Menopause is a point in time when a person has gone 12 consecutive months without a menstrual period. Menopause is a natural part of aging and marks the end of your reproductive years. On average, menopause happens at age 51.

What are the three stages of menopause?

Natural menopause is the permanent ending of menstruation that doesn’t happen because of any type of medical treatment. The process is gradual and happens in three stages:

• Perimenopause or “menopause transition”: Perimenopause can begin eight to 10 years before menopause when your ovaries gradually produce less estrogen. It usually starts when you’re in your 40s. Perimenopause lasts up until menopause, the point when your ovaries stop releasing eggs. In the last one to two years of perimenopause, the drop in estrogen accelerates. At this stage, many people may experience menopause symptoms. But, you’re still having menstrual cycles during this time and can get pregnant.
• Menopause: Menopause is the point when you no longer have menstrual periods. At this stage, your ovaries have stopped releasing eggs and stopped producing most of their estrogen. A healthcare provider diagnoses menopause when you’ve gone without a menstrual period for 12 consecutive months.
• Postmenopause: This is the name given to the time after you haven’t had a period for an entire year (or the rest of your life after menopause). During this stage, menopausal symptoms, such as hot flashes, may get better. However, some people continue to experience menopausal symptoms for a decade or longer after the menopause transition. As a result of a lower estrogen level, people in the postmenopausal phase are at an increased risk for several health conditions, such as osteoporosis and heart disease.

What are the signs of menopause?

You may be transitioning into menopause if you begin experiencing some or all of the following symptoms:

• Hot flashes, also known as vasomotor symptoms (a sudden feeling of warmth that spreads over your body).
• Night sweats and/or cold flashes.
• Vaginal dryness that causes discomfort during sex.
• Urinary urgency (a pressing need to pee more frequently).
• Difficulty sleeping (insomnia).
• Emotional changes (irritability, mood swings or mild depression).
• Dry skin, dry eyes or dry mouth.
• Breast tenderness.
• Worsening of premenstrual syndrome (PMS).
• Irregular periods or periods that are heavier or lighter than usual.

Some people might also experience:

• Racing heart.
• Headaches.
• Joint and muscle aches and pains.
• Changes in libido (sex drive).
• Difficulty concentrating or memory lapses (often temporary).
• Weight gain.
• Hair loss or thinning.

Can menopause be treated?

Menopause is a natural process that your body goes through. In some cases, you may not need any treatment for menopause. When discussing treatment for menopause with your provider, it’s about treating the symptoms of menopause that disrupt your life. There are many different types of treatments for the symptoms of menopause. The main types of treatment for menopause are:

• Hormone therapy.
• Nonhormonal treatments.

It’s important to talk to your healthcare provider while you’re going through menopause to craft a treatment plan that works for you. Every person is different and has unique needs.

What is hormone therapy for menopause like?

During menopause, your body goes through major hormonal changes — decreasing the amount of hormones it makes. Your ovaries produce estrogen and progesterone. When your ovaries no longer make enough estrogen and progesterone, hormone therapy can make up for lost hormones. Hormone therapy boosts your hormone levels and can help symptoms like hot flashes and vaginal dryness. It can also help prevent osteoporosis.

There are two main types of hormone therapy:

• Estrogen therapy (ET): In this treatment, you take estrogen alone. Your provider prescribes it in a low dose. Estrogen comes in many forms, such as a patch, pill, cream, vaginal ring, gel or spray. Estrogen therapy isn’t a good treatment for you if you still have a uterus.
• Estrogen Progesterone/Progestin Hormone Therapy (EPT): This treatment is also called combination therapy because it uses doses of estrogen and progesterone. Progesterone is available in its natural form, or also as a progestin (a synthetic form of progesterone). This type of hormone therapy is for people who still have their uterus.

Are there any risks to hormone therapy?

The health risks of hormone therapy include:

• Endometrial cancer (only increased if you use estrogen therapy and still have your uterus).
• Gallstones and gallbladder issues.
• Blood clots.
• Deep vein thrombosis.
• Pulmonary embolism.
• Stroke.

These risks are lower if you start hormone therapy within 10 years of menopause. After that point, your risk for cardiovascular diseases is higher.

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