Menopause 101: understanding menopause

Written on February 1, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• About menopause
• The 3 stages of menopause
• Signs and symptoms of menopause
• Management and treatment of menopause
• Women’s health with at-home lab tests and telehealth
• Related content

About menopause

Menopause occurs in women between the ages of 40 and 55 and is essentially the end of the menstrual cycle for women [1-5]. The average age of menopause in the United States is 51 years old. Menopause is caused by your body’s natural reduction of the hormones estrogen and progesterone as part of aging in women [1]. You can be diagnosed by a healthcare provider when you are without a menstrual period for 12 consecutive months [1-5]. Different tests are available to help evaluate and determine if you are approaching menopause by measuring estrogen and progesterone levels in your body. Menopause does not happen at once and is a gradual process [2].

The 3 stages of menopause

The process of menopause is a transition to the ending of menstruation in women. Menopause is a gradual process and occurs in three stages [5,6]:

• Perimenopause: Perimenopause is also known as menopause transition and can occur about 8 to 10 years before menopause with a gradual reduction in estrogen production. This phase typically begins in your 40s. Perimenopause continues until your ovaries stop releasing eggs. Even though you experience menopause symptoms during this stage, you still have menstrual cycles and can still get pregnant.
• Menopause: Having no more menstrual periods is when you are in menopause. During this stage, your ovaries barely produce estrogen and have stopped releasing eggs. You officially have menopause when you are without a menstrual period for 12 consecutive months.
• Postmenopause: During this stage, you have already gone through 12 months uninterrupted without a period. Some menopausal symptoms may improve; however, you may also experience symptoms for years after menopause. In postmenopause, you may be at higher risk for health conditions like osteoporosis or heart disease due to the low estrogen levels.

Signs and symptoms of menopause

The signs and symptoms of menopause are mainly caused by hormonal changes that can affect your physical, emotional, and social well-being [3]. Symptoms throughout menopause can vary from person to person; some may have few, while others can experience severe symptoms that significantly affect their daily activities and quality of life [3,5,6].

During perimenopause, or the years leading up to a menopause diagnosis, you may experience signs and symptoms that include [4-6]:

• Irregular periods
• Vaginal issues and dryness
• Hot flashes
• Chills
• Night sweats
• Sleep disturbances
• Mood changes
• Weight gain and slowed metabolism
• Thinning hair and dry skin
• Loss of breast fullness

Hot flashes are a frequent symptom of menopause [1,6]. It is described as a brief sensation of heat and may occur with a red and warm flushed face, neck, and chest, sweating, and a feeling of chills after the heat. How often, intense, or long hot flashes are present is different for everyone [1,6].

As you get closer to menopause, you may experience painful sex, urinary issues, memory problems, and an increased risk of depression and anxiety [7].

After menopause or postmenopause, you will no longer get a period or be able to get pregnant [1,2]. You may experience some symptom relief, like a decrease in hot flashes, but it can also continue. A study found that hot flashes can continue for 14 years after menopause [8,9].

Management and treatment of menopause

Depending on the severity of your symptoms, you may not need any treatment for your menopause [6,7]. It’s essential to discuss treatment options with your healthcare provider if menopause symptoms are disrupting your life. You and your healthcare provider can consider different choices for management involving hormone therapies or nonhormonal treatment options.

Hormone therapies

Hormone therapy is currently the most effective Food and Drug Administration-approved medicine to relieve hot flashes, night sweats, or vaginal dryness [1,6]. It can also reduce the risk of osteoporosis and colon cancer [1]. The two main hormone therapies are [1,6,7]:

• Estrogen therapy (ET): ET requires you to take estrogen alone and is available in different forms: patch, pill, cream, vaginal ring, gel, or spay. If you still have your uterus, this is not a good option for treatment.
• Estrogen progesterone/progestin hormone therapy (EPT): EPT is a combination therapy of estrogen and progesterone. Progesterone is available in its natural state and, as a synthetic form, progestin. EPT may be recommended if you still have your uterus.

Hormone therapies are not without risks. Your healthcare provider will evaluate your risks and benefits before starting hormone therapy [1,6,7]. Risks of hormone therapies include increased risk of endometrial cancer in women who still have a uterus, gallstones and gall bladder issues, blood clots, deep vein thrombosis, pulmonary embolism, and stroke [6].

Nonhormonal treatment options

Nonhormonal treatment is an option if hormone therapies are not ideal for you; it includes changing your diet, avoiding triggers to hot flashes, exercising, joining support groups, and using prescription medications [6]. Eating more beans, fruits, and vegetables, watching your weight, and remaining physically active are great management strategies for menopause [1,6,7].

Types of prescription medications for menopause include birth control pills and antidepressants to help manage symptoms such as mood swings and hot flashes [6]. Vaginal creams are an option for dryness. Speak with your healthcare provider to discuss your signs and symptoms, and they can help recommend other nonhormonal treatment options to manage your menopause symptoms.

Women’s health with at-home lab tests and telehealth

If you are wondering about symptoms and menstrual changes that indicate if menopause may be near, or if you are feeling different after menopause, at-home lab tests that measure your hormone levels are available, such as a perimenopause test and a postmenopause test.

Virtual care visits for online women's health support are another option if you're experiencing symptoms of menopause. You can book an appointment with a licensed, board-certified healthcare provider who can evaluate your hot flashes, night sweats, or other menopausal symptoms and offer guidance on the next steps, which may include prescriptions, test recommendations, or lifestyle changes.

Related content

6 possible signs of menopause

How long does menopause last?

Sex after menopause: keeping the heat after the hot flashes

References

1. What is menopause? how do hormones help with menopause? American Society for Reproductive Medicine. URL. Accessed January 30, 2023.
2. Menopause basics. Office on Women’s Health. https://www.womenshealth.gov/menopause/menopause-basics. Accessed January 30, 2023.
3. Menopause. World Health Organization. URL. Accessed January 30, 2023.
4. Menopause. Mayo Clinic. URL. Published December 17, 2022. Accessed January 30, 2023.
5. Menopause. Office on Women’s Health. URL. Accessed January 30, 2023.
6. Menopause: What it is, age, stages, signs & side effects. Cleveland Clinic. URL. Accessed January 30, 2023.
7. Menopause symptoms and relief. Office on Women’s Health. URL. Accessed January 30, 2023.
8. Tepper PG, Brooks MM, Randolph JF Jr, et al. Characterizing the trajectories of vasomotor symptoms across the menopausal transition. Menopause. 2016;23(10):1067-74. doi: 10.1097/GME.0000000000000676. URL.
9. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-9. doi: 10.1001/jamainternmed.2014.8063. URL.