Menopause: symptoms, age and treatment

To define menopause simply: it's the point when your periods have stopped for 12 months in a row, because your ovaries no longer release eggs and make much less estrogen and progesterone. After it, you can't get pregnant. The years of change leading up to it are called perimenopause, and the years after it are called postmenopause.

Usually a change in your periods: they come closer together or further apart, get heavier or lighter, or skip a month. Hot flashes, night sweats, trouble sleeping, mood swings and brain fog often start around the same time, sometimes before periods change much. These early changes are perimenopause, not menopause itself.

Most women reach menopause between 45 and 55. The average age is 52 in the United States, and the range can stretch from 45 to 58. Perimenopause usually starts in the mid- to late 40s, several years before the last period. Menopause before 45 is early, and before 40 is premature.

The changes usually begin in the mid- to late 40s, when perimenopause starts and periods become irregular. Menopause itself is reached when you've gone 12 months without a period, most often between 45 and 55. It can begin earlier after surgery to remove both ovaries, or after chemotherapy or pelvic radiation.

Menopause is a single point, so technically it doesn't end: once you've gone 12 months without a period, you're postmenopausal for the rest of your life. What does end is the symptoms. They usually last 7 to 9 years in total, although hot flashes continue for 10 years or more in about a third of women.

There are three: perimenopause, when periods become irregular and symptoms start; menopause, the point 12 months after your final period; and postmenopause, the years after. Doctors use the STRAW+10 system, which splits the transition into early and late stages and postmenopause into early and late phases.

If you're over 45 and haven't had a period for 12 months, and you're not on hormonal contraception, you've reached menopause. If your periods are irregular and you have symptoms like hot flashes, you're probably in perimenopause. Blood tests usually aren't needed after 45. Our 2-minute check shows which stage your symptoms fit.

Natural menopause is caused by the ovaries running down with age: they stop releasing eggs, and estrogen and progesterone fall. It can also be caused by surgery to remove both ovaries, which brings menopause on straight away, or by chemotherapy or pelvic radiation. Smoking and family history can make it happen earlier.

Falling estrogen affects most of the body. Periods stop, hot flashes and night sweats disrupt sleep, the vagina gets drier and thinner, and mood, memory and joints can be affected. Over the longer term, bone loss speeds up and the risk of heart disease and stroke rises, which is why checkups matter after menopause.

Menopause itself isn't painful, but some symptoms can be. Muscle aches and joint pains are common, headaches and migraines can get worse than usual, and vaginal dryness can make sex painful. Most of these respond to treatment, including HRT and vaginal estrogen, so pain isn't something you just have to put up with.

Yes. Periods stop for good, and most women get relief from period problems such as heavy bleeding and cramps. After menopause you can't get pregnant, so contraception is no longer needed once the rules for your age are met. Endometriosis symptoms usually stop after menopause too.

For hot flashes and night sweats, HRT is the most effective treatment, cutting their frequency by about 75%. For vaginal dryness, low-dose vaginal estrogen works best. If you can't or don't want to use hormones, SSRIs, SNRIs, gabapentin, fezolinetant and CBT all have good evidence. Herbal supplements don't.

Perimenopause is the transition, usually lasting about four years, when periods become irregular and symptoms start. Menopause is the point 12 months after your final period. You can still get pregnant in perimenopause but not after menopause, so contraception is needed until menopause is confirmed.