A Complete Guide on Menopause

Medically Reviewed by Poonam Sachdev on February 06, 2025
Written by Frances Gatta
11 min read

Menopause is the end of your menstrual cycles. The term is sometimes used to describe the changes you go through just before or after your periods stop, marking the end of your reproductive years. You've reached menopause if you don't have periods or spotting for a year. 

If you're female, you were born with all of your eggs, which are stored in your ovaries. Your ovaries also make the hormones estrogen and progesterone, which control your period (menstruation) and the release of eggs (ovulation). Menopause happens when your ovaries no longer release an egg every month and menstruation stops.

Menopause is a regular part of aging when it happens after age 40. But it's possible to go through menopause earlier. It can result from surgery, such as the removal of your ovaries during a hysterectomy, or from damage to your ovaries, such as from chemotherapy. If you go through menopause before age 40, for any reason, it's called premature menopause.

Most people begin their transition into menopause between the ages of 45 and 55, and it takes about four years to be completed. While the exact time menopause starts varies for each person, the average person in the U.S. reaches menopause around age 52. 

Early menopause is menopause that happens before age 45. Doctors call it premature menopause if you're younger than 40. 

Regardless of when you reach menopause, early symptoms include:

  • Irregular periods and changes in your period flow
  • Mood swings
  • Low sex drive
  • Sleep problems
  • Weight gain 
  • Hot flashes
  • Night sweats 

Other early signs include:

  • Sore breasts
  • Needing to pee more often
  • Dry skin, eyes, or mouth

However, these symptoms could also be caused by other health conditions, such as heart disease, thyroid problems, or autoimmune diseases. See your doctor if you have any of these early signs of menopause. They can find out if they're due to another health condition.

Signs of menopause include:

  • Fatigue
  • Depression
  • Crankiness
  • Headaches
  • Joint and muscle aches and pains
  • Weight gain
  • Hair loss
  • Changes in libido (sex drive)
  • Loss of bladder control or urinary problems
  • Problems sleeping
  • Memory problems
  • Depression and anxiety

Menopause hot flashes

Hot flashes are the most common symptom of menopause, occurring in three out of four people. You might start having these symptoms before menopause.

With hot flashes, you may feel heat in your upper body that comes on suddenly. Your face and neck may redden, and you might see red marks on your arms and neck. You may start sweating heavily. Some people get cold chills or flashes instead of hot flashes.

You'll likely start having hot flashes about a year before menopause, and it may stop a year after.

No one knows exactly what causes hot flashes. Research points to declining estrogen hormone levels, which affect your hypothalamus, your body’s thermostat. In menopause, your hypothalamus starts working differently, cooling your body down even when unnecessary.

Menopause mood swings

Many people experiencing menopause have mood swings, even during the early stages. However, scientists aren't clear about why mood swings happen. Some suggest they're due to declining estrogen and progesterone levels, hormones that regulate your menstrual cycle. When these hormones drop, it could lead to a drop in serotonin levels. Serotonin is a chemical messenger that affects your mood.

Mood swings during menopause may also be due to stress, exhaustion from rising family and job responsibilities as you get older, or related to your other menopausal symptoms.

See your doctor or mental health therapist if you have mood swings, or symptoms of depression and anxiety, such as feeling sad, hopeless, or restless.

Menopause weight gain

Weight gain during menopause can happen for various reasons.

During menopause, declining estrogen and progesterone levels may slow your body's metabolism, the rate at which your body uses food for energy. As your metabolism slows, you might gain weight faster than before, particularly around your stomach.

As you age, you may lose muscle mass and gain more fat, leading to extra weight gain.

Menopause can also affect your sleep and your energy level. When you don't get enough sleep, you're less physically active and eat more calories than your body needs, likely resulting in weight gain.

Natural menopause isn't caused by any type of medical or surgical treatment. It's slow and has three stages:

Perimenopause. This phase usually begins several years before menopause, when your ovaries slowly make less estrogen. Perimenopause lasts until menopause, the point at which your ovaries stop releasing eggs. In the last one to two years of this stage, estrogen levels fall faster and you'll likely have menopause symptoms.

Menopause. This is when it's been a year since you had a period. Your ovaries have stopped releasing eggs and making most of your estrogen.

Postmenopause. These are the years after menopause. Symptoms such as hot flashes and night sweats usually ease. But health risks related to the loss of estrogen increase.

Your genes, some immune system disorders, or medical procedures can cause premature menopause. Other causes include:

Premature ovarian failure (or primary ovarian insufficiency). When your ovaries prematurely stop releasing eggs for unknown reasons, your levels of estrogen and progesterone change. When this happens before you're 40, it's called premature ovarian failure. Unlike premature menopause, premature ovarian failure isn't always permanent.

Induced menopause. This happens when your doctor takes out your ovaries for medical reasons, such as uterine cancer or endometriosis. It can also happen when radiation or chemotherapy damages your ovaries.

Can your diet cause early menopause?

No specific diet is linked to early menopause, said Jane Limmer, MD, who is an obstetrician and gynecologist at Virginia Commonwealth University Health. However, your diet may affect the timing of your menopause.

A lack of essential nutrients such as Vitamin D, calcium, and omega-3- fatty acids may negatively impact your hormonal balance and reproductive health, according to Susan Treiser, MD, a reproductive endocrinologist. Not having enough protein, especially with strict vegetarian or vegan diets, can affect how your body produces hormones, which can affect the timing of menopause.

Eating disorders can also play a role in early menopause. 

"The extreme physical stress, hormone changes, and nutritional deficiencies caused by anorexia (an eating disorder that causes you not to eat enough calories) can significantly impact menstrual health and disrupt hormonal balance, potentially leading to early menopause or other reproductive issues,” Treiser said.

Here are some things you might think influence menopause age, but they don't.

Hormonal birth control. Even if you're using a birth control method that stops ovulation, it doesn't stop your loss of follicles -- the constant process of your ovary taking them from your resting pool of eggs. All of your follicles available that month die away, even if you're not ovulating, so experts don't think birth control delays menopause.

Ethnicity. A study of premenopausal and early perimenopausal women found that race and ethnicity play no role in the timing of menopause. The Study of Women's Health Across the Nation (SWAN) looked at women of different races from seven states. It found that they experienced menopause around the same age.

The length of menopause varies from person to person. In general, symptoms of perimenopause last about four years.

What signals the end of menopause?

Your doctor considers you postmenopausal if you've gone 12 months without a period. They may also do blood tests that check for hormones and help them know for sure you're postmenopausal.

"Women are most likely to have vasomotor symptoms (night sweats and hot flashes) in early postmenopause, and genital and urinary symptoms related to vaginal atrophy (thinning, dryness, and discomfort in the vaginal walls) in late postmenopause," Limmer said.

You might suspect you're going into menopause, or your doctor will know based on your symptoms.

You can keep track of your periods and chart them as they become uneven. The pattern will be another clue to your doctor that you're perimenopausal or nearing menopause.

Your doctor might also test your blood for levels of:

  • Follicle-stimulating hormone (FSH). This usually goes up as you near menopause.
  • Estradiol. This tells your doctor how much estrogen your ovaries are making. This level will go down in menopause.
  • Thyroid hormones. This shows problems with your thyroid gland, which can affect your period and cause symptoms that look like menopause.

Menopause is a natural process. Many symptoms go away over time. But if they’re causing problems, treatments can help you feel better. 

Common treatments include:

Hormone replacement therapy (HRT). This is also called menopausal hormone therapy. You take medications to replace hormones your body isn't making anymore. Certain drugs or combinations can help with hot flashes and vaginal symptoms, and make your bones stronger. But they can also put you at higher risk of health problems such as heart disease or breast cancer. So, take the lowest dose that works for the shortest time possible.

Topical hormone therapy. This is an estrogen cream, insert, or gel you put in your vagina to help with dryness.

Nonhormone medications. The depression drug paroxetine (Brisdelle, Paxil) is FDA-approved to treat hot flashes. The nerve drug gabapentin (Gralise, Neuraptine, Neurontin) and the blood pressure drug clonidine (Catapres, Kapvay) might also ease them. Medicines called selective estrogen receptor modulators (SERMs) help your body use its estrogen to treat hot flashes and vaginal dryness.

Medications for osteoporosis. You might take prescribed medicines or vitamin D supplements to help keep your bones strong.

Lifestyle tips for managing menopause

Some lifestyle changes can help you deal with menopause symptoms. Try these:

  • If you're having a vasomotor symptom, such as hot flashes, drink cold water, sit or sleep near a fan, and dress in layers.
  • Use an over-the-counter vaginal moisturizer or lubricant for dryness.
  • Exercise regularly to sleep better and prevent conditions such as heart disease, diabetes, and osteoporosis.
  • Strengthen your pelvic floor muscles with Kegel exercises to prevent bladder leaks.
  • Stay socially and mentally active to prevent memory problems.
  • Don't smoke. Tobacco might cause early menopause and increase hot flashes.
  • Limit how much alcohol you drink to lower your chance of getting breast cancer and help you sleep better.
  • Eat a variety of foods and keep a healthy weight to help with hot flashes.
  • Practice things such as yoga, deep breathing, or massage to help you relax.

Other lifestyle habits, such as cooling techniques, dietary changes, breathing practices, and dietary supplements, haven't been shown to decrease hot flashes. 

Menopause diet 

What you eat might affect when you enter menopause, research suggests.

After tracking more than 35,000 British women for four years, researchers found that menopause tends to start earlier for those whose diets are heavy in refined carbs. In contrast, it seems to begin later for those who eat a lot of fish and legumes.

"In particular, a higher consumption of oily fish was found to delay the timing of natural menopause by approximately three years, and fresh legumes -- such as peas and green beans -- were linked to a later menopause by around a year," said study author Yashvee Dunneram.

"On the other hand, a higher consumption of refined carbohydrates -- such as pasta and rice -- hastened the onset of menopause by 1.5 years," said Dunneram.

"Refined carbs are one of the main culprits for insulin resistance. A high level of circulating insulin could interfere with sex hormone activity and boost estrogen levels, both of which might increase the number of menstrual cycles and deplete egg supply faster, thus causing an earlier menopause."

Researchers also found that vegetarians experienced menopause about a year earlier than meat eaters. Some vegetarian meals that are high in fiber and low in animal fat have been linked to low estrogen levels.

But meat eaters who ate higher daily amounts of savory foods -- such as potato chips, pretzels, and peanuts -- experienced menopause about two years earlier than meat eaters who didn't.

More research is needed to further understand the diet-menopause connection.

Some studies suggest soy products relieve hot flashes, but researchers are still looking into it. There aren't many large studies on whether other supplements such as black cohosh or "bioidentical" hormones work for menopause symptoms. Talk to your doctor before starting any herbal or dietary supplements.

Yoga, tai chi, and acupuncture are usually safe ways to manage menopause symptoms. Check with your doctor before starting these.

The loss of estrogen linked with menopause is tied to other health problems that become more common as you age.

After menopause, you're more likely to have:

It can be tough to manage the sexual changes that come along with menopause, such as vaginal dryness and a loss of sex drive. You might find you don't enjoy sex as much and have trouble reaching orgasm. As long as it isn't painful, regular sexual activity may help keep your vagina healthy by promoting blood flow.

Your ovaries have stopped sending out eggs once you're in menopause, so you can't get pregnant. But you can still get a sexually transmitted disease. Use safe sex practices, especially if you're not in a relationship with one person.

  • Menopause happens when you don't have a menstrual period for 12 months, not caused by other health conditions. 

  • Menopause can cause symptoms like hot flashes, night sweats, mood swings, and a low sex drive. 

  • See a doctor if you have menopause symptoms, and they can confirm if you're in the early stages, already having it, or have another health condition. 

  • Your doctor may suggest treatment for your menopause, such as hormone therapy. Leaving menopause untreated may make your symptoms feel worse and raise your risk for heart disease and other health problems.

Is bleeding after menopause always cancer?

Bleeding after menopause can sometimes be a cancer symptom. But it may be harmless, or due to other health conditions such as vaginal dryness and thinning, polyps (noncancerous growths in your uterus), and inflammation of your cervix.

What causes menopause to happen later than usual?

No one knows what can cause menopause to happen later than expected. Some research suggests that light physical activity and eating more calories, including fruits and protein, may delay it.

How do you keep your joints and ligaments healthy with menopause?

You can keep your joints and ligaments healthy with menopause by exercising at least 30 minutes most days, and eating foods rich in vitamin D and calcium. Those foods include eggs, fatty fish like salmon and sardines, chicken breast, milk, and mushrooms. You can ask your doctor if supplements are right for you.

How much protein do postmenopausal women need?

Research suggests postmenopausal women need at least 0.8 grams of protein per kilogram of body weight, each day. Divide your protein intake into all of your daily meals.