The signs and symptoms of the menopausal transition are often associated with menopause itself, which is when you’ve gone one year without having a menstrual period. The years-long buildup to menopause is known as perimenopause. During this time, your body’s production of estrogen and progesterone hormones becomes less consistent. Varying hormone levels can cause menopausal symptoms, such as hot flashes and night sweats, irregular menstrual periods, mood changes and urinary incontinence.
However, menopausal symptoms occur in women irrespective of their hormone levels. While hormone imbalances do occur in perimenopause, the worsening of symptoms may not be able to be tracked based on hormone levels alone.
Transition Timing
When does the menopausal transition begin? For most women, perimenopause starts between ages 45 and 55 and lasts about seven years, according to the National Institute on Aging. Menopause occurs, on average, at age 52, according to the Office on Women’s Health.
For some women, menopause arrives even earlier. These women experience premature menopause, which is when menstrual periods end before age 40. Be careful not to confuse premature menopause with a condition known as primary ovarian insufficiency. This condition causes irregular periods, but unlike with premature menopause, periods may not stop altogether.
Women aren’t the only ones who experience declining hormone levels as they age. Men see their testosterone levels gradually drop as they get older, although the fall is less dramatic than women’s progesterone and estrogen levels. Low testosterone levels may lead to symptoms of so-called male menopause, such as muscle loss and less energy. The effects of reduced testosterone vary widely, though, and not all men experience symptoms.
The First Signs of Menopause
Keep a close eye on your menstrual periods as you move through your 40s. For many women, the first signs of menopause are changes to the frequency, length or intensity of their periods. If your periods occur less consistently than usual or are longer or shorter than they used to be, you may have started perimenopause.
Another potential early sign of menopause is unusual bleeding during your period. Some women experience heavier periods as a result of the menopausal transition. For others, bleeding is lighter.
Menstrual period changes are common during perimenopause. Still, it’s a good idea to tell your gynecologist about any changes you experience. That’s especially true if your periods are heavy, close together or last longer than a week, according to the National Institute on Aging. You should also report spotting and bleeding that occurs if it’s been more than a year since your last period.
When Menopause Turns Up the Heat
As the transition to menopause continues, you may experience other symptoms. Without warning, you may feel a wave of heat wash over your body, causing your face to flush and skin to redden. Known as a hot flash, this is a common sign of menopause. Some hot flashes last only seconds, but others may go on for several minutes. Nighttime hot flashes, also known as night sweats, can disrupt your sleep.
Hormone therapy can reduce hot flashes and night sweats, but some types of hormone therapy may increase the risk of certain cancers and heart disease. Be sure to weigh the risks and benefits of hormone therapy with your gynecologist, who can help you decide whether it makes sense for you.
You can also try other ways to help with hot flashes, like wearing layers of clothes that you can easily remove when a hot flash occurs and sleeping with a fan on. Also, consider lifestyle changes, such as weight loss, along with trying acupuncture and yoga. Track the foods you eat, any sources of stress or other factors that trigger your hot flashes so you can learn to avoid them.
More Signs and Symptoms of Menopause
In addition to hot flashes, other signs of menopause include:
- Mental health conditions. Menopause increases your risk for anxiety and depression. Making healthy lifestyle changes, such as exercising regularly and managing stress, may help. In addition, your primary care provider can prescribe medication or refer you to a behavioral health specialist if appropriate.
- Mood changes. Suddenly feeling irritable or downcast for no obvious reason? These types of mood changes can be signs of menopause. You can manage mood changes by getting enough sleep, exercising and seeking support from others who understand what you’re going through.
- Urinary problems. Lower estrogen levels may cause urinary incontinence, including sudden urges to urinate or leaking when you laugh or cough. Your gynecologist can recommend a variety of options to help, ranging from medicines and incontinence products to physical therapy or surgery.
- Vaginal dryness. Another potential consequence of lower estrogen production is changes to the tissue of the vagina. Vaginal dryness, for example, can cause itching or discomfort during sex. Over-the-counter treatments, such as vaginal moisturizers or lubricants, can provide relief. Your health care provider can also prescribe hormonal birth control or other treatment options for vaginal problems.
- Weight gain. The combination of varying hormone levels and a naturally slowing metabolism may cause you to gain weight leading up to and after menopause. A nutritious diet and regular physical activity can help you maintain a healthy weight.
A New Era for Your Health
Menopause doesn’t always bring an end to menopausal symptoms. For some women, symptoms may continue for years after their periods end. Whether or not the signs of menopause fade, it has a lasting effect on your health.
After menopause, it’s especially important to be proactive about your health because your risk for certain conditions rises. Estrogen plays a key role in heart health by helping balance your levels of good and bad cholesterol. With minimal estrogen post-menopause, your risk for unhealthy cholesterol levels (and, as a result, heart disease) increases. So does your osteoporosis risk level.
Menopause can have positive effects, too. The end of menstrual periods, for example, may be a welcome development. Most of all, menopause can be an opportunity to recommit to and refocus on your physical and mental health so you can thrive. Lean into your support system, and seek therapy if needed. Menopause can be a scary time, so ensure you have the support you need and stay educated by talking with your doctor about your changing body to better understand this natural process.
More to Read
- How to Cope with Menopause Sleep Problems
- 5 Things to Know About Weight Gain During Perimenopause
- Your Top Priority During Perimenopause? Your Health
- What Every Woman Should Know About Pelvic Organ Prolapse
Medically reviewed by Mokerrum Fatima Malik, MD, FACOG.
