What Is Menopause? A Complete Evidence-Based Guide

Menopause is the point when your periods have stopped for good, confirmed once you have gone 12 months in a row without one. It happens because the ovaries stop releasing eggs and estrogen falls. Most people reach menopause between 45 and 55. Symptoms usually begin earlier, in perimenopause, and can continue for years afterward.

What is menopause?

The World Health Organization defines natural menopause as 12 consecutive months without a period, when there is no other physical cause and no medical intervention is responsible. Menopause itself is one moment, recognized only in hindsight.

Three terms describe the stages around it:

In everyday conversation, "menopause" is often used for the whole experience, including perimenopause and the years after. On Midlife Atlas we use the precise terms where it matters, especially for treatment and contraception. Our guide to the stages of menopause explains each in detail, and our perimenopause guide covers the transition itself.

Natural and induced menopause

Most menopause is natural, but it can also be brought on by medical treatment:

• Surgical menopause happens immediately when both ovaries are removed. See surgical menopause.
• Medical menopause can follow chemotherapy, pelvic radiotherapy or certain hormone treatments.
• Hysterectomy alone stops periods but does not cause menopause if the ovaries are kept, although menopause may come sooner.

When does menopause happen?

The WHO notes that natural menopause generally happens between 45 and 55 in women worldwide. In the United States, the average age of the final period is 51.

Menopause before 45 is less common:

• Early menopause happens between 40 and 44.
• Premature ovarian insufficiency (POI) is menopause before 40. A 2024 international guideline notes that recent studies suggest it affects around 3.5% of women, higher than the 1% previously thought.

If your menopause comes early, the health advice is different. See early menopause and our guide to menopause at 40, 45, 50 and beyond.

Why does menopause happen?

You are born with all the egg-containing follicles you will ever have. Their number falls throughout life. By midlife, too few remain to keep the monthly cycle going.

As follicles run out, the ovaries respond less to signals from the brain. Estrogen fluctuates and then falls, progesterone drops as ovulation stops, and follicle-stimulating hormone (FSH) rises. Estrogen (spelled "oestrogen" in the UK) reaches its lowest levels one to two years after the final period. For a detailed explanation, see hormone changes during perimenopause.

Estrogen acts throughout the body, including the brain, bones, blood vessels, skin, bladder and vaginal tissue. That is why menopause can affect so many systems at once.

What are the symptoms of menopause?

Symptoms vary widely. Some people have very few; others find them disruptive for years.

Hot flashes and night sweats are the hallmark symptoms. Up to 80% of women experience them during the transition. See hot flashes (called hot flushes in the UK) and night sweats.

Vaginal, vulval and urinary changes are known as genitourinary syndrome of menopause. A systematic review found they affect about 55% of postmenopausal women. Unlike hot flashes, they tend to persist or worsen without treatment. See vaginal dryness and urinary changes.

Other common symptoms include:

• Sleep problems: see sleep problems
• Mood changes: anxiety and low mood
• Brain fog: difficulty concentrating or finding words. See brain fog
• Joint and muscle aches: see joint pain
• Lower sex drive: see low libido
• Changes in body shape: see weight changes

Experiences differ across cultures. A review of international studies found women in East and Southeast Asia generally reported hot flashes less often than women in Western countries, while insomnia, irritability and joint stiffness were more commonly reported.

How is menopause diagnosed?

For most people, menopause is recognized from your history rather than a test.

The UK’s National Institute for Health and Care Excellence (NICE) advises that, in otherwise healthy people aged 45 or over, menopause can be identified without laboratory tests if you have not had a period for at least 12 months and are not using hormonal contraception. If you have had a hysterectomy, NICE advises identifying menopause from your symptoms.

Tests play a bigger role if you are under 45, or under 40, when premature ovarian insufficiency is possible. Hormonal contraception and some treatments can make it harder to tell when menopause has happened. See how to know when menopause has started and perimenopause tests.

How long do menopause symptoms last?

Longer than many people expect. In the Study of Women’s Health Across the Nation (SWAN), women with frequent hot flashes or night sweats had them for a median of 7.4 years in total. They continued for a median of 4.5 years after the final period, and for longer in African American women.

Different symptoms follow different paths. Hot flashes usually ease with time, while vaginal dryness often persists. See how long menopause symptoms last.

What treatments are available?

The best approach depends on your symptoms, your health history, your age and your preferences. This is an overview, not a recommendation for any individual. Please do not start or stop prescription medicines based on a general article.

Everyday measures

Regular physical activity, especially strength training, protecting your sleep, cutting back on alcohol and stopping smoking all support your long-term health. Practical steps such as layered clothing and a cool bedroom make hot flashes and night sweats easier to manage.

Cognitive behavioral therapy (CBT)

In November 2024, NICE recommended that menopause-specific CBT be considered for hot flashes, night sweats, sleep problems and low mood linked to menopause. It can be used alongside or instead of hormone therapy. Evidence shows its biggest effect is on how disruptive symptoms feel.

Hormone therapy

Hormone therapy is called HRT in the UK, menopausal hormone therapy (MHT) in Australia and hormone therapy (HT) in the US. It replaces estrogen, and people who still have a womb also need a progestogen to protect the womb lining.

• Effectiveness: The Menopause Society describes hormone therapy as the most effective treatment for hot flashes and for vaginal and urinary symptoms.
• Benefit and risk: Its 2022 position statement concludes that, for people under 60 or within 10 years of menopause who have no contraindications, the benefits generally outweigh the risks for bothersome hot flashes and preventing bone loss.
• Individual factors: Risks depend on type, dose, route, timing and your personal history. Patches and gels may carry a lower risk of blood clots and stroke than tablets.
• Recent US changes: In November 2025, the US Food and Drug Administration (FDA) began removing statements about cardiovascular disease, breast cancer and probable dementia from the boxed warning on hormone therapy labels, following a review of the evidence. Hormone therapy still has risks that need individual discussion.
• Not suitable for everyone: Clinicians take particular care with people who have had a heart attack, stroke, blood clot, hormone-sensitive cancer or active liver disease.

A quick guide to hormone therapy types

Our planned HRT section will cover each option in depth.

Non-hormonal prescription medicines

• Fezolinetant acts on the brain’s temperature-control center. NICE recommends it for moderate to severe hot flashes when HRT is unsuitable.
• Elinzanetant works on a similar pathway. The FDA approved it in October 2025, following approvals in the UK, Canada, Australia and Switzerland.
• Some antidepressants, gabapentin and clonidine are also used, although NICE advises against offering them routinely as first-line treatment for hot flashes alone.

Availability and cost differ by country.

Vaginal estrogen

For vaginal dryness, discomfort and urinary symptoms, NICE recommends offering low-dose vaginal estrogen, including to people already using HRT. Only minimal amounts are absorbed into the bloodstream.

Supplements

NICE notes some evidence that isoflavones or black cohosh may ease hot flashes. However, preparations vary and their safety is uncertain, so tell your clinician what you take.

How does menopause affect everyday life?

The NHS notes that menopause symptoms can have a big impact on relationships, social life, family life and work, or hardly any impact at all. A few areas come up often:

• Work. Poor sleep, hot flashes and difficulty concentrating can make work harder. Simple adjustments, such as temperature control, flexible hours or breaks, can help. Employment rights vary by country.
• Relationships and intimacy. Low mood, irritability, lower sex drive and vaginal discomfort can strain relationships. Treating physical symptoms and talking openly often helps.
• Confidence and identity. Some people find menopause unsettling; others describe it as a time of new freedom. Both are normal.

Talking to others can make a real difference, whether that’s friends, family, a support group or a menopause café. If symptoms are affecting your life, that alone is a good reason to seek help.

What about menopause after cancer treatment?

Chemotherapy, pelvic radiotherapy and some hormone treatments for cancer can bring on menopause suddenly, sometimes at a young age. Symptoms can be intense.

Hormone therapy is generally not recommended after breast cancer. However, there are other options:

• Non-hormonal medicines, CBT and practical measures
• Elinzanetant, which has been studied specifically in women with a history of breast cancer
• Low-dose vaginal estrogen, which is sometimes considered for severe vaginal symptoms after specialist discussion

Your oncology team should be part of these decisions.

How does menopause affect long-term health?

Menopause is a turning point for several aspects of health:

• Bones. SWAN found that a phase of fast bone loss starts about a year before the final period. Bone density falls by about 2% a year for around three years, then more slowly. That adds up to roughly 10% over a decade, which raises the risk of osteoporosis and fractures.
• Body composition. In SWAN, the rate of fat gain doubled and lean muscle began to decline around the start of the transition. These changes continued until about two years after the final period. Weight on the scale rose steadily with age rather than jumping at menopause, which can hide what is changing underneath.
• Heart and circulation. Cardiovascular risk rises after menopause. Population studies link earlier menopause with higher risks of heart disease, stroke and osteoporosis.
• Brain. SWAN found a subtle, temporary dip in learning and memory scores during perimenopause that resolved after menopause.

This is why the years around menopause are a good time to check blood pressure, cholesterol and diabetes risk. It is also a good time to review bone health and build strength training into your routine. The WHO describes menopause as an opportunity to reassess your health and goals.

Menopause is a global experience

In 2021, women aged 50 and over made up 26% of all women and girls worldwide, according to the WHO, and that share is growing. Yet access to menopause information and treatment varies enormously between countries. How menopause is experienced also depends on culture, family, work and how society views ageing.

What about menopause myths?

Many beliefs about menopause are outdated or only half true. Examples include "HRT is dangerous for everyone," "you need a blood test" and "hot flashes only last a year." See menopause myths and facts.

When should you see a doctor?

Book an appointment if:

• Symptoms are affecting your sleep, work, relationships or wellbeing
• You are under 45 and think you are going through menopause
• You would like to discuss treatment options
• You need advice on contraception, which is still needed until guidance says you can stop. See pregnancy during perimenopause.

Get checked promptly if you have:

• Any vaginal bleeding 12 months or more after your last period, however light
• Bleeding after sex or between periods
• Very heavy bleeding, such as soaking through a pad or tampon every hour for several hours
• Periods that stop before age 40

Seek emergency care for chest pain, sudden breathlessness, or signs of a stroke. If low mood includes thoughts of harming yourself, contact emergency services or a crisis line in your country straight away.

Our guide to your first menopause appointment lists the questions worth asking. Our private Symptom Explorer can help you prepare a summary.

What happens after menopause?

After menopause, you are postmenopausal for the rest of your life. Hot flashes usually ease over time, but vaginal and urinary symptoms may continue or begin later, and bone and heart health need attention. Treatment decisions can be revisited as your needs change. The Menopause Society does not recommend routinely stopping hormone therapy at a fixed age.

A practical checklist

• Track your symptoms and any bleeding for two or three months.
• Book an appointment if symptoms affect your life. You don’t need to wait until they’re severe.
• Review contraception until guidance says you can stop.
• Move more, including strength training twice a week, for muscles, bones and mood.
• Check your numbers: blood pressure, cholesterol and blood sugar.
• Know the red flags, especially any bleeding after menopause.
• Revisit decisions as your symptoms and needs change.

Frequently asked questions

What is the average age of menopause?

Most people reach menopause between 45 and 55. In the United States, the average age of the final period is 51.

Can you have menopause symptoms and still have periods?

Yes. Symptoms often begin during perimenopause, while periods are still happening, sometimes years before they stop.

Is menopause a disease?

No. Natural menopause is a normal life stage. Its symptoms and health effects can still deserve treatment, and there is no need to "put up with" symptoms that affect your life.

Does everyone get hot flashes?

No. Up to 80% of women experience them, but some have few or none, and severity varies widely.

Can menopause happen in your 30s?

Yes, although it is uncommon. Menopause before 40 is called premature ovarian insufficiency and needs medical assessment, partly because of its effects on bone and heart health.

References

1. World Health Organization: Menopause fact sheet
2. NICE guideline NG23: Menopause, identification and management (recommendations)
3. NICE: Updated menopause guidance and HRT discussion aid (November 2024)
4. The Pharmaceutical Journal: NICE recommends CBT for menopause symptoms
5. ACOG: Perimenopausal bleeding and bleeding after menopause
6. ESHRE/ASRM/IMS: Evidence-based guideline on premature ovarian insufficiency, 2024
7. Avis NE et al. Duration of menopausal vasomotor symptoms. JAMA Internal Medicine, 2015
8. ScienceDaily: Hot flashes, night sweats last seven or more years (SWAN)
9. Prevalence of psychosomatic and genitourinary syndrome among menopausal women: systematic review and meta-analysis
10. The 2022 hormone therapy position statement of The North American Menopause Society
11. US FDA: FDA approves labeling changes to menopausal hormone therapy products
12. Harvard Health: FDA removes menopause hormone therapy black box warnings
13. Contemporary OB/GYN: FDA approves elinzanetant (Lynkuet)
14. Bayer: Lynkuet (elinzanetant) US approval
15. SWAN fact sheet: Bone health over the menopause transition
16. Greendale GA et al. Changes in body composition and weight during the menopause transition. JCI Insight, 2019
17. El Khoudary SR et al. The menopause transition and women’s health at midlife: SWAN progress report
18. Schoenaker DAJM et al. Socioeconomic position, lifestyle factors and age at natural menopause. International Journal of Epidemiology, 2014
19. Menopause-associated depression (review, including cross-country symptom differences)
20. NHS: Hysterectomy: considerations
21. NHS: Menopause: symptoms
22. NHS inform: Menopause: symptoms, treatment and support
23. Living Beyond Breast Cancer: FDA approves elinzanetant
24. Leeds Teaching Hospitals NHS Trust: HRT and unscheduled vaginal bleeding (regimen types)
25. Australasian Menopause Society: Bleeding in perimenopause, postmenopause and on MHT

Editorial status: evidence-based educational article. Last evidence check: September 10, 2026.