Menopause is a natural part of aging. Your ovaries stop making hormones, ending your periods. You can no longer get pregnant naturally. Menopause can also happen when ovaries are surgically removed.

There are no lab tests that can predict when you'll enter menopause or tell you if it has started. If you think that you are entering menopause, talk to your provider about what to expect.

You reach menopause 12 months after your last period. This usually happens between ages 45 and 55. The average age is 51.

Most women enter perimenopause, the time leading up to menopause, in their 40s. A change in your period often signals that menopause is near. You may:

• Skip one or more periods.
• Bleed more heavily or lightly than usual.
• Bleed for more or fewer days than usual.

You can still get pregnant before your period stops completely. If you don’t want to be pregnant, it’s important to use birth control until you’ve gone at least 12 months without a period.

Menopause is different for everyone. You may have physical, emotional and sexual changes that can be hard to cope with, or you may notice little difference. Common symptoms:

Hot flashes: A sudden feeling of heat rushes through your upper body and face. You may go red or break out in a sweat. Hot flashes may happen only a few times a month or many times a day. You may have them for months or years — or not at all. Up to 75% of women in the U.S. will have them.

Vaginal changes: Loss of estrogen can make the walls of your vagina thin and dry, making sex painful. A change in your vagina’s bacterial balance can cause itching and burning. 

Sexual changes: You may have less interest in sex when you enter menopause. Sex may be painful, or your orgasms may change. There are many treatment options.

Emotional changes: Changes in hormone levels and lack of sleep may make you anxious, irritable or tired. If you have been depressed in the past, perimenopause and menopause can be challenging. Stressful midlife changes can also make menopause harder to cope with.

Sleep problems: Hot flashes, night sweats and feelings of stress can disrupt sleep as you transition to menopause. Too little sleep can affect your mood, health and weight.

Bone changes: Bone loss, a normal part of aging, can speed up when you are in menopause. Bones are also at higher risk of breaking. The hips, wrists and spine are most vulnerable.

Even though periods at midlife tend to be irregular, it’s a good idea to talk with your doctor if you:

• Haven’t had a period for 12 months or more and then start bleeding or spotting.
• Have very heavy bleeding with clots.
• Infrequent bleeding that recurs for years.
• Bleed more often than every three weeks.

What is hormone therapy?

Medicine that replaces the sex hormones (estrogen and progesterone) that your ovaries once made.

How is it given?

• Pills, patches, gels or sprays place estrogen and progestin (a synthetic progesterone) in the bloodstream. These hormones travel to the organs and tissues where they're needed.
• A cream, tablet or ring can be placed in the vagina to release small doses to treat dryness locally.
• Since every person is different, we don't use lab tests to determine what kind of hormone therapy to prescribe. We'll work closely with you to adjust your treatment based on your symptoms.

Benefits:

• About 80% of women find relief from hot flashes and night sweats within two weeks of starting hormone therapy.
• It can relieve vaginal dryness and help with some urinary problems.
• It may slow bone loss and reduce the risk of breaks. Studies show that people who use hormone therapy for three or four years around menopause have better bone density and fewer breaks fifteen years later than people who have taken a placebo.
• If you enter menopause early (before your 50s), hormone therapy can help protect your heart health.

Risks:

• Increased risk of uterine cancer: Estrogen makes the lining of the uterus grow, increasing the risk of endometrial cancer (cancer of the uterine lining). Pairing estrogen with a progestogen can counteract this.
• Mixed picture on breast cancer risks: Studies show a slight increase in risk of breast cancer for women who took estrogen and a progestin. However, studies show a slight decrease in risk for women who took estrogen alone. We know that breast cancer risk is higher for people who are obese, not very active, or consume a lot of alcohol. Talk to your provider about your breast cancer risk.
• Mixed picture on cardiovascular risks: A 2002 study by the Women's Health Initiative raised concerns about an increased risk of heart attack, stroke and blood clots for women taking hormones. The average age of women in the study was 64. Since then, researchers have found that short-term therapy for women around age 51, the average age of menopause, has a low risk of heart problems. In fact, recent studies suggest that hormone therapy around the time of menopause may actually carry heart benefits.

Other medications to manage menopause symptoms:

Selective estrogen receptor modulators (SERMS): These medications, usually taken as pills, block or activate estrogen in specific parts of the body. They can protect you from bone loss and fractures and help with sexual pain. They also can help manage menopause symptoms if you have a history of breast cancer and cannot use traditional hormone therapy.

Antidepressants: Low doses help with hot flashes and mood changes.

New medicines: KNDy neurons help control ovulation and are near the part of the brain that controls body temperature. Researchers are studying a non-hormonal drug to relieve hot flashes that quiets the KNDy neurons in the brain. These drugs will be available soon.

Over-the-counter products, such as vaginal lubricants and moisturizers, treat dryness and may help with pain during sex.

Lifestyle changes may lessen discomfort from hot flashes and other symptoms:

• Dress in layers.
• Have a fan at your desk and/or in your bedroom.
• Avoid or cut down on spicy foods, alcohol and coffee.
• Quit smoking.

Alternative or complementary therapies can help with hot flashes, insomnia and sexual and emotional changes. These include:

• Paced breathing, a method of slow, deep breathing, has been shown to reduce the strength and number of hot flashes.
• Yoga can be especially helpful for sleep problems.
• Hypnosis
• Mindfulness, focusing on the present and accepting your body’s sensations, can help with hot flashes and painful sex.

• Diet: Eat foods that are low in saturated fat and added sugars, including fruits and vegetables, whole grains and lean protein.
• Calcium: Women older than 51 need at least 1,200 milligrams of calcium a day. It can be hard to get this from dairy products and vegetables. Talk with your doctor about a calcium supplement.
• Vitamin D: Your body can’t absorb calcium without vitamin D. Good sources are fortified milk and sunlight. Talk with your doctor about supplements.

The U.S. Department of Health and Human Services recommends:

Moderate aerobic activity five days a week: Try brisk walking, cycling, hiking or swimming for 30 minutes.

Strength training twice a week: Choose weights that challenge you after 10 to 12 repetitions.

This amount of exercise can help with:

• Obesity
• Depression
• Stress
• High blood pressure
• Diabetes
• Bone loss
• Heart health