Menopause is when your periods stop permanently and you can no longer get pregnant. You have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.
Menopause
Menopause is the time when your menstrual periods stop permanently and you can no longer get pregnant. Some people call the time leading up to a woman’s last period menopause. This time actually is the transition to menopause, or perimenopause. After menopause, your body makes much less of the hormones estrogen and progesterone. Very low estrogen levels after menopause can affect your health and cause symptoms such as hot flashes. You can take steps to protect your health and relieve your symptoms.
Top questions about menopause
- What is menopause?
- When does menopause usually happen?
- How will I know I am in perimenopause?
- Can I treat my menopause symptoms at home?
- When should I see my doctor about my menopause symptoms?
- What happens after menopause?
- Do I still need birth control during perimenopause?
- Will I gain weight after menopause?
- How can I protect my heart health after menopause?
- Is menopausal hormone therapy safe?
- What effects will menopause have on my sex life?
Menopause basics
Menopause is when your period stops permanently. Menopause is a normal part of a woman’s life. It is sometimes called “the change of life." Menopause does not happen all at once. As your body transitions to menopause over several years, you may have menopause symptoms and irregular periods. The average age for menopause in the United States is 52.
What is menopause?
Menopause is when your periods stop permanently and you can no longer get pregnant. You have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.
After menopause your ovaries make very low levels of the hormones estrogen and progesterone. These low hormone levels can raise your risk for certain health problems.
What is perimenopause, or the transition to menopause?
Perimenopause (PER-ee-MEN-oh-pawz), or the menopausal transition, is the time leading up to your last period. Perimenopause means “around menopause.”
Perimenopause is a long transition to menopause, or the time when your periods stop permanently and you can no longer get pregnant. As your body transitions to menopause, your hormone levels may change randomly, causing menopause symptoms unexpectedly. During this transition, your ovaries make different amounts of the hormones estrogen (ES-truh-jin) and progesterone (proh-JES-tuh-RONE) than usual.
Irregular periods happen during this time because you may not ovulate every month. Your periods may be longer or shorter than usual. You might skip a few months or have unusually long or short menstrual cycles. Your period may be heavier or lighter than before. Many women also have hot flashes and other menopause symptoms during this transition.
When does the transition to menopause usually start?
Perimenopause, the transition to menopause, usually starts in a woman's mid- to late 40s. On average, women are in perimenopause for four years before their periods stop.
How will I know if I am starting the transition to menopause?
Sometimes it can be hard for you and your doctor to tell whether you are in perimenopause, the transition to menopause:
- Symptoms: Tell your doctor or nurse about any menopause symptoms, such as hot flashes or trouble sleeping.
- Irregular periods: Track your periods. Irregular periods may be your first sign of menopause.
- Hormone levels: Your doctor may test the amount of hormones in your blood if your periods stopped at an early age (before 40). Doctors don’t usually recommend this test unless there is a medical reason to do so. This is because, for most women, hormone levels go up and down in an unpredictable way during the transition to menopause. So it is difficult to tell for sure whether you have gone through menopause or are getting close to it based on this blood test.
How will menopause affect me?
Symptoms of menopause may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time once they begin, or they may happen only once in a while. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome (PMS). Others may be new to you. For example:
- Your menstrual periods may not come as regularly as before. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.
- Your periods might be heavier or lighter than before.
- You might have hot flashes and problems sleeping.
- You might experience mood swings or be irritable.
- You might experience vaginal dryness. Sex may be uncomfortable or painful.
- You may have less interest in sex. It may take longer for you to get aroused.
Other possible changes are not as noticeable. For example, you might begin to lose bone density because you have less estrogen. This can lead to osteoporosis, a condition that causes bones to become weak and break easily. Changing estrogen levels can also raise cholesterol levels and increase your risk for heart disease and stroke.
Talk to your doctor about possible treatment for your menopause symptoms if they bother you.
How long does the transition to menopause last?
Perimenopause, the transition to menopause, can last between two and eight years before your periods stop permanently. For most women, this transition to menopause lasts about four years. You will know you have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.
Should I continue using birth control during the transition to menopause?
Yes. You can still get pregnant during perimenopause, the transition to menopause, even if you miss your period for a month or a few months. During perimenopause you may still ovulate, or release an egg, on some months.
But it is impossible to know for sure when you will ovulate. If you don’t want to get pregnant, you should continue to use birth control until one full year after your last period. Talk to your doctor about your birth control needs. Learn more about different birth control methods.
You can’t get pregnant after menopause, but anyone who has sex can get sexually transmitted infections (STIs, or STDs). If you are not in a monogamous relationship in which you and your partner have sex with each other and no one else, protect yourself by using a male condom or dental dam correctly every time you have vaginal, oral, or anal sex. After menopause you may be more likely to get an STI from sex without a condom. Vaginal dryness or irritation is more common after menopause and can cause small cuts or tears during sex, exposing you to STIs.
When does menopause usually happen?
Menopause happens when you have gone 12 months in a row without a period. The average age of menopause in the United States is 52. The range for women is usually between 45 and 58.2 One way to tell when you might go through menopause is the age your mother went through it.
Menopause may happen earlier if you:
- Never had children. Pregnancy, especially more than one pregnancy, may delay menopause.
- Smoke. Studies show smoking can cause you to start menopause up to two years earlier than women who don’t smoke.
Certain health problems can also cause you to start menopause earlier.
Menopause usually happens on its own. However, you may enter menopause earlier than you normally would if you have had chemotherapy or surgery to remove both ovaries. Learn more about early menopause on our Early or premature menopause page.
What happens after menopause?
After menopause you will no longer be able to get pregnant and you will no longer get a period. If you have any type of vaginal bleeding after menopause, you should see a doctor as soon as possible. Vaginal bleeding after menopause is not normal and can mean that you have a serious health problem.
You may experience any of the following after menopause:
- Low hormone levels. With menopause, your ovaries make very little of the hormones estrogen and progesterone. Because of changing hormone levels, you may develop certain health risks, including osteoporosis, heart disease, and stroke.
- Menopause symptoms instead of period problems. After menopause, most women get relief from period problems or menopause symptoms. However, you may still experience symptoms such as hot flashes because of changing estrogen levels. One recent study found that hot flashes can continue for up to 14 years after menopause.6,7
- Vaginal dryness. Vaginal dryness may be more common post-menopause. Learn more about treatments for vaginal dryness.
Did we answer your question about menopause?
For more information about menopause, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:
Menopause symptoms and relief
During the transition to menopause, changing hormone levels can affect your menstrual cycle and cause symptoms like hot flashes and problems sleeping. As you get closer to menopause, you may notice other symptoms, such as pain during sex, urinary problems, and irregular periods. Talk to your doctor or nurse about your symptoms. Medicines and other treatments can help relieve your symptoms.
Menopause symptom: Hot flashes
Hot flashes, also called hot flushes, are the most common menopause symptom. As many as three out of four women experience hot flashes. Some women begin having hot flashes before menopause, when they are still getting a period.2
Hot flashes are a sudden feeling of heat in the upper part of your body. Your face and neck may become red. Red blotches may appear on your chest, back, and arms. You may also get heavy sweating during hot flashes or cold chills after the hot flashes. Some women get more cold chills (also called cold flashes) than hot flashes.
Hot flashes are most common in women in the year before their period stops and in the year after their period stops. However, recent studies show that hot flashes can continue for up to 14 years after menopause.1,3 Doctors and researchers do not know why hot flashes are so common during menopause. There are medicines that can prevent some hot flashes, and there are ways you can try to manage hot flashes when they do happen.
What you can do
- Consider using hormones. If you still have menstrual periods, ask your doctor about low-dose hormonal birth control. This may help your symptoms. For women who have gone through menopause, menopausal hormone therapy helps relieve hot flashes and night sweats. There are risks to menopausal hormone therapy. Ask your doctor whether it may help you. If you decide to use menopausal hormone therapy, take it for the shortest amount of time possible in the lowest dose that helps your symptoms.
- Consider other medicines. If hormone treatments are not an option for you, ask your doctor about prescription medicines used for other health problems. Certain antidepressants, epilepsy medicine, and blood pressure medicines may help with hot flashes, even if you don’t have these specific health problems.
- Track your hot flashes. Write down what triggers your hot flashes and try to avoid those things. Possible triggers might include spicy foods, alcohol, caffeine, stress, or being in a hot place.
- Drink cold water. Keep ice water close by to drink when you feel a hot flash coming on.
- Take off a layer of clothing. Dress in layers as much as possible.
- Use a fan. Turn on a fan at night by your bed and keep one at work if possible.
- Take deep breaths. Try taking slow, deep breaths when a hot flash starts. Slow, deep breaths tell your body that it is time to relax and be calm. This might make hot flashes shorter.
- Lose weight. Hot flashes may be worse in women who have overweight or obesity. A recent study found that losing weight may help improve hot flashes.4
Menopause symptom: Vaginal problems and infections
Vaginal problems, such as vaginal dryness, may start or get worse in the time around menopause. Low levels of the hormone estrogen may cause your vaginal tissue to get drier and thinner. This can cause itching, burning and pain or discomfort. It also can make sex painful and cause small cuts and tears in your vagina during sex.5 Vaginal cuts or tears put you at higher risk for sexually transmitted infections (STIs, or STDs).
What you can do
- Vaginal moisturizer. An over-the-counter vaginal moisturizer can help keep your vagina lubricated and can make sex more comfortable. You use this every few days.
- Vaginal lubricant. A water-based, over-the-counter vaginal lubricant can help make sex more comfortable. You use this before or during sex.
- Prescription medicine. You can also talk to your doctor about other ways to treat your vaginal dryness, including hormonal birth control, menopausal hormone therapy, or a prescription estrogen cream, gel, or ring that is inserted into your vagina. Learn more about menopause treatments. All medicines have risks so talk to your doctor first.
Menopause symptom: Irregular periods or bleeding
Your periods may come more often or less. They may last more days or fewer, and be lighter or heavier. Missing a few of periods does not always mean you are in perimenopause or the transition to menopause.
What you can do
- See your doctor to make sure there are no other reasons for your missed periods, like pregnancy or a health problem.
- See your doctor also if you have not had a period for a year and start bleeding or spotting. In women who have gone through menopause, spotting or light bleeding could be caused by cancer or another serious health problem.
Menopause symptom: Problems sleeping
Many women in menopause find it hard to sleep through the night. Low levels of progesterone can make it hard to fall and stay asleep. Low estrogen levels can also cause hot flashes that make you sweat while you sleep.6 This is sometimes called night sweats. Many menopausal women get urinary symptoms that make them get up several times during sleep to urinate. You may also feel more tired than usual during the day.
What you can do
- Exercise. One of the best ways to get a good night’s sleep is to get regular physical activity. But you may need to work out earlier in the day. Too much activity close to bedtime can make you more awake. Even if you have not exercised regularly in the past, starting to exercise during menopause may help you feel better. Studies show that certain exercises, such as yoga and stretching, may help improve hot flashes.7
- Do not eat, drink alcohol, or smoke before bed. Avoid large meals, smoking, and drinking alcohol right before bedtime. Avoid caffeine after noon.
- Drink warm drinks. Try drinking something warm before bedtime, such as caffeine-free tea or warm milk.
- Limit screen-time near bedtime. Limit TV, phone, or computer use near bedtime, especially in your bedroom. The bright light of the screens tell your brain to wake up instead of sleep.8
- Practice good sleep habits. Keep your bedroom dark, quiet, and cool. Use your bedroom only for sleep and sex, if you can.
- Don’t nap during the day. Try to go to bed and get up at the same times every day.
- Train your brain. If you wake during the night and can’t get back to sleep, get up and do something relaxing until you’re sleepy again.
- Talk to your doctor or nurse. Talk to your doctor or nurse about your sleep problems, as it could be something serious. Many women develop sleep apnea or insomnia.9 Treating sleep problems can also help improve chronic pain.
- Consider treatment for hot flashes. Talk to your doctor or nurse about treatment for your hot flashes if they are causing your sleep problems. This will usually improve your sleep.
- Treat bladder problems. Talk to your doctor or nurse about treatment for urinary problems. Urinary or bladder incontinence is not a normal part of the aging process. There are treatments that work.
Menopause symptom: Memory problems
You might become forgetful or have trouble focusing. As many as two-thirds of women going through perimenopause say they have problems with memory or trouble focusing.10 Menopausal hormone therapy does not treat or prevent memory loss or brain diseases, including dementia and Alzheimer’s disease. In a recent study, memory problems were linked to depression and loss of sleep but not to levels of the hormone estrogen.10
What you can do
- Get enough sleep and physical activity, eat healthy and don’t smoke. This may improve memory.11
- Stay socially active. Join a group or club that focuses on activities you enjoy, such as a hiking club or a quilting bee. Social interaction may help delay memory loss and prevent diseases such as dementia and Alzheimer’s disease.12
- Stay mentally active. You may be able to boost your memory and focus by doing mental activities like crossword puzzles, taking a class, or learning a new skill like a foreign language.
- Talk to your doctor if forgetfulness or other mental problems affect your daily life.
Menopause symptom: Urinary problems
Many women develop bladder or urinary problems during menopause. Lower estrogen levels may weaken the urethra. Some women find it hard to hold their urine long enough to get to the bathroom. This is called urinary urge incontinence. Urine might also leak out when you sneeze, cough, or laugh. This is called urinary stress incontinence. Some women have disrupted sleep during menopause because of the need to urinate during sleep. Urinary problems after menopause are not a normal part of aging and can be treated.
What you can do
- Treatment for urinary incontinence can include limiting or avoiding caffeine, taking medicine, using special medical devices, physical therapy, or having surgery, depending on the cause of the condition.
- If you have urine leakage, you can try urinary incontinence products such as pads, a urethra cap, or a pessary. A urethra cap fits over your urinary opening. It is reusable. A pessary is a round disk that is inserted into your vagina to support your bladder. Your doctor or nurse will fit you for your pessary, but you can remove, wash, and reinsert it yourself.
- Talk to your doctor or nurse about things you can do at home to help treat urinary incontinence. These may include a special kind of exercise for your pelvic floor muscles called Kegel exercises. Your doctor or nurse may also suggest losing weight, since extra weight puts more pressure on your bladder and nearby muscles.
Menopause symptom: Mood changes
You might feel irritable or have crying spells. If you had mood changes with your monthly periods or depression after giving birth, you may be more likely to have mood changes with menopause, too.13 Even if you never experienced mood changes during your monthly periods or after giving birth, you may still get mood changes during menopause. Mood changes at this time also could be from stress, family changes, or feeling tired. Mood changes are not the same as depression.
What you can do
- Try to get seven to eight hours of sleep.
- Get active to help you feel your best. Find ways to get active.
- Avoid taking on too many duties as much as possible. Look for positive ways to ease your stress.
- Join a support group online or in your community with women who are also going through menopause.
- Talk to your doctor or nurse about menopausal hormone therapy, which can help with mild mood changes. All medicines have risks, including menopausal hormone therapy. Mood changes that happen during menopause are usually not the same as depression, which is a different, serious illness that also needs treatment.
Menopause symptom: Depression and anxiety
Your risk for depression and anxiety is higher during the time around menopause. This may be caused by changing hormones, menopausal symptoms, or both. You may experience sadness or depression over the loss of fertility or the changes in your body. If you have symptoms of depression or anxiety, see your doctor. Your doctor may recommend therapy or medicine or both to treat depression or anxiety.
What you can do
- Sleep. Try to get enough sleep. Most adults need between seven and eight hours of sleep each night. Lack of sleep is linked to depression.9
- Exercise. Get at least 30 minutes of physical activity on most days of the week. Exercise is proven to help with depression. See our Fitness section for tips on how to get active.
- Limit alcohol. Limit how much alcohol you drink, if any. A moderate amount of alcohol for women is one drink a day, and no more than seven drinks in a week. More than four drinks at a time is considered binge drinking.
- Lower stress. Set limits for how much you take on. Look for positive ways to unwind and ease daily stress. Try relaxation techniques, reading a book, spending some quiet time outdoors, or other healthy ways to unwind.
Menopause symptom: Changing feelings about sex
Some women feel more comfortable with their sexuality after menopause. Others may feel less aroused. You may feel less interested in sex if it is uncomfortable or painful. This can happen because of drier or thinner vaginal tissue.
What you can do
- If you are bothered by vaginal dryness, there are safe over-the-counter and prescription treatments to improve vaginal lubrication. Learn more about menopause and your sexuality.
- Some women are less interested in sex during menopause because of other menopause symptoms such as depression, anxiety, or lack of sleep. Talk with your doctor or nurse about possible treatments if your menopause symptoms bother you.
How can I talk to my family and friends about my menopause symptoms?
Many women find it helpful to reach out to supportive family or friends during menopause.
If you are having trouble talking about menopause:
- Remember that you are not alone. All women go through menopause after a certain age.
- Mention that you are dealing with menopause symptoms and would like to talk about it.
- Ask questions and talk about your experiences.
Talking with your friends and family can help them understand how menopause affects you. They may have tips for you or ideas on how they can help.
When should I see my doctor about my menopause symptoms?
If any of your menopause symptoms bother you, talk with your doctor or nurse. When you talk about treatments, you might discuss:
- Your symptoms and how much they bother you
- Your health risks based on your age and your health
- Whether you have used a treatment like menopausal hormone therapy before
- Whether menopausal hormone therapy is an option for you, based on your past health and family history
- Whether you have already reached post-menopause and, if so, how long ago
Did we answer your question about menopause symptoms?
following resources from other organizations:
Menopause treatment
Many women do not need treatment for their menopause symptoms. You may find that your symptoms go away by themselves. Or you may not find the symptoms uncomfortable. If you are bothered by your symptoms, talk to your doctor or nurse about ways to relieve them. You can work together to find a treatment that is right for you. Some women find that changing their eating habits and getting more physical activity can help. Others may need medicine to help relieve their symptoms.
What medicines treat menopause symptoms?
If your menopause symptoms bother you, talk to your doctor or nurse. Your doctor or nurse can suggest medicines to help with your symptoms. All medicines have risks, and your doctor can help you figure out which medicines are best for you.
- Low-dose hormonal birth control may help if you are in the years leading up to your final period. These may help stop or reduce hot flashes, vaginal dryness, and mood swings. They can also help with heavy or irregular periods. You should not use hormonal birth control if you smoke. Hormonal birth control, especially combination birth control pills and possibly other forms of combination hormonal birth control like the vaginal ring or skin patch, can raise your risk for blood clots and high blood pressure, and the risk is higher for women who smoke.
- Menopausal hormone therapy helps treat menopause symptoms after menopause, but it can raise your risk for blood clots, stroke, and some cancers. Learn more about menopausal hormone therapy. If you decide to take menopausal hormone therapy, use the lowest dose possible for the shortest amount of time that helps your symptoms.
- Two non-hormonal medicines approved by the Food and Drug Administration (FDA) may help treat certain menopause symptoms. One low-dose selective serotonin reuptake inhibitor (SSRI), a type of medicine usually used to treat depression, is approved to treat hot flashes in women who do not already have mood or anxiety problems. A medicine that acts like estrogen in the body is approved for the treatment of painful sex caused by menopause. You can also talk to your doctor about other medicines approved by the FDA for depression and anxiety that may also help with menopause symptoms.
- A hormonal medicine, with the generic name prasterone, is approved by the FDA to treat women who experience pain during sex caused by vaginal dryness after menopause. The medicine is applied in the vagina once a day.
- Over-the-counter (OTC) products can treat vaginal discomfort, dryness, or pain. A water-based vaginal lubricant can help make sex more comfortable. A vaginal moisturizer can help keep needed moisture in vaginal tissues and make sex more comfortable.
- Certain prescription medicines may help with vaginal discomfort, dryness, or pain if OTC products don’t work. These include estrogen creams, tablets, or rings that you put in your vagina (see information on topical hormone therapy).
- Menopausal hormone therapy pill or patch may help if you have severe vaginal dryness.
What is menopausal hormone therapy?
Menopausal hormone therapy is prescription medicine to help relieve your menopause symptoms, such as hot flashes and vaginal dryness, if they are severe enough to disrupt your daily life. Menopausal hormone therapy is sometimes called hormone therapy or hormone replacement therapy.
During menopause, your ovaries make very low levels of the hormones estrogen and progesterone. Menopausal hormone therapy replaces some of the hormones no longer made by your ovaries with artificial estrogen and progesterone.
Menopausal hormone therapy can help with hot flashes and other menopause symptoms. It is usually taken as a pill each day. You can also get estrogen or estrogen plus progesterone menopausal hormone therapy as a skin patch. Like all medicines, menopausal hormone therapy has risks. If you decide to take it, use the lowest dose for the shortest time needed. Other types of menopausal hormone therapy, called topical hormone therapy, do not treat hot flashes but can help with vaginal dryness.
There are many different brands of menopause hormone therapy. Read more about and find a list of FDA-approved hormone therapies.
What is topical hormone therapy?
Topical (TOP-ih-kuhl) hormone therapy is usually a low-dose estrogen cream applied directly to the vagina. It relieves vaginal dryness but does not help with other symptoms, such as hot flashes. It also is available as a vaginal ring, insert, and gel. The risks of topical hormone therapy are different from the risks of menopausal or hormone replacement therapy.
Is menopausal hormone therapy safe?
Menopausal hormone therapy, sometimes called hormone replacement therapy, is safe for some women, but it also has risks. That is why the FDA advises women who want to try menopausal hormone therapy to use the lowest dose that works for the shortest time needed.
Research shows that:
- Menopausal hormone therapy may be an option for women up to age 59, but usually only within 10 years of menopause. Younger women and those closer to their final menstrual period are less likely to have the harmful side effects from menopausal hormone therapy.
- Menopausal hormone therapy reduces menopause symptoms, such as hot flashes, sleep problems, mood changes, and vaginal dryness.
- Hot flashes usually require higher doses of estrogen therapy that affect the whole body.
- Women with vaginal dryness or discomfort during sex may find relief with low doses of topical vaginal estrogen.
- Estrogen alone and estrogen plus progesterone raise the risk of stroke and blood clots in the legs and lungs. The risks are rare in women between 50 and 59.
Who should not take menopausal hormone therapy?
Menopausal hormone therapy may not be safe for some women. You should discuss your risks with your doctor if you have:
- A history of heart disease or risk factors, such as high cholesterol
- A family or personal history of breast cancer
- High levels of triglycerides, a type of fat in your blood
- A family history of gallbladder disease
- Liver disease
- A history of stroke or blood clots
How long should I take menopausal hormone therapy?
The FDA recommends that women take estrogen-only or estrogen plus progesterone menopausal hormone therapy at the lowest dose that works for the shortest time needed.
Talk to your doctor to weigh the risk and benefits of menopausal hormone therapy based on your symptoms, age, and risk factors.
What is bioidentical hormone therapy?
Companies that make bioidentical hormone therapy use the term “bioidentical” to suggest that their products are exactly the same as natural hormones. Many of these companies also claim that their products are safer than menopausal hormone therapy. However, the FDA does not recognize this term or regulate these products. No studies have been done to evaluate how safe or effective these products are.
Read more about bioidentical hormone therapy. Talk to your doctor or nurse before trying any bioidentical hormone therapy.
What are some natural remedies for menopause symptoms?
Some women report relief for hot flashes and other menopause symptoms with complementary or alternative therapies. Talk to your doctor or nurse before taking any herbal or vitamin supplement. The Food and Drug Administration (FDA) does not regulate supplements in the same way they regulate medicines. Many supplements can interfere with medicines and make them work incorrectly or not at all.
Some research studies show relief from premenstrual syndrome (PMS) symptoms with these herbal supplements, but other studies do not. Many herbal supplements should not be used with other medicines. Some herbal supplements women use for menopause symptoms are:3
- Black cohosh. The underground stems and root of black cohosh are used fresh or dried to make tea, capsules, pills, or liquid extracts. Black cohosh is used to help treat menopausal symptoms, such as hot flashes.
- Red clover. Red clover has phytoestrogens (fayh-toh-ES-truh-juhnz), which are similar to estrogen. Phytoestrogens are also found in some cereals, vegetables, legumes (peas, beans, soy). You can take red clover in tea or as a pill. Red clover may not be safe for women who should not take menopausal hormone therapy with estrogen.
- Soy. Soy is a plant in the pea family. The seeds of soy are soybeans. Soybeans make isoflavones, a type of phytoestrogen. Soy can be found in dietary supplements or added to foods such as cheese and pasta. Soybeans can be cooked and eaten or used to make foods such as tofu and soy milk. Soy may not be safe for women who should not take menopausal hormone therapy with estrogen.
- Mind and body practices. Yoga, tai chi, and acupuncture may help reduce menopause symptoms, including sleep and mood problems, stress, and muscle and joint pain. One study also found that hypnosis (a trance-like state during which your mind is relaxed) helped decrease hot flashes by 74%.4
Research continues on these and other alternative ways of relieving menopause. Talk to your doctor or nurse before trying natural remedies.
Did we answer your question about menopause treatment?
Early or premature menopause
Menopause that happens before age 40 is called premature menopause. Menopause that happens between 40 and 45 is called early menopause. About 5% of women naturally go through early menopause.1 Smoking and certain medicines or treatments can cause menopause to come earlier than usual.
What is the difference between early and premature menopause?
Early or premature menopause happens when ovaries stop making hormones and periods stop at a younger age than usual (the average age for menopause in the United States is 52). This can happen naturally or for a medical reason, such as when both ovaries are removed in a hysterectomy.
Early and premature menopause can have the same causes. The only difference is the age at which it happens. Menopause that happens before age 45 is called early menopause. Menopause that happens before age 40 is called premature menopause.
Women who have gone through early or premature menopause cannot get pregnant.
What causes early or premature menopause?
Early or premature menopause can happen on its own for no clear reason, or it can happen because of certain surgeries, medicines, or health conditions.
Reasons for early or premature menopause can include:
- Family history. Women with a family history of early or premature menopause are more likely to have early or premature menopause.
- Smoking. Women who smoke may reach menopause as much as two years before nonsmokers. They may also get more severe menopause symptoms.2 Research suggests that women who have early or premature menopause and smoke die about two years earlier than nonsmoking women.3
- Chemotherapy or pelvic radiation treatments for cancer. These treatments can damage your ovaries and cause your periods to stop forever or just for a while. You also may have trouble getting pregnant or not be able to get pregnant again. Not all women who have chemotherapy or radiation will go through menopause. The younger a woman is at the time of chemotherapy or radiation, the less likely she is to go through menopause.
- Surgery to remove the ovaries. Surgical removal of both ovaries, called a bilateral oophorectomy (OH-fuh-REK-tuh-mee), may cause menopausal symptoms right away. Your periods will stop after this surgery, and your hormone levels will drop quickly. You may have strong menopausal symptoms, like hot flashes and less sexual desire.
- Surgery to remove the uterus. Some women who have a hysterectomy, which removes the uterus, can keep their ovaries. If this happens, you will no longer have periods, and you cannot get pregnant. But you will probably not go through menopause right away because your ovaries will continue to make hormones. Later on, you might have natural menopause a year or two earlier than expected.
- Certain health conditions:
- Autoimmune diseases, such as thyroid disease and rheumatoid arthritis. Although rare, the body’s immune system, which normally fights off diseases, may mistakenly attack the ovaries and keep them from making hormones.
- HIV and AIDS. Women with HIV whose infection is not well controlled with medicine may experience early menopause.4 Women with HIV may also have more severe hot flashes than women without HIV.5
- Missing chromosomes. Women born with missing chromosomes or problems with chromosomes can go through menopause early. For example, women with the condition called Turner’s syndrome are born without all or part of one X chromosome, so their ovaries do not form normally at birth and their menstrual cycles, including the time around menopause, may not be normal.
- Chronic fatigue syndrome. Women with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have extreme tiredness, weakness, muscle and joint pain, memory loss, headache, unrefreshing sleep, and other symptoms. Research has found that women with ME/CFS are more likely to have early or premature menopause.6
How do I know if I am going through early or premature menopause?
You know you have gone through menopause when you have not had your period for 12 months in a row. If you think you may be reaching menopause early, talk to your doctor or nurse.
- Your doctor or nurse will ask you about your symptoms, such as hot flashes, irregular periods, sleep problems, and vaginal dryness.
- Your doctor or nurse may give you a blood test to measure estrogen and related hormones, like follicle-stimulating hormone (FSH). You may choose to get tested if you want to know whether you can still get pregnant. Your doctor or nurse will test your hormone levels in the first few days of your menstrual cycle (when bleeding begins).
What are the effects of early or premature menopause?
Women who go through menopause early may have symptoms or health problems similar to those of regular menopause.
But some women with early or premature menopause may also have:
- Higher risk of serious health problems, such as heart disease and osteoporosis, since women will live longer without the health benefits of higher estrogen levels. Talk to your doctor or nurse about steps to lower your risk for these health problems.
- More severe menopause symptoms. Talk to your doctor or nurse about treatments to help with symptoms if they affect your daily life.
- Sadness or depression over the early loss of fertility or the change in their bodies. Talk to your doctor if you have symptoms of depression, including less energy or a lack of interest in things you once enjoyed that lasts longer than a few weeks. Your doctor or nurse can recommend specialists who can help you deal with your feelings. Your doctor or nurse can also discuss options, such as adoption or donor egg programs, if you want to have children.
Did we answer your question about early or premature menopause?
For more information about early or premature menopause, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:
- Premature Ovarian Failure: Premature Menopause (link is external) – Information from the American Pregnancy Association.
- Primary Ovarian Insufficiency (POI) – Information from the Eunice Kennedy Shriver National Institute of Child Health and Human Development
- Women.Smokefree.gov. (n.d.). 11 Harmful Effects of Smoking on Women’s Health.
- Bellavia, A., Wolk, A., Orsini, N. (2016);23: Differences in age at death according to smoking and age at menopause. Menopause, 108–110.
- Imai, K., Sutton, M.Y., Mdodo, R., del Rio, C. (2013). HIV and menopause: A systematic review of the effects of HIV infection on age at menopause and the effects of menopause on response to antiretroviral therapy (link is external). Obstetrics and Gynecology International, 2013:340309 (Epub 2013 Dec 19).
Menopause and your health
Changes in your body in the years around menopause may raise your risk for certain health problems. Low levels of estrogen and other changes related to aging (like gaining weight) can raise your risk of heart disease, stroke, and osteoporosis.
How will menopause affect my health?
After menopause, your ovaries make very little estrogen. Women who have gone through menopause have very low estrogen levels. Low levels of estrogen and progesterone raise your risk for certain health problems after menopause. Other health problems may happen naturally as you age.
Examples of common health problems in the years after menopause include:
- Heart disease. Before age 55, women have a lower risk of heart disease than men. Estrogen helps keep blood vessels relaxed and open and helps the body maintain a healthy balance of good and bad cholesterol. Without estrogen, cholesterol may start building up on artery walls leading to the heart. By age 70, women have about the same risk for heart disease as men of the same age.
- Stroke. Your risk for stroke doubles every decade after age 55.1 The lower levels of estrogen in your body may play a role in cholesterol build-up on artery walls leading to the brain.
- Osteoporosis. Having less estrogen after menopause causes you to lose bone mass much more quickly than you did before, which puts you at risk for osteoporosis. Osteoporosis is a condition that causes your bones to become brittle and weak and break easily. A recent large study found that women who have severe hot flashes and night sweats during the years around menopause usually have more bone loss and are at higher risk for hip fractures than women who do not have severe symptoms.2
- Lead poisoning. Lead that you are exposed to over your lifetime gets stored in your bones. Because bone begins to break down much more quickly after menopause, that lead is more likely to be released into the blood. Older women can have blood lead levels 30% higher than before they reached menopause. This lead increases your risk for high blood pressure and atherosclerosis (sometimes called hardening of the arteries). This lead in your blood can also cause your kidneys to not work as well. It can also cause symptoms similar to dementia, affecting your memory and ability to think.3
- Urinary incontinence. About half of postmenopausal women have trouble holding in their urine.4 Lower estrogen levels may weaken the urethra. Learn about treatment options for incontinence.
- Oral issues. Dry mouth and an increased risk for cavities are more common after menopause. Learn more about oral health.
Does hormone therapy during menopause prevent these health problems?
No. Menopausal hormone therapy is medicine to help relieve your menopause symptoms, such as hot flashes and vaginal dryness. Menopausal hormone therapy may actually raise your risk for blood clots, stroke, and some cancers and does not help prevent heart disease or dementia. Learn more about menopausal hormone therapy.
What screenings do I need after menopause?
All women need regular checkups and screening tests throughout their lives. Most women can help take care of their health with:
- Regular mammograms after age 50 through age 75
- Regular Pap tests, even after menopause. You should get a Pap test and HPV test together every five years if you have a cervix, until you are 65 and have had three clear tests in a row.
- Regular height measurements to detect loss of height due to bone loss
- Blood, urine, and other tests to screen for risk of diabetes and heart disease
- Blood pressure, cholesterol, and other tests your doctor recommends
Ask your doctor or nurse about flu shots and other vaccines. Besides the flu shot, vaccinations are available for pneumonia, shingles, and other diseases.
Your doctor or nurse might also recommend other tests, depending on your health. For example, you might need to see a specialist for some specific problems, like urinary incontinence.
Find out what other screenings you need based on your age.
How can I stay healthy during and after menopause?
There are many important steps you can take to build your health in the years around menopause.
- Quit smoking. Quitting smoking is the most important step you can take to be healthier. Smoking hurts your health in many ways, including by damaging your bones and causing heart disease and as many as 12 types of cancer in women.5,6 Stay away from secondhand smoke and get help quitting if you need it. Visit Women.Smokefree.gov for woman-specific information, tips, and tools.
- Be active. Getting at least 30 minutes of physical activity on most days of the week is one of the best ways you can be healthier. Physical activity can help your bones, heart, and mood. Exercise doesn't’t have to be complicated. Brisk walking and regular household chores are good for your health. Ask your doctor about what activities are right for you. Aim to do:
- At least 2 hours and 30 minutes a week of moderate aerobic physical activity or 1 hour and 15 minutes of vigorous aerobic activity or some combination of the two
- Exercises that build muscle strength on two days each week
Get a free exercise guide and other tips for older adults at the Go4Life from the National Institute on Aging at NIH website.
- Eat well. Getting vitamins, minerals, fiber, and other essential nutrients is just as important as when you were younger. But older women usually need fewer calories for energy. Find out how many calories you need each day, based on your age, height, weight, and activity level.
- Talk to your doctor or nurse about dietary supplements.
- Women older than 50 need 2.4 micrograms of vitamin B12 and 1.5 milligrams of vitamin B6 each day. Ask your doctor or nurse if you need a vitamin supplement.
- After menopause, calcium needs go up to maintain bone health. Doctors recommend that women 51 and older get 1,200 milligrams of calcium each day. Vitamin D also is important to bone health. Doctors also recommend that women 51 to 70 get 600 international units (IU) of vitamin D each day and women ages 71 and older get 800 IU of vitamin D each day. Ask your doctor or nurse if you need a calcium supplement or if you need more vitamin D.
- Practice safe sex. After menopause, you can’t get pregnant. But you can still get a sexually transmitted infection (STI, or STD). Condoms are the best way to prevent STIs when you have sex. After menopause the vagina may be drier and thinner, leading to small cuts or tears during sex. Vaginal cuts or tears put you at higher risk for STIs. Learn other ways to prevent STIs.
Will I gain weight after menopause?
Maybe. Many women gain an average of 5 pounds after menopause. Lower estrogen levels may play a role in weight gain after menopause. But weight gain may be caused by your metabolism slowing down as you age. You may also not eat as healthy or be as active as when you were younger. You also lose muscle mass as you age (muscle burns more calories at rest than other types of tissue in the body).
Weight gain can raise your risk for high blood pressure, cholesterol, diabetes, heart attack, and stroke. The risk is greater if you are already overweight or are not active or eating healthy. Learn about the effects of overweight and obesity on heart health.
The best way to lose weight, if you are overweight or obese, is to eat fewer calories each day. Exercise or physical activity is also important for good health, but works better to keep weight off than it does to help you lose weight. Researchers think this might be because people who are physically active are usually hungrier. Eating healthy and getting at least 30 minutes of exercise on most days is the best way to keep a healthy weight.
Did we answer your question about menopause and your health?
Menopause and sexuality
In the years around menopause, you may experience changes in your sex life. Some women say they enjoy sex more. Other women find that they think about sex less often or don’t enjoy it as much. Low hormone levels after menopause cause vaginal tissues to be thinner or drier. There are treatments to help your symptoms.
What effects will menopause have on my sex life?
Menopause may cause changes in your sex life, or you may not notice any changes at all. Here are some possible changes:
- Lower hormone levels can make your vaginal tissue drier and thinner. This condition, called vaginal atrophy, can make sex uncomfortable or painful.
- Lower hormones may lower your sex drive. It may take you longer to get aroused.
- Night sweats can disturb your sleep and make you tired.
- Emotional changes can make you feel stressed or irritable.
Being less interested in sex as you get older is not a medical condition that requires treatment. But if changes in your sexual health bother you, talk to your doctor or nurse about ways to help, such as treatments to relieve vaginal dryness.
What can I do to improve my sexual health before and after menopause?
You can steps to improve your sexual health during perimenopause and after menopause:
- Be active. Physical activity can boost your energy levels, lift your mood, and improve your body image. All of these can help increase your interest in sex.
- Don’t smoke. Cigarette smoking can reduce blood flow to the vagina and lower the effects of estrogen. This can make it more difficult to get aroused.
- Avoid drugs and alcohol. They can slow down how your body responds.
- Have sex more often. If you choose to have sex, it can increase blood flow to your vagina and help keep tissues healthy.
- Allow time to become aroused during sex. Moisture from being aroused protects tissues and makes sex more comfortable.
- Practice pelvic floor exercises. These can increase blood flow to the vagina and strengthen the muscles involved in orgasm. Learn more about pelvic floor exercises.
- Avoid products that irritate your vagina. Bubble bath and strong soaps might cause irritation. See your doctor or nurse if you have vaginal itching or irritation as it may be a sign of infection.
- Talk to your doctor or nurse about products to increase your sex drive if you are bothered by a low level of interest in sex. Some women try products like pills or creams with the male hormone testosterone or similar products. The Food and Drug Administration (FDA) has not approved these products for treating low female sex drive. But, the FDA has approved flibanserin, a medicine to treat low sexual desire. If you take flibanserin, you cannot drink alcohol because of its risks for serious low blood pressure problems and loss of consciousness. Flibanserin can increase the number of times you have a satisfying sexual experience by once a month or once every two months. Talk to your doctor about the benefits and other risks of taking any medicine.
How can I treat vaginal dryness after menopause?
For vaginal dryness that causes mild discomfort during sex:
- Use an over-the-counter, water-based vaginal lubricant when you have sex.
- Try an over-the-counter vaginal moisturizer to help increase moisture. You may need to use it every few days.
For more severe vaginal dryness, your doctor might prescribe medicines that you put into your vagina to increase moisture and sensation. These may include:2
- Vaginal estrogen creams
- Estrogen tablets or rings for insertion into the vagina
- A non-hormonal medicine called ospemifene
Discuss your symptoms and personal health issues with your doctor or nurse to decide whether one or more treatment options are right for you.
How can I talk with my partner about menopause and sex?
Talking with your partner about your concerns can strengthen your relationship. Getting older and chronic health problems like heart disease or diabetes can affect your sexual health and how you feel about sex. Some possible topics to discuss include:
- What feels good and what doesn’t
- Times that you may feel more relaxed
- Which positions are more comfortable
- Whether you need more time to get aroused than before
- Concerns you have about the way your appearance may be changing
- Ways to enjoy physical connection other than vaginal intercourse, such as oral sex or massage
You may want to also consider meeting with a therapist or sex counselor for individual or couples therapy if changes in your sex life bother you.
Do I still need to practice safe sex after menopause?
Yes, you still need to use condoms after menopause if you are not in a monogamous relationship. In a monogamous relationship, you and your partner have sex only with each other and no one else. Also, you have both been tested for sexually transmitted infections (STIs, or STDs) before having sex without a condom.
Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get some STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. After menopause you may be more likely to get an STI from sex without a condom. Vaginal dryness or irritation is more common after menopause. This can cause small cuts or tears during sex, making you more likely to get an STI.
Learn more ways to prevent STIs.
Did we answer your question about menopause and your sexuality?
For more information about menopause and your sexuality, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:
Menopause resources
Menopause (PDF, 104 KB)
Source: OWH, HHS