Menopause is the permanent cessation of menstruation caused by decreased ovarian estrogen and progesterone production. Perimenopause often begins in the mid-40s. Common symptoms include hot flashes, sleep disturbance, and vaginal dryness. Hormone therapy is the most effective treatment for many symptoms but requires individualized discussion about risks and benefits; local vaginal estrogen and non-hormonal prescription options are available. Lifestyle measures, pelvic floor exercises, calcium and vitamin D, and screening for bone health support long-term well-being.
What is menopause?
Menopause is the permanent end of menstrual periods, diagnosed after 12 consecutive months without a period. In the United States the average age is about 51, though perimenopause - the transition period with fluctuating hormones and irregular cycles - often begins in the mid-40s and can start earlier for some women.
What causes the changes?
Menopause results from the ovaries producing much less estrogen and progesterone. As ovarian hormone production falls, the body responds with changes in the reproductive cycle and in other systems regulated by these hormones. Follicle-stimulating hormone (FSH) typically rises as ovarian function declines.
Common symptoms
Symptoms vary in type and severity. Typical changes include:
- Hot flashes and night sweats
- Sleep disturbances and insomnia
- Vaginal dryness and painful intercourse (genitourinary syndrome of menopause, or GSM)
- Mood changes such as increased irritability or low mood
- Changes in menstrual pattern before periods stop
- Long-term shifts in bone density and cardiovascular risk
Medical and prescription options
Hormone therapy (estrogen with or without progestogen) remains the most effective treatment for hot flashes and GSM. Current guidance recommends individualized decisions: use the lowest effective dose for the shortest duration needed, and avoid systemic hormone therapy when contraindicated (for example, in some people with a history of certain cancers or blood clots). Local vaginal estrogen preparations can treat dryness with minimal systemic exposure.
Non-hormonal prescription options can help reduce hot flashes for women who cannot or choose not to take hormones. These include some antidepressants (SSRIs/SNRIs), gabapentin, and clonidine. Discuss benefits and side effects with your clinician.
Lifestyle and self-care
Simple measures help many women: stop smoking, limit alcohol and caffeine if they trigger symptoms, wear layered clothing, and practice paced breathing for instant relief from hot flashes. Regular weight-bearing exercise, adequate calcium and vitamin D intake, and maintaining a healthy weight support bone and heart health. Pelvic floor exercises (Kegels) and water-based lubricants can relieve vaginal symptoms.
Complementary approaches such as cognitive behavioral therapy (CBT), mindfulness, and acupuncture may provide symptom relief for some people, though evidence varies.
Screening and when to see a clinician
Talk to your clinician about individualized risks and benefits of hormone therapy. Bone density screening (DEXA) is generally recommended at age 65 or earlier for those with risk factors. Seek evaluation for severe or sudden symptoms, heavy bleeding before menopause, or any concern about significant mood change or sexual health.
Menopause is a natural life stage. With updated options and personalized care, most women find effective ways to manage symptoms and protect long-term health.