Medically reviewed by Soma Mandal, MD
Menopause is a normal part of aging that occurs when you stop having menstrual periods for at least one year. Generally, menopause starts in your 40s and 50s and marks the end of your reproductive years—or, the ability to conceive a child. Symptoms of menopause can begin as early as perimenopause, or the period of transition leading up to menopause, which lasts about four years before menopause begins.
During menopause, your hormone levels for estrogen and progesterone change, which can affect how you feel and how your body functions. During perimenopause, your hormone levels will rise and fall. But as you go through menopause, your body starts to make less and less estrogen and progesterone. When these hormonal changes occur, it's common to experience symptoms like irregular periods, trouble sleeping, hot flashes, night sweats, and fatigue.
Menopause affects everyone a little differently—you might have symptoms that come on gradually, start all at once, or change as time goes on. You may also experience a variety of symptoms that affect different parts of your body. But, most people who undergo menopause do share some symptoms in common. These symptoms are known as vasomotor symptoms and may include:
Vasomotor symptoms cause a sudden feeling of heat that you might feel on your head, neck, chest, upper back, and arms. Episodes of these symptoms can last anywhere from 30 seconds to 10 minutes. It's also common to experience cold chills after having a hot flash. Keep in mind: while most people who go through menopause experience hot flashes the year before and after menopause, hot flashes can continue for up to 14 years after you've completed menopause.
Vaginal and Urological Symptoms
Before you start menopause, your body gradually transitions to no longer having periods. During this time, you may notice that you're skipping periods or have periods that are heavier or lighter than normal. This could last for one to three years before your periods eventually stop altogether. Once you’ve gone a full year without having a period, you’ve officially reached menopause.
Because your estrogen levels are dropping, you might notice that your vaginal tissue is becoming drier and thinner. This can feel uncomfortable, itchy, or even painful—especially during sex. You might feel the need to use more lubricant or apply prescription estrogen cream inside your vagina to make sex less uncomfortable. Having sex while your vaginal tissue is dry can also result in small cuts in your vagina, which may increase your risk of sexually transmitted infections.
Separate from how sex feels, your feelings about having sex can also change during perimenopause and after menopause. These feelings are normal and it's OK to experience them. Some people may lose interest in sex or feel less sexual desire, while others may have an increased sexual libido and want to have more sex during menopause.
Menopause not only affects your vagina, but also the urethra (or, your pee hole) and your overall ability to pee. Once you start perimenopause, the bladder muscles weaken. As a result, you may start experiencing urinary incontinence—or, when you start leaking urine by accident. Leaking tends to happen when you sneeze, cough, laugh, vomit, or run.
Neurological and Cognitive Symptoms
Neurological (brain-related) symptoms of perimenopause and menopause may involve fatigue, headaches, sleeping issues, and trouble thinking. In fact, up to two out of three people who go through perimenopause have trouble remembering things or concentrating.
Menopause can affect your quality of sleep in a variety of ways. You might experience night sweats and insomnia, or not being able to fall asleep or stay asleep. Not getting enough sleep can then lead to fatigue, or feeling exhausted throughout the day and lacking energy to complete daily activities. As a result of poor sleeping, you might become more forgetful and have difficulty focusing on the task at hand.
Many people experience mood swings, or rapid changes in their mood, during perimenopause and menopause. Changes in hormonal levels can increase your risk of experiencing mental health concerns, such as irritability, anger, anxiety, depression, and lower self-esteem. You may also feel more emotional than normal or have crying spells for no apparent reason. While this can feel frustrating, it's important to treat yourself with care as you adjust to your new body.
While vaginal, neurological, and psychological symptoms tend to be most common as you go through menopause, it's also normal to experience other changes that affect your body's overall functioning.
As you begin to produce less estrogen, you might start losing muscle mass unless you are exercising regularly and incorporating strength training into your workout routine. Your metabolism also slows down, which can lead to weight gain or require more physical activity to maintain your current weight.
The risk of heart disease also increases after menopause, partly because of lower estrogen levels and sometimes because of changes in your weight. As your risk of heart disease rises, you may also notice an increase in your blood pressure and blood sugar. Some people can also feel a racing or irregular heartbeat at times.
The loss of estrogen can also contribute to a loss in your bone mineral density, meaning you have fewer minerals in your bones. A decrease in your bone mineral density can boost the likelihood of fracturing or breaking your bones. As a result, you might be at an increased risk of developing conditions like osteopenia and osteoporosis, which occur when your bone mass decreases and causes you to lose strength in your bones
Symptoms in Trans and Non-Binary People
Much of the current research available about menopause describes how this period of life affects cisgender women. However, perimenopause and menopause can occur to anyone who has a period, including trans people and non-binary people—or folks who identify with no gender, more than one gender, or have a fluctuating or fluid gender identity.
If you have ovaries (or were born with them) and get periods, you will eventually experience perimenopause and menopause when your body stops menstruating. Symptoms of perimenopause and menopause can vary from person to person, but the same symptoms that cisgender women experience can also occur in trans and non-binary people.
Trans men—those who were assigned female at birth—who still have ovaries will go through natural perimenopause and menopause. If you had your ovaries removed, you may likely experience surgical menopause, which involves the same symptoms as menopause, but symptoms that happen less gradually. Trans women—those who were assigned male at birth—may experience pseudo-menopausal symptoms, or symptoms that resemble aspects of menopause, if they stop hormone treatment or their hormone levels become unstable.
When to Contact a Healthcare Provider
Once you enter your 40s and 50s, you likely expect to go into menopause at some point soon. If you start experiencing symptoms of menopause or before you're 40 years old, consider seeing your healthcare provider. It's also important to see your provider if you're bleeding between periods or if you go a full year without a period and then experience menstrual bleeding again.
If you're going through menopause, you should also see your healthcare provider if any of your symptoms are interfering with your daily life. While menopausal symptoms can be uncomfortable from time to time, it's a good idea to seek medical care if you're having difficulty completing regular activities, experiencing trouble with functioning at home or at work, or feeling a lack of joy in activities you once enjoyed.
A Quick Review
Menopause is a normal part of aging that refers to the time in your life when your periods have completely stopped for at least one year. As you go through menopause, your hormone production of estrogen and progesterone starts to drop. These hormonal changes can cause a variety of symptoms, such as hot flashes, night sweats, trouble sleeping, vaginal dryness, and and increased risk of anxiety and depression.
It's worth noting that the current research on menopausal symptoms is primarily conducted on cisgender women. However, trans people, those who identify as non-binary, and anyone born with ovaries can experience symptoms of menopause. While symptoms of menopause can be uncomfortable from time to time, it's important to seek care from your healthcare provider if your symptoms are interfering with your daily life.
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