Raise your hand if menopause symptoms took you by surprise. Or confused the heck out of you. Or you feel clueless about what’s headed your way. Cool, so most of us, right? That checks out: While 100% of midlife women experience menopause, a 2022 study published in the journal Women’s Health found that 60% of those in perimenopause did not feel informed at all about this phase of life. And more than two-thirds only started looking for information once symptoms set in.
The four blind spots, according to those surveyed: the overarching knowledge gap, the onset and impact of symptoms, WTH is up with perimenopause (I’m paraphrasing here) and different ways to manage symptoms. So let’s fill in the blanks. Below, experts tackle the most common menopause questions — from symptoms to causes to treatments.
What is menopause, anyway?
Menopause is that magic moment when you’ve gone 12 consecutive months without a menstrual period. That moment is the clear evidence that your ovaries no longer produce estrogen, and just like that, you’re in menopause. It sounds straightforward enough, but as most women in their mid-to-late 40s know (and some even younger than that), it can be a wild ride leading up to the official onset of menopause.
When does menopause start and how long does it last?
The menopause transition starts when you first experience subtle perimenopause symptoms, like your period comes a few days earlier or later than normal. This stage usually starts in your mid-40s. All together, you’re looking at an average of four to nine years of lead-up to the Big M, complete with hormone upheaval and a grab bag of symptoms, according to a study in the journal Menopause.
“There’s no tool to tell you when you’ll reach menopause,” says Dr. Monica Christmas, associate medical director of the Menopause Society. “And Mother Nature has a cruel sense of humor: You might not have a period for six months and get rid of your menstrual products, then boom, your cycle comes back. It’s frustrating.” That unpredictability aside, the average age of menopause is 52, and about “95% of women reach it between 45 and 55,” says Christmas.
What’s the difference between perimenopause, menopause and postmenopause?
Have you ever gone down the Google rabbit hole of “perimenopause vs. menopause?” Uh, same. Rest assured, the confusion isn’t brain fog showing itself. The terms are often used interchangeably (and incorrectly), as in “perimenopause/menopause is driving me bananas.” But they’re different stages of the menopause transition:
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Perimenopause. This begins when you first experience symptoms, specifically when your period is consistently early — or late — by seven days on either end. (Learn more about the perimenopause timeline.)
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Menopause. Less a stage than a moment in time, when you hit a full year with no period — and when it’s actually safe to ditch your tampons.
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Postmenopause. Welcome to the rest of your life. “People ask, When will menopause be over? Well, it’s never really over; you just enter the post-reproductive phase of life,” Christmas says. “But this is when symptoms usually start to get better.”
What causes menopause?
Simply put, your ovaries run out of eggs. We’re born with a fixed number of ovarian follicles, or tiny sacs that hold our eggs. “Each month during the reproductive years, ovaries develop and release a single mature follicle, which produces about 90% of all your estrogen,” says Dr. Nanette Santoro, professor of reproductive endocrinology and infertility and reproductive sciences at the University of Colorado.
As your follicle supply dwindles with age, hormone production gets erratic. “The decline in estrogen isn’t gradual or gentle, it happens in fits and starts,” says Santoro. Picture a roller coaster — steady for a few cycles, then estrogen surges or plunges. But the ride does end. By the time you hit menopause, only about 1,000 follicles remain — a steep drop from 25,000 at age 37 and 400,000 at puberty. Those stragglers don’t do much, and within a year or two, your body adjusts to this new normal.
What is early, surgical or medical menopause?
When it comes to timing, there are exceptions to menopause norms.
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Early menopause is when you get there before age 45. Genetic factors, smoking status, your mom’s menopause timing and various syndromes may play a role, but experts aren’t sure what exactly causes early menopause, which impacts 5% of women.
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Premature menopause happens before 40 and is even more rare, affecting about 1% of women.
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Surgical menopause is triggered suddenly by surgery to remove your ovaries — or medical treatment (chemo or radiation). This abrupt shift can make symptoms more severe, which is why higher doses of hormone therapy may be used, if you’re a candidate.
What are the symptoms of menopause?
Symptoms of perimenopause and menopause range from the usual suspects like hot flashes and irregular periods to some head scratchers you might not expect (frozen shoulder, anyone?). And sometimes, you just can’t put your finger on it. “Many women don’t have a clear-cut set of symptoms, especially early in perimenopause, they just report what we call ‘NFM’ — not feeling myself,” Santoro says. In fact, a 2024 study of more than 1,600 women in perimenopause found that about 63% reported “not feeling like themselves” at least half the time over the previous three months.
Early signs
Perimenopause officially announces its arrival with changes to your cycle (though irregular periods may not show up if you’re on hormonal birth control). Early symptoms are often milder, such as:
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Hot flashes and night sweats (especially around your period)
You might also experience changes to your working memory and … wait, what’s that word? Oh yeah … symptoms of attention deficit disorder. “These can be bewildering if you’re still getting periods semi-regularly, so you may not attribute them to menopause,” Santoro says. “Women often worry about future dementia, but the symptoms are normal.”
Common symptoms
As you move into the later years of perimenopause, periods become less frequent and symptoms ramp up. The most common include:
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Hot flashes or night sweats (moderate to severe for about 25% of women, Santoro says)
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Irritability and mood changes
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Bladder issues (leakage, UTIs)
Some of these symptoms fall under the very unsexy term genitourinary syndrome of menopause (GSM). And spoiler — literally — these symptoms don’t resolve on their own after menopause. In fact, according to the Menopause Society, GSM often worsens without treatment. (Learn what you can do about GSM.)
“If you have a history of depression or anxiety, even if you’ve been stable or off meds, you’re at a higher risk for recurrence,” Christmas says. Research backs that up: A systematic review found that women with a prior history of depression were more than twice as likely to relapse during the menopausal transition compared to those without one. “Consider talking to your health care provider about going back on medication or adjusting dosage,” Christmas says.
Lesser-known symptoms
You might chalk some of your symptoms up to getting older or stress (and midlife has no shortage of that). But many are driven or made worse by the hormonal roller coaster, like:
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Vaginal itching or burning
How can menopause be treated or managed?
Menopause itself doesn’t need fixing. The symptoms that hijack your life? Those deserve a smackdown. Right now, the research shows that the most effective menopause treatments out there target hot flashes, night sweats, vaginal and urinary changes. Here are the basics:
Systemic hormone therapy
This type of hormone therapy for menopause (estrogen plus progestin if you still have a uterus) comes in the form of pills, patches, sprays, gels or high-dose vaginal rings and is absorbed into the bloodstream and travels throughout your body. It’s the go-to for classic menopause symptoms like hot flashes and night sweats, but many women see downstream benefits in sleep, mood, energy and bone health.
“Hormone therapy is an easy-to-use, first-line treatment that’s effective for common symptoms, and for most women, it’s low risk with a lot of benefit,” Santoro says. “I encourage patients to try it for three months. If they see benefits, it can be an easy decision to continue in the face of small risks. If the benefits aren’t there, we move on to other options.”
Local (vaginal) hormone therapy
When vaginal dryness strikes, local estrogen therapy can be a game changer. “Some women think, ‘I’m not sexually active so it doesn’t matter. But if it’s irritating you, why struggle with it?” says Christmas. Vaginal dryness is often the first sign of vaginal atrophy (aka GSM), which can cause burning, itching, recurrent UTIs and sudden bladder leaks. So yeah, it’s worth addressing, whether or not sex is on your agenda.
Local hormones (creams, suppositories, gels and low-dose vaginal rings) stay mostly in the vaginal tissues — restoring elasticity, blood flow and comfort — without significantly raising hormone levels in the rest of your body. Importantly, local therapy doesn’t increase the risk of blood clots or cancer, and may even be safe for breast cancer survivors.
Non-hormonal meds and lifestyle changes
Other options include selective serotonin reuptake inhibitors (SSRIs). These meds, which are commonly used for depression, may improve hot flashes, mood-related symptoms and sleep, says Christmas. Another treatment is gabapentin, an anti-seizure medication that reduces hot flash frequency and severity, according to a review in the American Journal of Obstetrics and Gynecology.
As for nonmedicinal strategies, a 2025 report in the journal Women’s Health Reports found that clinical hypnosis reduced hot flash frequency and severity by 60% — and improved sleep, mood and quality of life, while cognitive behavior therapy (CBT) reduced stress associated with hot flashes. While we’re talking stress relief, don’t underestimate the power of mindful meditation, smart smartphone use, and even things like getting outside or a girls’ night out.
Finally, good, old-fashioned lifestyle upgrades like regular exercise, following a healthy Mediterranean diet, quitting smoking, amping your omega-3s, limiting alcohol and solid sleep hygiene are all recommended by the Menopause Society.
Can menopause cause weight gain?
Yes and no. “Patients say, ‘It’s as if I went to sleep and woke up 20 pounds heavier,’ and I always say, ‘I believe you,'” Christmas says. It’s not just in your head: A 2019 study of 1,246 women found that starting in the two years before menopause, women gained fat at nearly double their previous rate, all while losing lean mass too.
But weight gain — versus a change in body composition (more fat, less muscle) — likely has more to do with aging than hormones, says Christmas. What’s probably happening is a perfect storm of contributing factors:
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Low energy and poor sleep: Menopause symptoms drain energy and disrupt sleep and mood, making you less likely to stay active. (Nearly half of women in perimenopause report significant fatigue, and this jumps to more than 8 in 10 after menopause, according to a 2019 report.)
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Shifts in appetite: Those same symptoms make it harder to choose healthy foods and keep your cravings in check.
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Midlife fat redistribution: Fat naturally shifts toward the belly with age. (Hello, menopause belly.) “There are brilliant people working on this problem, but it’s a tough one to crack,” Santoro says.
Resistance training plus a diet high in lean protein and fiber is a combo proven to help. (Learn more about this “healthy trinity of menopause.”) Still, the struggle is real. “Losing weight is extremely difficult during the menopause transition, just like at any stage,” says Santoro. When lifestyle changes aren’t enough and weight gain puts your health at risk, medications such as GLP-1s aren’t an “easy way out,” but a lifesaving option for some. Bottom line: Menopause makes weight harder to manage, but not impossible.
Can menopause affect heart or bone health?
Yes to both. Estrogen protects your heart and bones, so as it declines, so too does your natural protection. In fact, women who experience early or premature menopause have a 15% and 36% increased risk of heart disease, respectively, according to a 2019 study in the Lancet Public Health.
As for bones, you start to shed bone density at a faster pace in the year before your final period and for the next three years — losing on average 2% each year, per the findings of the SWAN Study, a multicenter research initiative on midlife women’s health. With the right steps — from exercise and diet to medications when needed — you can keep your bones sturdy and your heart resilient well beyond menopause.
Should I see a doctor for menopause?
Yes! If you’re younger than 40 and experiencing menopause-like symptoms, for sure make an appointment so your provider can rule out any other conditions, like thyroid disorders. For everyone else, start the menopause talks early, like as soon as you start to experience symptoms or have irregular or skipped periods. This is important to not only address symptoms, but your long-term health as you start to move into menopause. And if you don’t feel heard, get a second opinion. “It’s important to know that all symptoms are treatable,” says Santoro. (Learn all about getting the menopause care you deserve.)
Meet our experts
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Monica Christmas, MD, director of the menopause program at the Center for Women’s Integrated Health and associate professor of obstetrics and gynecology at the University of Chicago and associate medical director of the Menopause Society.
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Nanette Santoro, MD, professor of reproductive endocrinology and reproductive sciences at the University of Colorado Anschutz in Aurora, Colo.
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