Menopause is the time when menstrual periods permanently stop, marking the end of the reproductive stage for the female human. It typically occurs between the ages of 45 and 55, although the exact timing can vary. Menopause is usually a natural change related to a decrease in circulating blood estrogen levels. It can occur earlier in those who smoke tobacco. Other causes include surgery that removes both ovaries, some types of chemotherapy, or anything that leads to a decrease in hormone levels. At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone. While typically not needed, measuring hormone levels in the blood or urine can confirm a diagnosis. Menopause is the opposite of menarche, the time when periods start. In the years before menopause, a woman's periods typically become irregular, which means that periods may be longer or shorter in duration, or be lighter or heavier in the amount of flow. During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, night sweats, and reddening of the skin. Hot flashes can recur for four to five years. Other symptoms may include vaginal dryness, trouble sleeping, and mood changes. The severity of symptoms varies between women. Menopause is also known to cause thinning and drying of the skin as 30% of the skin's collagen is lost during the first five years of menopause. Menopause before the age of 45 years is considered to be "early menopause", and ovarian failure or surgical removal of the ovaries before the age of 40 years is termed "premature ovarian insufficiency". In addition to symptoms (hot flushes/flashes, night sweats, mood changes, arthralgia and vaginal dryness), the physical consequences of menopause include bone loss, increased central abdominal fat, and adverse changes in a woman's cholesterol profile and vascular function. These changes predispose postmenopausal women to increased risks of osteoporosis and bone fracture, and of cardio-metabolic disease (diabetes and cardiovascular disease). Medical professionals often define menopause as having occurred when a woman has not had any menstrual bleeding for a year. It may also be defined by a decrease in hormone production by the ovaries. In those who have had surgery to remove their uterus but still have functioning ovaries, menopause is not considered to have yet occurred. Following the removal of the uterus, symptoms of menopause typically occur earlier. Iatrogenic menopause occurs when both ovaries are surgically removed (oophorectomy) along with the uterus for medical reasons. A survey in 2023 found that less than one-third of the obstetrics and gynecology resident programs offer standardized menopause curriculum, leading to incorrect diagnosis and referrals to specialists for each symptom. Medical treatment of menopause is primarily to ameliorate symptoms and prevent bone loss. Mild symptoms may be improved with treatment. With respect to hot flashes, avoiding nicotine, caffeine, and alcohol is often recommended; sleeping naked in a cool room and using a fan may help. The most effective treatment for menopausal symptoms is menopausal hormone therapy (MHT). Non-hormonal therapies for hot flashes include cognitive-behavioral therapy, clinical hypnosis, gabapentin, and fezolinetant or selective serotonin reuptake inhibitors. These will not improve symptoms such as neurocognitive impairments, joint pain or vaginal dryness, which affect over 55% of women. Neurocognitive symptoms of menopause can be treated with lisdexamfetamine. Exercise may help with sleep disturbances. Many of the concerns about the use of MHT raised by older studies are no longer considered barriers to MHT in healthy women. High-quality evidence for the effectiveness of alternative medicine has not been found.
Stages of menstrual cycle changes According to the gold-standard STRAW +10 framework, the transition is divided into clear and biological milestones: premenopause covers regular cycles; perimenopause is explicitly defined by a persistent cycle length variation of over 7 days or skipped cycles of over 60 days; and menopause is confirmed retroactively after 12 consecutive months without bleeding.
Premenopause: The entire reproductive lifespan leading up to perimenopause. Hormone levels are stable and cycles are regular. Perimenopause: An initial transitional phase before menopause; Estrogen drops and spikes erratically. New symptoms may arise as a result of the fluctuations. Perimenopuase symptoms can begin late 30s or early- to mid-40s. Menopause: A specific point in time, defined retroactively once a woman has gone 12 consecutive months without a period (and without an underlying medical cause or medication causing the absence).
Signs and symptoms
During early menopause transition, the menstrual cycles remain regular but the interval between cycles begins to lengthen. Hormone levels begin to fluctuate. Ovulation may not occur with each cycle. The term menopause refers to a point in time that follows one year after the last menstruation. During the menopausal transition and after menopause, women can experience a range of symptoms. However, for women who enter the menopause transition without having regular menstrual cycles (due to prior surgery, other medical conditions or ongoing hormonal contraception) the menopause cannot be identified by bleeding patterns and is defined as the permanent loss of ovarian function.
Vagina, uterus and bladder (urogenital tract)
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