopause helps women make informed decisions about managing their health. Whether through hormone therapy, non-hormonal treatments, or lifestyle adjustments, there are various options to ease the transition and maintain well-being. Embracing this phase with knowledge and proactive care can help women navigate menopause with confidence and vitality.