Menopause is a normal and natural part of aging. As you enter your 40s, your body will likely begin to produce less estrogen until you no longer menstruate. Once you stop menstruating, you will have entered menopause. Natural menopause, which happens without medical intervention, occurs in three stages:

  • perimenopause
  • menopause
  • postmenopause

Many people confuse menopause with perimenopause. Perimenopause is the stage when a woman begins to transition into menopause. Some common symptoms of the perimenopausal phase include:

  • hot flashes
  • night sweats
  • vaginal dryness

During perimenopause, your body begins to make less estrogen until the last one or two years until your hormone levels drop rapidly. Perimenopause can start up to 10 years before you enter menopause. It often begins in your 40s, but some women enter perimenopause in their 30s.

Doctors will diagnose you with menopause when you have not had a period for 12 consecutive months. After 12 months, you will enter the postmenopausal stage. If you’ve had your ovaries surgically removed, you’ll experience "sudden" menopause.


Perimenopausal symptoms can last four years on average. The symptoms associated with this phase will gradually ease during menopause and the years following called postmenopause. Women who've gone an entire year without a period are considered postmenopausal.

Hot flashes, also known as hot flushes, are a common symptom of perimenopause. One study found that moderate to severe hot flashes could continue past perimenopause and may last for a median of 10.2 years.

But some researchers say that exceeds the generally accepted timeframe. Researchers of the study also found that black women and women of average weight experience hot flashes for a longer period than white women and women who are considered overweight.

It’s possible for a woman to experience menopause before the age of 55. Early menopause occurs in women who go through menopause before they're 45 years old. If you're menopausal and are 40 years old or younger, it’s considered premature menopause.

Early or premature menopause can happen for many reasons. Some women can go through early or premature menopause because of surgical intervention, like a hysterectomy. It could also occur from damages to the ovaries caused by chemotherapy or other conditions and treatments.


You’ll experience a host of symptoms while going through perimenopause. The most common include:

Hot flashes: These cause you to feel a sudden rush of warmth in your face and upper body. They can last a few seconds to several minutes, or longer. Hot flashes can occur several times a day or a few times a month.

Night sweats: Hot flashes during sleep can result in night sweats. Night sweats can wake you up and make you feel extra tired during the day.

Cold flashes: You may experience chills, cold feet, and shivering after your body cools down from a hot flash.

Vaginal changes: Vaginal dryness, discomfort during sex, low libido, and an urgent need to urinate are symptoms of genitourinary syndrome of menopause (GSM).

Emotional changes: These may include mild depression, mood swings, and irritability.

Trouble sleeping: Sleep problems such as insomnia can occur because of night sweats.

Other symptoms of perimenopause can include:

  • breast tenderness
  • heavier or lighter periods
  • worsening premenstrual syndrome (PMS)
  • dry skin, eyes, or mouth

Some women may also experience:

  • headaches
  • racing heart
  • muscle and joint pain
  • focus and memory issues
  • hair loss or thinning
  • weight gain

If you experience any of these additional symptoms, visit your doctor to rule out other causes.

You can experience all of these symptoms throughout perimenopause. But hot flashes typically occur at the onset of perimenopause.


Going through perimenopause and menopause can be uncomfortable and sometimes painful for many women. But it's a normal and manageable part of aging. Here are some tips to help you manage your symptoms:

Hot flashes

To prevent and manage hot flashes:

  • identify and avoid hot flash triggers like spicy foods or alcohol
  • use a fan at work or at home
  • take low-dose oral contraceptives if you still have your period
  • take slow, deep breaths when a hot flash starts
  • remove some layers of clothing when you feel a flash coming on

Vaginal dryness

Vaginal dryness can be managed by using a water-based, over-the-counter (OTC) lubricant during sex or by an OTC vaginal moisturizer used every few days. Your doctor could also prescribe medication to help with more severe vaginal discomfort. But if you’re reluctant to engage in intercourse with your partner, see your doctor.

Sleep problems and mood swings

If you have sleep problems, you can:

  • avoid large meals, smoking, coffee, or caffeine after noon
  • avoid napping during the day
  • avoid exercise or alcohol close to bedtime
  • drink warm milk or warm caffeine-free tea before bed
  • sleep in a dark, quiet, and cool room
  • treat hot flashes to improve sleep

Easing stress, eating right, and staying physically active can help with any mood swings and sleeping problems. Your doctor may also prescribe medication to help with mood swings.

You should talk to your doctor about managing your symptoms and to rule out other conditions that may cause your symptoms, like depression or asthma. It's also helpful to join a support group for women in menopause so you have a safe place to share your concerns and issues.

Learn more: The 10 best menopause blogs of the year »

Additional treatments

Your doctor may also prescribe menopausal hormone therapy (MHT) to help treat your symptoms. MHT, once known as hormone replacement therapy, can ease:

  • hot flashes
  • night sweats
  • sleep problems
  • irritability
  • vaginal dryness

MHT may also help slow bone loss, and reduce mood swings and mild depressive symptoms. Side effects of MHT include:

  • vaginal bleeding
  • bloating
  • breast swelling or tenderness
  • headaches
  • mood changes
  • nausea

Studies show that women who take MHT are at an increased risk of heart attack, stroke, and blood clots. The risks are similar for women using contraceptive pills, patches, and rings, but women taking MHT are older and the risks increase with age.

Many women can’t take MHT because of previous illness such as cancer or because they take other medications.

Other research has found that breast cancer can increase with five or more years of continuous MHT use that includes estrogen and progestogen. Women who have had their uterus removed will only take estrogen therapy. Talk to your doctor to learn more about hormonal therapy before making a decision to use it.

When to seek help

It’s common and normal to experience irregular periods when you're perimenopausal. Other conditions, like polycystic ovary syndrome or cervical cancer, can cause irregular bleeding. See your doctor to rule out other causes if you:

  • suddenly experience very heavy periods or periods with blood clots
  • have periods lasting longer than usual
  • spot or bleed after sex
  • bleed or spot after your period
  • have periods close together

Osteoporosis and heart disease are long-term health risks associated with menopause. That is because estrogen plays a significant role in protecting your bones and your heart. Without estrogen, you're at an increased risk for both diseases. You should speak with your doctor about treatment options to protect yourself against both diseases.

You're also at an increased risk of urinary tract infections because menopause can cause your urethra to become dry, irritated, or inflamed. Vaginal infections can also occur more frequently because your vagina has become dryer and thinner.

Benefits of menopause

Although menopause can cause uncomfortable symptoms for some women, this natural process has possible upsides, too. There are several potential benefits of menopause to consider:

  • A positive perspective. The Massachusetts Women’s Health Study, one of the largest longitudinal studies to focus on middle-aged women, found that most women had overwhelmingly positive or neutral attitudes toward menopause. Most women don’t seek outside help for menopause.
  • No change in health or health behaviors. The same study found that women’s health and health behaviors are unlikely to change with menopause. That means if you already lead a healthy lifestyle, you’ll likely stick with it.
  • The wisdom of experience. Menopause goes hand-in-hand with aging, which carries with it the value of life experience. Psychologist Sylvia Gearing, PhD, told the American Psychology Association’s Monitor on Psychology that, in her experience, women in menopause have increased “clarity, decisiveness, and emotional intelligence,” among other positives.
  • No menstruation. Some women like that menstruation comes to an end with menopause, especially if they experienced heavy periods, cramping, or premenstrual syndrome (PMS). Once your monthly cycle stops, there’s no need to purchase tampons, pads, or other menstrual products.
  • No need for birth control after no periods for one year.
  • It’s still possible to become pregnant during perimenopause, so don’t abandon birth control right away. After a year without your period, it’s generally accepted that pregnancy isn’t possible without medical intervention, which may be a relief for some women. You will still need to protect yourself from sexually transmitted diseases.


Life after menopause is not much different than life during your reproductive years. Remember to eat right, exercise, and receive routine healthcare, including dental and eye exams. A nutritious diet and regular exercise will help maintain strong bones, while regular doctor visits will help you catch problems early.