What to expect during menopause
Menopause usually starts between the ages of 40 and 58 years in developed countries, where the average age is 51 years. For some, it will occur earlier due to a medical condition or treatment, such as the removal of the ovaries.
Around the time of menopause, many females experience physical symptoms such as hot flashes, night sweats, vaginal dryness, and a reduced sex drive. It can also lead to anxiety, changes in mood, and a reduced sex drive.
These symptoms may start before menstruation ends, and they can last for several years. The impact on a person's quality of life can range from mild to severe. However, there are ways of managing these symptoms.
Each person will experience menopause differently. Many have full, active lives throughout the transition and afterward, and some feel relieved by no longer having to deal with menstruation or birth control.
Maintaining a healthful diet and getting regular exercise can help a person feel better and boost their overall health in the long term. For those who experience menopause symptoms, treatments and support are available.
In this article, find out more about what to expect during menopause.
What is menopause?
A person will experience menopause when their menstrual cycle finishes.
Menopause is the stage of life that follows the end of the menstrual cycles. Each person may experience menopause differently.
It can last for several years, and there are three stages:
Perimenopause is the transitional time that starts before menopause and includes the 12 months that follow a person's last period.
Menopause starts either 12 months after the last period or when menstruation has stopped for a clinical reason, such as the removal of the ovaries.
Postmenopause refers to the years after menopause, although it can be difficult to know when menopause finished and postmenopause starts.
How long do menopause symptoms last? Find out here.
Signs and symptoms
The changes involved in perimenopause and menopause include:
As a female approaches the end of the reproductive stage, but before menopause begins, estrogen levels start to fall. This reduces the chances of becoming pregnant.
The first sign that menopause is approaching is usually periods occurring less regularly. They may come more or less frequently than usual, and they may be heavier or lighter.
Anyone who has concerns about menstrual changes should see a doctor, as these changes can also indicate pregnancy or some health issues.
Vaginal dryness and discomfort
Vaginal dryness, itching, and discomfort may start during perimenopause and continue into menopause. A person with any of these symptoms may experience chafing and discomfort during vaginal sex. Also, if the skin breaks, this can increase the risk of infection.
Various moisturizers, lubricants, and medications can relieve vaginal dryness and associated issues.
Learn more about atrophic vaginitis here.
Hot flashes are common around the time of menopause. They cause a person to feel a sudden sensation of heat in the upper body. The sensation may start in the face, neck, or chest and progress upward or downward.
A hot flash can also cause:
- red patches to form on the skin
Some people experience night sweats and cold flashes, or chills, in addition to or instead of hot flashes.
Hot flashes usually occur in the first year after menstruation ends, but they can continue for up to 14 years after menopause.
What does a hot flash feel like? Find out here.
Sleep problems can arise during menopause, and they may stem from:
- night sweats
- an increased need to urinate
Getting plenty of exercise and avoiding heavy meals before bedtime can help with managing these issues, but if they persist, contact a healthcare provider.
Click here for some tips on how to get better sleep.
Depression, anxiety, and low mood are common during menopause. It is not unusual to experience times of irritability and crying spells.
Hormonal changes and sleep disturbances can contribute to these issues. Also, a person's feelings about menopause may come into play. For example, distress about low libido or the end of fertility can contribute to depression during menopause.
While feelings of sadness, irritability, and tiredness are common during menopause, they do not necessarily indicate depression. However, anyone who experiences a low mood for 2 weeks or longer should see a doctor, who will be able to advise about the best course of action.
Anyone who has concerns about sleep or any changes related to menopause should contact a healthcare provider.
An article published in 2018 suggests that there may, in some cases, be a link between menopause and suicide. Anyone who is thinking about suicide should seek help from a counselor or health professional. There are also anonymous hotlines available.
- If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Call 911 or the local emergency number.
- Stay with the person until professional help arrives.
- Remove any weapons, medications, or other potentially harmful objects.
- Listen to the person without judgment.
- If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.
Trouble focusing and learning
In the lead-up to menopause two-thirds of women may have difficulty with concentration and memory.
Keeping physically and mentally active, following a healthful diet, and maintaining an active social life can help with these issues. For example, some people benefit from finding a new hobby or joining a club or a local activity.
Various physical changes can develop around the time of menopause.
People may experience:
- a buildup of fat around the abdomen
- weight gain
- changes in hair color, texture, and volume
- breast reduction and tenderness
- urinary incontinence
Increased risk of some health conditions
After menopause, the risk of certain health issues appears to increase. Menopause does not cause these conditions, but the hormonal changes involved may play some role.
Osteoporosis: This is a long-term condition in which bone strength and density decrease. A doctor may recommend taking vitamin D supplements and eating more calcium-rich foods to maintain bone strength.
Cardiovascular disease: The American Heart Association (AHA) note that, while a decline in estrogen due to menopause may increase the risk of cardiovascular disease, taking hormone therapy will not reduce this risk.
Skin changes can also occur around the time of menopause. Find out more.
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LGBTQIA+ and menopause
Most information about menopause describes the experiences of cisgender, heterosexual women. However, menopause can affect anyone who is born with ovaries.
A person who transitions to male but who retains their ovaries may experience menopause when their ovaries stop producing eggs.
If a person starts taking supplementary testosterone as part of their transition, they may experience menopause symptoms then. Also, menopause symptoms can develop when a person undergoes surgery to remove their ovaries.
When transitioning involves any of these experiences, the symptoms of menopause will be the same as those of cisgender women.
However, transgender people can face additional difficulties, depending on the attitude of their medical team. It is essential that transgender people have access to healthcare providers who understand their needs and can address them effectively.
Menopause is not a health problem but a natural transition. However, it can involve unwanted physical and mental changes.
Anyone who has concerns about these changes should seek medical advice. A doctor may recommend one or more of the following:
Hormone therapy comes in various forms, including skin patches and topical creams. It can help reduce the occurrence of hot flashes and other menopause symptoms.
However, using it may increase the risk of developing certain diseases and health conditions.
A person should not use hormone therapy if they have risk factors for the following health problems, or if they have a personal or family history of these issues:
- heart disease
- blood clots
- high levels of triglycerides in the blood
- gallbladder disease
- liver disease
- breast cancer
It is important to discuss the possible benefits and risks of hormone therapy with a doctor before deciding to use it.
A person may find that the following can also help relieve symptoms:
- over-the-counter gels and other products for vaginal dryness
- prescription pills, creams, and rings for vaginal dryness
- low-dose hormonal birth control pills for hot flashes, vaginal dryness, and mood changes
- low-dose antidepressants for hot flashes, even among people who do not have depression
Tips for managing the challenges of menopause include:
- getting regular exercise
- practicing relaxation and deep breathing exercises
- having a healthful diet that includes plenty of fresh fruits, vegetables, and whole grains
- quitting smoking and avoiding secondhand smoke
- limiting the intake of alcohol
- seeking counseling for anxiety, mood changes, and relationship concerns
- establishing good sleeping habits and getting plenty of rest
- doing Kegel exercises to strengthen the pelvic floor
- talking to friends and family about the experience of menopause
- exploring new ways of enjoying intimacy with a partner
- joining a club, volunteering, or taking up a new hobby
Keeping an active sex life
Menopause can reduce a person's sex drive and lead to vaginal dryness, but it also removes the need for birth control. For some, this can make sex more enjoyable.
Having sex often can increase vaginal blood flow and help keep the tissues healthy.
Some tips for maintaining sexual health and activity during menopause include:
- staying physically active
- avoiding tobacco products, recreational drugs, and alcohol
- taking the time to become aroused, which will improve lubrication
- doing Kegel exercises to strengthen the pelvic floor
- not using any strong soaps around the vagina, as these can worsen irritation
Also, menopause symptoms lead some people to find satisfying forms of sex that do not involve the vagina as much or at all.
It is worth remembering that, while a woman cannot become pregnant once menopause starts, it is still important to use barrier protection during penetrative sex to protect against sexually transmitted infections.
Often, sexual partners will be getting older — and may be experiencing menopause — at the same time. They, too, may be feeling a drop in sex drive. Opening up about any concerns can help both partners feel better and explore new forms of intimacy.
Menopause is a stage in life, not an illness. Most women experience natural menopause during midlife. However, surgery and other factors can cause menopause to start earlier.
A female's reproductive years last from puberty to menopause — from one natural transition to another.
Toward menopause, the levels of the hormones estrogen and progesterone in the body fall because they are no longer necessary to support reproduction. These changes trigger menopause.
Surgery and treatment
If a person undergoes surgery to remove their ovaries, they will experience menopause. If this happens before middle age, doctors may refer to it as "early menopause."
A doctor may recommend hormone therapy to reduce some symptoms, but as always, it is important to discuss the risks as well as the potential benefits of this treatment.
Some treatments, such as chemotherapy and radiotherapy, can cause the ovaries to stop working either temporarily or permanently. The likelihood of this happening depends on the person's age and the type and location of the treatment.
A person who experiences menopause because of a clinical treatment will experience the same symptoms as a person who experiences natural menopause. However, the symptoms may appear more abruptly, because the physical change is more sudden.
A person may also experience sadness or depression about an early loss of fertility. Some people decide to freeze eggs or pursue other options for having children later in life before undergoing this type of treatment. Counseling is often available.
It is also important to discuss related health effects with a doctor, as people who experience menopause early may have a higher risk of developing heart disease and osteoporosis.
Some people experience menopause earlier than others for reasons other than medical interventions.
Doctors consider menopause to be "premature" if it develops before the age of 40 and "early" if it starts between the ages of 40 and 45. Early menopause naturally occurs in around 5% of females.
Sometimes, menopause develops early if a person has:
- a genetic condition that affects the chromosomes, such as Turner's syndrome
- an autoimmune disease
- in rare cases, an infection, such as tuberculosis, malaria, or mumps
Anyone who experiences changes in menstrual patterns before the age of 45 should see a doctor.
Menopause is not an illness, but many people benefit from seeing their doctors when menstruation ends.
A doctor can often confirm whether the reason for this change is perimenopause or menopause by asking some questions. They may also test hormone levels and perform other analyses of the blood and urine to rule out health issues. No tests, however, can conclusively indicate that menopause has begun.
People can check their hormone levels at home with testing kits, some of which are available for purchase online.
For many people, menopause is not the only transition that occurs during middle age. Changes in relationships and work or home life — such as children moving away — can also have a significant impact. When more than one of these changes occurs in a short period, it can feel overwhelming.
However, many people live active, healthy lives throughout menopause and for many decades afterward, and midlife can often be the start of a new chapter.
Do males go through a kind of menopause?
Not quite. The natural aging process for people with male reproductive organs involves a gradual decline in testosterone over a lifetime.
For people with ovaries, menopause is a relatively short period of time during which there is a significant drop in the production of estrogen and progesterone. This may result in the undesired symptoms described in this article.Carolyn Kay, M.D. Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.