Menopause occurs when a woman stops menstruating, usually around age 52. You’ll know you’ve reached menopause when you haven’t had a period for 12 consecutive months.

That said, menopause doesn’t just suddenly happen. It comes on the heels of perimenopause, the transitional phase leading up to menopause, which can last several years. During those years, the levels of the hormones estrogen, progesterone, and testosterone drop off, which may bring a series of side effects. It’s also possible to induce menopause by removing the ovaries or by administering chemotherapy.

Types of Menopause Transitions

You can enter menopause a few ways, though it’s difficult to predict when this transition will start and how long it may last.

Perimenopause

Perimenopause is different from menopause, but they’re part of the same journey. Perimenopause marks the transitional time leading up to menopause. It typically begins during the forties and may last up to 10 years. During this time, estrogen levels start dropping, which can lead to certain symptoms.

Erratic periods are common in perimenopause, as is spotting between cycles, shorter cycles, lighter or heavier cycles, and even missed cycles. Perimenopause happens in two stages: Early-stage perimenopause is when your menstrual cycle starts to become unpredictable. Over a few months, you may get your period a week or more later than during your usual cycle. Late-stage perimenopause occurs when you start having two months between cycles.

Premature or Early Menopause

Premature menopause is when the onset occurs before age 40, and early menopause happens before age 45. Possible causes include disease, surgery, chemotherapy, and genetics, though the cause isn’t always known. Research suggests that giving birth and breastfeeding exclusively may help prevent early onset.

Signs and Symptoms of Menopause

Each experience with menopause is unique; you may have all of the following symptoms or just a few of them. The intensity of symptoms may be relatively mild or severe enough to affect your quality of life. In many cases, periods first become irregular and possibly heavier or lighter. But for some people, periods can just stop suddenly. If that happens to you, see your doctor to make sure no other issues are at play.

Common symptoms of menopause include the following:

• Hot flashes

• Night sweats

• Weight gain

• Mood changes, including symptoms of depression and anxiety

• Sleep problems

• Hair loss, brittle nails, dry eyes and mouth, and skin issues

• Vaginal dryness or irritation

• Incontinence and bladder problems

• Loss of libido

• Memory issues or brain fog

Causes and Risk Factors That Can Affect the Timing of Menopause

All women go through menopause, but certain factors can influence the timing of onset. When menopause occurs before age 40, it’s considered “premature,” while “early onset” describes menopause before age 45.

The following factors may contribute to determining the timing of menopause:

• Family History and Genetics Research has suggested that genetics play a large role when it comes to the timing of natural menopause.

• Race and Ethnicity Research has also identified differences in natural menopause timing by race and ethnicity, though more studies are needed to better understand this connection.

• Giving Birth and Breastfeeding Women who have given birth and women who spent months exclusively breastfeeding may be less likely to experience early-onset menopause.

• Surgery, Chemotherapy, and Genetics The removal of the ovaries (surgical menopause), ovarian failure due to chemotherapy, and some genetic and endocrine issues will bring on menopause.

• Medical Conditions Women who smoke or have certain medical conditions, such as autoimmune diseases, thyroid disease, and Crohn’s disease, have a higher risk of early menopause.

• Cycle Length Women with menstrual cycles fewer than 25 days are likely to reach menopause earlier.

• Trauma Research suggests that personal trauma and post-traumatic stress disorder may have an impact.

• Weight Extremes Obesity or being underweight can have an impact.

How Is Menopause Diagnosed?

Menopause diagnoses happen in hindsight: Women are able to confirm they’ve reached menopause after not having a period for more than a year (12 consecutive months).

Most women don’t require a formal test or diagnosis to confirm menopause. One potential method of gauging where you are in the process is to check your blood levels of anti-Müllerian hormone. This is the best marker to estimate your ovarian egg count, and research suggests that levels of the hormone decline before menopause. While the test can be helpful to indicate menopause is imminent, it isn’t considered accurate enough to predict precise menopause timing, and more research is needed to determine the test’s role in clinical practice.

Treatment and Medication Options for Menopause Symptoms

Many menopause symptoms are treatable, or at least manageable, through medications, complementary and alternative medicine, or lifestyle changes. Your doctor can tailor treatments specifically for you.

If you want to try any supplements or vitamins, check with your physician first. Certain supplements may interfere with your current medications, and some may have serious side effects.

Medication Options

• antidepressants

• clonidine (Catapres)

• elinzanetant (Lynkuet)

• fezolinetant (Veozah)

• gabapentin (Gralise, Neurontin)

• hormone therapy, including bioidentical hormones and low-dose estradiol vaginal inserts

• ospemifene (Osphena)

Complementary and Integrative Health Therapies

• Acupuncture

• Hypnotherapy

• Yoga

• Meditation

• Vaginal moisturizers and lubricants

• Lifestyle changes, such as layering clothing, quitting smoking, exercising more intensely and regularly, and eating a diet of foods with calcium, vitamin C, and vitamin D to support bone health

Hormone Therapy

There has been a complicated relationship between breast cancer and hormone treatments for menopause.

Early results from the Women’s Health Initiative’s Hormone Therapy Trials suggested that women who took estrogen plus progestin had a slightly higher risk of developing breast cancer. Women who didn’t have a uterus had a slightly lower risk, which may be because their treatment only included estrogen, rather than estrogen plus progestin.More than 10 years and many more comprehensive studies later, the nuances are better understood. For most women, hormone therapy is okay to use to help control moderate to severe symptoms such as hot flashes, as long as treatment is started within 10 years of menopause or before age 60, according to the Menopause Society. The general advice about menopause hormone therapy from the Menopause Society is to use the lowest dose for the shortest amount of time.The U.S. Preventive Services Task Force recommends against using menopause hormone therapy in postmenopausal people to help prevent chronic diseases like heart disease and cancer.

Everyone’s risk profile is unique, so it’s best to discuss the right option for you with your healthcare practitioner.

Disparities and Inequities in Menopause

Every woman’s experience with menopause may look different. One may breeze through it with minimal discomfort; another may experience extreme hot flashes and mood disorders.

Race and ethnicity are also factors. Data from the Study of Women’s Health Across the Nation (SWAN) concludes that race and ethnicity may play a role in the experience of menopause in the United States.Additional research concludes that women of certain ethnicities may be more likely to experience menopause-related gastrointestinal symptoms.

The reasons for the disparities are not fully understood, but current hypotheses hold that chronic stress, lifestyle factors, socioeconomic status, and more — which all may relate to systemic racism — can contribute significantly.

Lifestyle Changes for Weight Management During Menopause

That stubborn belly fat you may experience with the onset of menopause may be due to the drop in hormones, which in turn slows your metabolism. You can work to manage your weight with these tips:

• Exercise regularly. Focus on aerobics for at least 150 minutes a week, and strength train two or more times a week. Mix moderate and intense activities. If you get in an exercise rut or start feeling bored, try different workouts to target other muscle groups, or exercise with friends to keep you on track. Check out our cheat sheet on age-related exercise recommendations.

• Stand more. If doing so is accessible to you, stand instead of sitting. Try using a standing desk when working on a computer.

• Practice portion control. Moderate when eating, and eat three meals a day.

• Choose healthy unsaturated fats. Cut back on restaurant and takeout food, which is often high in unhealthy fats, salt, and sugar. Especially watch your carb intake because your body converts it into sugar.

• Eat according to your circadian rhythm. Have meals during an 8- to 12-hour window, such as from 7 a.m. to 7 p.m. only. Avoid or limit eating late at night.

• Follow good sleep hygiene. Not getting enough sleep wakes up your hunger hormones, among other health impacts., and research has linked weight gain during menopause to disrupted sleep cycles. To get better sleep at night, establish a regular sleep routine.

• Reduce your stress levels. Lowering stress can help you more successfully avoid unhealthy eating.

• Talk with your doctor or nutritionist. They can help you develop a plan that suits you.

Menopause Prognosis

Menopause is not an “if” but a “when.” Every woman goes through menopause, which is an irreversible change. Many women spend one-third of their lives postmenopausal.The average age of menopause onset in the United States is 51 years old, according to Mayo Clinic. And most women will experience their last menstrual period between ages 45 and 58.

In the months and years leading up to menopause (called perimenopause), women are likely to begin experiencing certain symptoms of the transition.

Complications of Menopause

The main feature of perimenopause and menopause is the drop in levels of hormones such as estrogen, and with that, a coinciding drop in estrogen’s many protective effects. As your estrogen levels decline, you may experience other complications:

• Mood Disorders The risk of depression is higher in menopausal women, even those who have never experienced this mood disorder.

• Weight Gain Fat distribution can change during menopause, with more of it developing around your belly. This can increase your risk of type 2 diabetes, hypertension, heart disease, and some cancers.

• Metabolic Syndrome During the menopause transition, you have a higher risk of developing metabolic syndrome, a group of conditions that includes high blood pressure, belly fat, high cholesterol, and high blood sugar. This risk is 27 percent higher for those who naturally undergo menopause earlier (around age 47).

• Sleep Disorders Menopausal women may have problems with falling asleep and not staying asleep once they do. They are also at a higher risk of obstructive sleep apnea than premenopausal women.

• Sexual Dysfunction Some postmenopausal women experience vaginal dryness or pain during sexual intercourse.