Introduction to Menopause
Rina Carlini, PhD
Reviewed by Rina Carlini, PhD and Joanne Tejeda, PhD
May 16, 2023

Menopause is a natural physiological transition experienced by all women, and individuals assigned female at birth. The menopause transition will span about 5-8 years for most women between the ages of 45-55 years, but it can naturally start as early as age 40 or end as late as age 60. The term 'menopause' is clinically determined as the date which is 12 months after your last menstrual cycle. As the levels of a woman's natural reproductive hormones decline - which include estrogen (present in the body as estradiol) and progesterone decline - these changing levels lead to reduced function of the ovaries to produce egg cells (ova), and result in halting menstruation.
Menopause is categorized in 3 stages:
Stage 1 - Perimenopause: a transition period associated with the onset of fluctuating reproductive hormones and associated symptoms (see partial list below) which typically lasts from 1 to 5 years (however it can span a longer period of up to 10 years for some women).
Stage 2 - Menopause: the date that represents 12 consecutive months with no menstrual cycle, following your last menstruation period.
Stage 3 - Post-menopause: the period that following the menopause date, which is the rest of your adult life; symptoms will typically get milder and be manageable, and for some women, may even disappear.
Menopause is not a disease but rather a natural hormonal transition. However, the physiological changes that accompany the menopause transition can give rise to serious health conditions that require ongoing medical care - these include:
Cardiovascular diseases such as hyperlipidemia (elevated cholesterol) and arrhythmia
Osteoporosis
Type II diabetes
Colorectal cancer
For some women, and individuals assigned female at birth, a surgery to remove the reproductive organs including ovaries and/or uterus (as in the case of partial or total hysterectomies) can trigger menopause abruptly, which is referred to as premature menopause.
Symptoms
There have been more than 30 'symptoms' or signs of perimenopause reported in teh clinical literature, which may be experienced by individuals - a partial list is provided below:
Vasomotor symptoms such as hot flashes and/or night sweats (the most reported symptom)
Irregular menstrual cycles - these can be light or heavy periods
Heavy prolonged menstrual bleeding
Vaginal dryness - experienced during intercourse, and sometimes also with walking
Painful intercourse
Sleep disturbances
Alcohol intolerance
Frequent urination, frequent flatulence
Frequent urinary tract infection (UTIs)
Moodiness and irritability
Depression and/or anxiety
Heart palpitations, and decreasing heart rate
Weight gain
Increasing waist size
Hair thinning or hair loss
Dry hair texture, more grey/white hair growth
Dry flaky skin, dull or hyper-pigmented skin
Acne, rosacea, and other skin blemishes
Weakened muscle strength
Joint aches and pains with regular movement
Treatment Options
Symptom management for menopause needs to be personalized, and can include a combination of drug and non-drug options along with lifestyle changes, such as:
Hormone therapies:
Estrogen supplementation (Menopausal Hormone Therapy, MHT)
Progesterone-based therapeutic agents
Synthetic steroids that mimic progesterones and/or estrogens
Non-hormonal therapies:
Low-dose paroxetine
Gabapentin
Fezolinetant
Venlafaxine
Herbal remedies, such as chasteberry
Lifestyle changes:
Regular exercise and weight-bearing strengthening exercise
Good protein-based nutrition for managing weight and heart health
Psychotherapy, if you experience ongoing depression and/or anxiety
Water-based lubricants and vaginal moisturizers to counteract dryness and vaginal pain with intercourse (symptoms of GSM, genitourinary syndrome of menopause)
Regular sleep routines, meditation, and relaxation techniques
Naturopathic solutions, such as vitamin supplementation
Limiting caffeine (1-2 cups of coffee per day) and alcohol (1 beverage per week)
The transition through all stages of menopause occurs very slowly, lasting up to 8 years, and in some cases, symptoms can last up to 10 years after menopause. The menopause transition is an inevitable progression of aging in women, and about 75% of all women experience life-disrupting symptoms of menopause. Being proactive about this natural phase of life is key to minimizing these disruption and living a healthyher life.
Below are a collection of articles that address the specific symptoms of perimenopause transition, which ends with menopause (the date when a women's menstruation has stopped for a full 12 months). We hope they are helpful when you ask questions with a women's healthcare professional who is trained as a Menopause Society Certified Professional (MSCP).
References:
[1] Pachman DR, Jones JM, Loprinzi CL. Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions. Int J Womens Health. 2010;2(1):123-135. doi:10.2147/ijwh.s7721
[2] Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinol Metab Clin North Am. 2015;44(3):497-515. doi:10.1016/j.ecl.2015.05.001
[3] Greendale GA, Lee NP, Arriola ER. The Menopause. Vol 353.; 1999. doi:10.1016/S0140-6736(98)05352-5
[4] Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause - Global prevalence, physiology and implications. Nat Rev Endocrinol. 2018;14(4):199-215. doi:10.1038/nrendo.2017.180
[5] Canderelli R, Leccesse LA, Miller NL. Benefits of hormone replacement therapy in postmenopausal women. J Am Acad Nurse Pract. 2007;19(12):635-641. doi:10.1111/j.1745-7599.2007.00269.x
[6] Falcone T, Walters MD. Clinical Expert Series Hysterectomy for Benign Disease. Obstetrics & Gynecology. 2008;111(3):753-767. doi:10.1097/AOG.0b013e318165f18c
[7] Kołodyńska G, Zalewski M, Rozek-Piechura K. Urinary incontinence in postmenopausal women - Causes, symptoms, treatment. Przeglad Menopauzalny. 2019;18(1):46-50. doi:10.5114/pm.2019.84157
[8] Newton KM, Buist DSM, Keenan NL, Anderson LA, LaCroix AZ. Use of alternative therapies for menopause symptoms: Results of a population-based survey. Obstetrics and Gynecology. 2002;100(1):18-25. doi:10.1016/s0029-7844(02)02005-7
[9] Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL. Risk for New Onset of Depression During the Menopausal Transition The Harvard Study of Moods and Cycles. Arch Gen Psychiatry. 2006;64(4):385-390. doi: 10.1001/archpsyc.63.4.385
[10] Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: How important is vaginal lubricant and moisturizer composition? Climacteric. 2016;19(2):151-161. doi:10.3109/13697137.2015.1124259
[11] Hill DA, Crider M. Hormone Therapy and Other Treatments for Symptoms of Menopause. Am Fam Physician. 2016;94:884-889. https://www.aafp.org/pubs/afp/issues/2016/1201/p884.html
[12] Hickey M, Szabo RA, Hunter MS. Non-hormonal treatments for menopausal symptoms. BMJ. 2017;359:j5101. doi:10.1136/bmj.j5101
[13] Kleinman NL, Rohrbacker NJ, Bushmakin AG, Whiteley J, Lynch WD, Shah SN. Direct and indirect costs of women diagnosed with menopause symptoms. J Occup Environ Med. 2013;55(4):465-470. doi:10.1097/JOM.0b013e3182820515