When Does Menopause Start?

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Menopause occurs when a person's menstrual cycle (period) stops permanently for 12 consecutive months. It is generally a natural process. However, it can be induced by surgery, medical treatments, or certain diseases. It marks the end of a person's fertility because they can no longer conceive a child; it is often called "the change of life."

The natural menopausal transition is a gradual process that happens over several years. It usually begins when a person is in their 40s or 50s, with the average age of menopause being 52 years old.

Menopausal symptoms are the result of decreased ovarian function. The ovaries stop the production of reproductive hormones such as estrogen and progesterone. The first symptom is usually irregular menstrual cycles. Other symptoms include hot flashes, mood changes, insomnia (sleep problems), vaginal dryness, and a decreased sex drive.

Stages of Menopause

Verywell / Jessica Olah

What Is Menopause?

Menopause is the permanent end of a person's menstrual period. It is defined by the absence of menses for 12 months in a row. It occurs when a person's ovaries stop making estrogen and progesterone. These are the hormones needed for fertility or to conceive a baby. Menopause usually happens naturally with age. However, it can be induced by surgery, medical treatment, or an illness.

At What Age Does Menopause Begin? 

Perimenopause (before menopause) spans several years and usually begins in a person's mid- to late-40s. The average age at which one reaches natural menopause is 51-52. There are exceptions, and some people reach menopause in their late 30s or early 60s.

Early Menopause

About 5% of people who menstruate experience early menopause between the ages of 40-45 years old.

What Is Premature Menopause?

Menopause that occurs before a person is 40 years old is considered premature. It is also called primary ovarian insufficiency (POI).

Premature menopause may be due to:

  • Genetics
  • Metabolic changes
  • Autoimmune disorders


Premature menopause can also be induced by:

  • A bilateral oophorectomy (a surgery where both ovaries are removed)
  • Medical treatments such as cancer or endometriosis treatment
  • Illnesses such as (POI)  

Premature Menopause Statistics

Premature menopause is rare and only occurs in about 1% of people who menstruate in the United States.

The Stages of Menopause

Natural menopause occurs slowly over three stages: perimenopause, menopause, and postmenopause. This is the body’s way of gradually ending a person's reproductive stage of life. 

Perimenopause

Perimenopause means around or near menopause. It is the transitional time leading up to a person's last period. During this time, the ovaries stop producing reproductive hormones such as estrogen and progesterone.

This transition usually starts when a person reaches their mid to late 40s. It can last two to eight years. However, the average time someone is in perimenopause is four years before their period completely stops.

The first physical clue that the perimenopause process has started is usually a change in a person's menstrual cycle or period. They become irregular because the person is not ovulating every month. Those irregularities may include:

  • Shorter or longer time between periods 
  • Shorter or longer bleeding time
  • Skipping a few months of periods
  • Heavier or lighter blood flow or cramps than before
  • Spotting between periods

During this transition, many people start having menopause symptoms like hot flashes, night sweats, mood changes, insomnia, and vaginal dryness. Severe symptoms may require medical treatment. 

Pregnancy and Perimenopause

It is important to note that there is still a slight chance you could become pregnant during perimenopause. To avoid unplanned pregnancies, contraception or birth control is recommended until menopause is confirmed by a doctor. This is usually one year after your last period.

Menopause

People reach menopause when their menstrual periods stop permanently for 12 consecutive months. This means no bleeding or spotting for 12 months in a row. Menopause may happen naturally or stem from surgery, treatment of disease, or an illness.

People are no longer able to conceive children after menopause occurs. However, menopause should be confirmed by a doctor before a person stops using contraception to avoid unplanned pregnancies.

Postmenopause

Postmenopause is defined by the period of time following the year mark after a person's final period (menopause). Once that happens, a person is considered postmenopausal for the rest of their life.

Vaginal bleeding for post-menopausal people is not normal. It’s important to notify your doctor as soon as possible if this occurs.

Some symptoms, such as hot flashes and vaginal dryness, will continue and are not a cause for concern unless they affect your quality of life. 

Symptoms

Noticeable changes in a person's body occur during the three phases of menopause. These changes or symptoms result from a decreased production of reproductive (sex) hormones such as estrogen and progesterone in the ovaries.

Irregular Periods

Irregular periods are often the first sign of the start of menopause. Periods may be spaced closer or farther apart. Cramping may get better or worsen. Bleeding time may be shorter or longer, and blood flow may increase or decrease. 

Hot Flashes

Hot flashes are a common symptom that may start in perimenopause and last several years after menopause. Hot flashes make you suddenly feel hot, and you may start sweating. Your face may become red, and your heart may race. A chill or anxiety sometimes occurs after the hot flash. Hot flashes that happen at night are called night sweats.

Are Hot Flashes Disruptive?

For 10% to 15% of people who menstruate, hot flashes disrupt their daily functions. Being woken up by night sweats can cause fatigue, irritability, and forgetfulness. If any symptoms disrupt daily functioning, it’s important to talk to your primary doctor or gynecologist. 

Vaginal or Sexual Changes

These symptoms may include vaginal dryness, itchiness, soreness, or painful sex. Some people also report a decrease in libido (sex drive).

Urination Changes

Primarily urinary changes include:

  • Increased urinary frequency
  • Incontinence (involuntary urinary leakage)
  • Nocturia (waking up during the night to urinate)
  • Increased urgency to urinate

Mood or Brain Changes

Changes in mood and cognition often occur during the menopausal transition. It is unclear whether these changes are due to a decrease in estrogen or other factors. These changes include:

  • Insomnia (trouble sleeping)
  • Depression
  • Irritability
  • Anxiety 
  • Loss of concentration 
  • Low self-esteem or confidence

Sleeping Problems During Perimenopause

Study estimates show that about 40% of perimenopausal people experience trouble sleeping.

Physical Changes 

Other physical changes can often occur. This may consist of:

  • Weight gain and slowed metabolism
  • Breast tenderness
  • Loss of breast fullness
  • Thinning hair and dry skin
  • Racing heart
  • Increased blood pressure
  • Headaches

Induced Menopause Symptoms

Induced menopause includes the same symptoms as naturally occurring menopause. However, symptoms may be more intense due to sudden, rather than gradual, changes in hormones. Medical treatment such as hormone therapy may be necessary for severe symptoms in both types of menopause.

Testing

Menopause is usually detected due to age and symptoms. Tracking your menstrual cycle and symptoms can help you and your healthcare provider identify if you are in any stage of menopause. Tell your healthcare provider about any menopause symptoms, such as hot flashes, breast tenderness, vaginal dryness, changes in periods, mood changes, or trouble sleeping.

Hormone Levels

While laboratory tests are not usually necessary to diagnose menopause, your doctor may test the amount of hormones in your blood. This is especially true if your periods stopped at an early age (before 40) or there is a medical reason to do so.

  • Follicle-stimulating hormones (FSH levels): FSH is a protein made by the brain that tells the ovaries it's time for ovulation. When menopause begins, the ovaries start to shut down and don’t respond to the stimulation. This causes the brain to send more FSH into the body. Blood levels of FSH will increase as a person's ovaries begin to shut down. These levels fluctuate, so these tests may need to be tracked over time.
  • Estradiol levels: Estradiol is the main form of estrogen found in a person before menopause. Generally, blood levels fall after menopause. However, there are exceptions for people who take certain medications. 

Bone Density Testing

Bone density tests do not indicate menopause. However, they are used to monitor and screen postmenopausal people for osteoporosis, which weakens the bones.

A Word From Verywell

It may be challenging to recognize that you have entered perimenopause. Keeping track of your periods is helpful because changes in your cycle may be the first sign that you are in this transition towards menopause. 

Some people don’t have problems with menopausal symptoms, and it is a smooth transition. For others, symptoms can be frustrating, uncomfortable, or life-altering. Menopause can often correlate with other changes in life, such as children leaving home, or caring for aging parents. It’s essential to have regular visits with your doctor and seek treatment for symptoms that affect your quality of life.

Postmenopausal people have an increased risk for heart disease and osteoporosis. It’s important to eat a healthy diet, check your blood pressure and cholesterol regularly, get adequate calcium and/or vitamin D in your diet or take supplements if directed, and keep up with recommended health screenings. 

Remember, it is not normal for postmenopausal people to have vaginal bleeding. See your doctor as soon as possible if this occurs. 

Frequently Asked Questions

  • How do you know when menopause has started?

    A change in your period is usually the first sign menopause has started. This includes skipping your period, heavier or lighter bleeding, shorter time between periods, spotting, shorter, or longer periods.

  • What is the earliest age for menopause?

    Menopause is considered premature when it occurs anytime before age 40, the average age for a person to reach menopause is 52.

  • What are the stages of menopause?

    Perimenopause: The time leading up to menopause.

    Menopause: When a person who menstruates has not had a period for 12 months.

    Postmenopause: The time period after a person reaches menopause.

  • Does the number of children you have impact the age you start menopause?

    Pregnancy, especially more than one, may delay menopause.

  • How long do menopause symptoms last?

    Generally, symptoms such as hot flashes last four to 10 years after menopause. Some changes, such as vaginal atrophy (thinning of vaginal tissues) may remain, especially without hormone therapy. 

 

 

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14 Sources
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