When Does Menopause Start?

Natural menopause doesn’t occur all at once. It’s a gradual process made up of three stages: perimenopause, menopause, and postmenopause.⁽¹⁾ This can understandably lead to confusion about when menopause actually starts.

There’s no universal age at which all women start menopause. Genetic and lifestyle factors are believed to influence whether a woman reaches menopause earlier or later in life.⁽²⁾ However, there’s an average age range at which most women enter the menopause transition. Understanding the factors that can affect menopause onset can help women prepare for the different changes their bodies will undergo during each stage of menopause.

What is menopause?

Menopause is a life event that occurs when a woman has gone 12 months in a row without a menstrual period. At this stage, the ovaries no longer produce eggs, and the body’s production of estrogen and progesterone significantly declines. As a result of these changes, women can no longer conceive once they reach menopause.⁽¹⁾⁽³⁾ 

When does menopause begin?

Between the ages of 45 and 55 is when the menopause transition begins for most women, according to the National Institute on Aging.⁽²⁾ This is also known as perimenopause, or the years before a woman gets their last period. It’s during these transitional years when hormone levels begin to shift, and women start to experience changes in their menstrual cycle along with other common menopausal symptoms.⁽¹⁾

The perimenopause stage lasts until a woman reaches menopause and has gone one year without a menstrual period.⁽¹⁾ Research shows that the average age of menopause is between 50 and 52.⁽⁴⁾ After the final menstrual period, women enter the postmenopause stage, which lasts for the rest of their lives. Postmenopause makes up approximately 40% of a woman’s life.⁽¹⁾

Factors Affecting Menopause Onset

Whether a woman starts menopause at an earlier or later age may be influenced by the following factors:⁽²⁾⁽⁴⁾

• Age at first period

• Age at which a woman’s mother entered menopause

• How many pregnancies a woman has had

• Use of birth control pills

• Gynecological health

• Mental health

• Body mass index (BMI)

• Physical activity levels

• Diet

• Smoking

• Alcohol use

How Gynecological Surgery Affects the Start of Menopause

Certain gynecological surgeries can affect the start of menopause. Women who undergo a hysterectomy (surgical removal of the uterus) may enter menopause at an earlier age. In some cases, a woman may have a hysterectomy along with a bilateral oophorectomy (surgical removal of both ovaries). Removal of the ovaries triggers the start of menopause, known as surgically induced menopause. Women may immediately begin experiencing menopausal symptoms.⁽⁵⁾

How Age at Natural Menopause Affects Women’s Health

Age at natural menopause can impact women’s health in different ways, particularly if it occurs at an earlier age. When a woman experiences menopause before the age of 40, it’s called premature menopause. Roughly 1% to 3% of women fall into this category. Menopause between the ages of 40 and 44 is known as early menopause. Early menopause occurs in about 5% to 10% of women.⁽⁴⁾⁽⁶⁾

Women who reach menopause at an earlier age may be more susceptible to type 2 diabetes, cardiovascular disease, osteoporosis, premature cognitive decline, and depression. They may also have a shorter lifespan. Menopausal symptoms may also be more intense in cases of premature menopause or early menopause.⁽⁴⁾⁽⁶⁾

Women who experience menopause at a later age may live longer and have a lower risk of stroke, cardiovascular disease, osteoporosis, bone fractures, and all-cause mortality. However, later age at natural menopause has been linked to an increased risk of breast cancer and certain gynecological cancers.⁽⁷⁾

Signs That Menopause Is Starting

A woman may be starting menopause if they’re in their 40s or 50s and develops the following symptoms:⁽¹⁾

• Irregular periods (a sign of perimenopause)

• Hot flashes

• Night sweats

• Sleep issues

• Vaginal dryness

• Decreased libido

• Mood shifts

• Weight gain

• Migraines

• Urinary symptoms

Some symptoms may improve as women enter their postmenopausal years and hormones reach a new, stable low. For example, research suggests that menopausal migraines may become less severe during this stage of life. However, other health issues like recurrent urinary tract infections (UTIs) may become more common due to changes in vaginal pH levels caused by a loss of estrogen.⁽¹⁾

Diagnosing Menopause and Perimenopause

There’s no clinical menopause test that can determine whether a woman is in menopause or perimenopause. There are cases in which hormone testing of estradiol and follicle-stimulating hormone (FSH) levels may be used as an indicator of menopause for women with certain health issues or those who have undergone certain gynecological surgeries. However, because the body’s hormone levels are always changing, hormone testing is not recommended as a reliable diagnostic tool for menopause.⁽¹⁾

Age and symptoms are the primary factors a doctor will consider when evaluating menopause status.⁽¹⁾ If you’re experiencing menopausal symptoms, such as hot flashes or vaginal dryness, take Winona's quiz to see where you are in the menopause transition and determine if hormone replacement therapy (HRT) may be right for you.