Menopause: Age, Causes, Symptoms, Treatment & More

Last updated 01.15.2024 | by Dr. Karen Pike | 11 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


Menopause is the time in a woman’s life when her menstrual periods stop, and she can no longer conceive.

According to the medical community, a woman has reached menopause after experiencing twelve consecutive months without menstruation. But there’s much more in the transition to menopause than the absence of your monthly cycle. 

A wide variety of changes can happen to our bodies during this transitional time, and understanding those changes and how to manage them is essential.

I’ve worked with countless women who were unprepared for their journeys, and this natural process took them by surprise. But it doesn’t have to be this way. With the right knowledge, you can access the tools you need to navigate menopause with confidence, health, and happiness.

Are you prepared for the onset of menopause, or are there still gaps in your knowledge? Is your partner going through menopause, and you’d like to understand more about the process so you can support them on their journey? In this post, I’ll take a deep dive into the world of menopause. I’ll explain when and why it happens, symptoms and causes, and the best ways to manage them.

At What Age Does Menopause Begin?

A small proportion of women (around 1 in every 100) will begin menopause before they reach the age of 40. It’s known as premature menopause. It is also called primary ovarian insufficiency or premature ovarian failure.  

A slighter larger proportion of women (around 5 in every 100) experience what is known as ‘early menopause.’ It occurs between the ages of 40 and 45.

However, most women begin experiencing menopause between the ages of 45 and 55. In the United States, the average age of menopause is 51.

What Causes Menopause?

There are two major driving forces behind the natural menopause process.

  1. As a woman ages, she produces less hormones estrogen and progesterone. As these reproductive hormone levels drop, the menstrual cycle becomes less regular. Eventually, it stops altogether.
  2. Alongside these hormonal changes, a woman also experiences a natural decline in the number of eggs stored in her ovaries. Her egg reserve depletes with each passing cycle until ovulation ceases altogether.

Menopause is a natural process and is not considered to be a disease. These processes are a normal part of a woman’s life and a natural part of biological aging. This happens, so the ovaries stop releasing eggs leading to no pregnancy. 

However, some women experience menopause sooner than expected due to surgery or certain medical treatments. It’s known as induced menopause.

Induced Menopause

Induced menopause occurs when a woman has her uterus and ovaries surgically removed. Removal of the uterus through surgery is called hysterectomy. It causes a sudden disruption in hormones.

Certain chemotherapy and radiotherapy treatments can also cause induced menopause. It occurs when the ovaries are damaged, leading to hormone suppression and a potential shutdown of the menstrual cycle.

This shutdown may be temporary in younger women, and normal ovarian function returns after treatment. However, in older female patients, this induced medical menopause is more likely to be permanent.

How Long Do Menopause Symptoms Last?

Menopause is officially complete after twelve consecutive months without menstruation. But the signs and symptoms of menopause may occur much earlier than this milestone. They can also present themselves for several months or even years afterward.

Perimenopause

Perimenopause marks the transition which occurs before menopause. This phase usually begins during a woman’s mid 40’s. It lasts an average of 4 years before her final period. However, some women remain in this perimenopausal phase for much longer.

Symptoms of perimenopause include late, irregular, or missed periods and a change in menstrual flow (heavier or lighter). Many perimenopausal women experience symptoms typically associated with menopause, including severe hot flashes, excessive sweating, anxiety, and mood swings.

Not all women go through this stage. Some experience none of these early signs and, instead, enter menopause suddenly.

Postmenopause

After an absence of menstrual flow for at least 12 months, the official menopause phase is considered complete. A woman’s ovaries have become inactive, and she can no longer become pregnant.

During this postmenopausal phase, symptoms like hot flashes, mood disturbances, and brain fog can persist. They typically last around 4-5 years before tapering off. However, some women suffer ongoing postmenopausal symptoms for longer.

What Are the Symptoms of Menopause?

Symptoms of Menopause

Most of us will notice several symptoms as we enter menopause, and many of them can be uncomfortable and challenging. Thankfully, there are a number of medical treatments and lifestyle modifications that can be deployed to help make this time of transition easier to manage. 

I’ve worked with countless women dealing with this phase since beginning my research, and they all report experiencing one or more of the following symptoms:

1. Menstrual Pattern Changes

During the transition, you may notice your cycle becoming shorter each month. Your flow may be heavier or lighter than usual, and you might experience spotting or bleeding between your periods.

Important: Irregular bleeding patterns are a normal part of the early transition phase and menopause. However, postmenopausal women should consult their doctor if they notice vaginal bleeding. In rare cases, this could be a sign of a malignancy.

2. Emotional Disruptions

Hormonal changes in the body can lead to various emotional disruptions, including mood swings, irritability, anxiety, or depression.

3. Hot Flashes

Hot flashes are one of the most commonly reported symptoms, and they were the first signs I noticed when I began my own menopause transition. Hot flashes are characterized by a sudden feeling of heat across the body, which can also present with sweating and redness/flushing.

4. Difficulty Falling Asleep

Hormonal changes during menopause can affect the body’s natural circadian rhythms. It can lead to symptoms of insomnia.

5. Night Sweats

Many women report waking up drenched in sweat during the night. These episodes of excessive sweating can also cause further issues of disrupted sleep.

6. Decreased Libido and Vaginal Dryness

Hormonal changes cause decreased sexual desire and reduced lubrication of the genitals area. It can lead to significant discomfort or pain during sex.

7. Brain Fog and Fatigue

Low energy levels and brain fog can leave you tired and unable to function properly during the day. Sleep disturbances related to menopause can also make these symptoms worse.

8. Weight Gain

Many women I’ve worked with find they gain weight and have a harder time losing weight once menopause happens. It’s due to hormonal fluctuations, a decrease in muscle mass, and a slowing of the metabolism. However, women should be cautious as excessive weight gain can lead to heart disease. Exercise regularly and seek medical assistance if needed.

9. Aches and Pains

Hormonal changes affect joint and muscle mobility. It can cause stiffness and generalized or localized aches and pains.

10. Urinary Urgency or Incontinence

Many women undergo changes in their urinary system, including the need to urinate more frequently.

11. Atrophic Vaginitis

Atrophic vaginitis refers to a thinning of the vaginal membranes and the cervix, along with a loss of elasticity and shrinkage in the inner genitals.

12. Loss of Bone Density

A decrease in the production of levels of estrogen sparks a period of accelerated bone loss. It can last for several years after menopause is complete. It can also contribute to conditions such as osteopenia and osteoporosis and increase the risk of bone fractures.

As an emergency room doctor, I treat a high proportion of postmenopausal women who have suffered fractures due to these conditions. So, I encourage everyone to take steps to improve bone density after menopause.

What Treatments Are Available for the Symptoms of Menopause?

Treatments Are Available for the Symptoms of Menopause

Menopause is a natural part of aging, yet the symptoms can be severe and uncomfortable and affect all aspects of your life.

If you’re struggling with varied symptoms, the good news is that various natural and pharmaceutical treatments for menopause are available.

These include:

Hormone Replacement Therapy (HRT)

Also known as menopausal hormone therapy (MHT), hormone replacement therapy (HRT) is one of the most commonly used medical interventions for women.

It works by supplementing depleted reserves of estrogen and progestogen. By replacing these reproductive hormones, symptoms such as mood swings, moderate to severe hot flashes and night sweats, decreased libido, and even bone density loss can be reversed.

HRT can significantly improve the quality of life for many women going through menopause. Yet, the treatment does come with risks and side effects and isn’t suitable for everyone. Speak to your doctor to determine if HRT is the right choice for you.

Vaginal Estrogen Therapy

There are several forms of vaginal estrogen treatments available. These are designed to reduce or eliminate urogenital symptoms, including vaginal dryness, vaginal atrophy, and pain or discomfort during intercourse. This type of medication usually comes in the form of creams, tablets, or rings, which are inserted into the vagina for localized relief.

Non-Hormonal Medications

Some menopause symptoms can be treated with common antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs).

An alternative to traditional HRT, these non-hormonal medications have been shown to reduce vasomotor symptoms. I’ve met a considerable number of women who have found success with these treatments.

However, like most pharmacological treatment options, these medicines also come with the risk of side effects. These include disrupted sleep, changes to bowel habits, and altered appetite. Speak with your doctor before deciding whether this is the right treatment plan.

Lifestyle Changes

Alongside pharmacological interventions, certain lifestyle changes can help in the management of menopausal symptoms.  

I advise my patients to start by eating a balanced diet with plenty of fruits, vegetables, and healthy proteins and fats. Avoid processed foods and reduce your consumption of alcohol and caffeine. It can greatly relieve your symptoms like brain fog, fatigue, stress, and other mood-related issues.

Regular exercise can boost your mood and help you sleep better at night.

During menopause, your estrogen levels drop, causing a dip in endorphins. I’ve found that regular exercise helps to counteract this decrease and significantly improves my mood. Not only that, but exercise can also help tackle issues of muscle loss and weight gain.

Mindfulness and CBT

A recent review and meta-analysis showed that natural interventions of mindfulness practices and cognitive behavioral therapy (CBT) had a significant impact on the number of hot flashes experienced by the study participants.

Mindfulness and CBT can also improve mood, reduce insomnia, and lead to greater feelings of well-being.

After introducing mindfulness practices into my daily routine, I noticed my hot flashes were gradually subsiding, and my mood greatly improved.

FAQs

Q. How can I predict when menopause will occur?

Even with technological advances, predicting when menopause will occur with 100% accuracy is impossible. The Anti-Mullerian Hormone (AMH) blood test can offer a ballpark idea, especially if the test is taken 12-24 months before a woman’s final period.
However, the AMH test still isn’t widely available, and most women I speak to aren’t offered this test by their healthcare providers. So, if you really want to know when menopause might hit, ask your mother when hers arrived. Genes are still the best indicator most of us have at our disposal.

Q. What are the earliest symptoms of perimenopause?

This phase can hit any time from your 30s onwards. However, most women notice the first symptoms at around age 42. Here are some indicators to look out for:
1. Irregular and unpredictable periods
2. Breast pain and soreness
3. Hot flashes
4. Heavier than usual bleeding during your period
5. A lower sex drive
6. Mood swings
7. Fatigue
8. Bladder incontinence

Q. Can I still get pregnant after menopause?

During the menopausal transition phase (leading up to menopause before your periods permanently stop), it is still possible to conceive naturally. That said, lower levels of hormone production and poorer egg quality mean your chances are reduced.
It’s only after menopause is officially complete (you haven’t had a period in more than 12 months) that the chance of becoming pregnant naturally falls to zero.

Conclusion

Menopause is a normal part of a woman’s life which marks the end of her reproductive years. But this natural process comes with its own unique set of symptoms.

Some of these symptoms present challenges that affect women’s health and life. It may include your physical and emotional health conditions, the ability to do your job, and your relationships with family and friends.

If you’re struggling with the menopausal symptoms, you don’t have to suffer alone. With the right support, you can continue to thrive during this period of change.

References:

Author

  • Dr. Karen Pike

    Dr. Pike is a senior physician administrator and board-certified emergency room doctor actively working in northern California. She received her undergraduate degree at Dartmouth College, where she graduated Phi Beta Kappa and played collegiate soccer. She attended Georgetown University for medical school and performed her residency in emergency medicine at Stanford University. She was part of the first-ever, women-majority emergency medicine program in United States. Dr. Pike is also the primary medical consultant for “Grey’s Anatomy,” a role she has held since the pilot episode when she partnered with Shonda Rhimes as the show’s original medical consultant. At her hospital, she was the second woman Chief of Staff. Today serves as the Director of the Emergency Department. Whether in leadership or direct patient care, her dedication to excellence in communication, quality, and collaboration is unwavering.