Menopause: symptoms, age, stages, diagnosis and natural ways to manage it

Menopause is a natural stage of life, but that does not mean every woman experiences it in the same way. For some, the transition is relatively mild. For others, hot flashes, night sweats, sleep problems, mood changes, vaginal dryness and irregular periods can significantly affect everyday life.

It is also important to understand that menopause itself is not a disease. It is the point in time when a woman has gone 12 consecutive months without a menstrual period, provided there is no other explanation for the absence of periods. The years leading up to this point are called perimenopause, or the menopausal transition.

This guide explains menopause in simple terms, including when it usually begins, the early signs to look for, how menopause is confirmed, lifestyle measures that may help, suitable foods and drinks, and when it is important to speak to a doctor.

What is menopause in females?

Menopause is the permanent end of menstrual periods and natural reproductive fertility. It occurs when the ovaries gradually reduce their production of reproductive hormones, particularly oestrogen and progesterone, and eventually stop releasing eggs regularly.

However, menopause does not happen suddenly for most women.

There are three commonly discussed stages:

• Perimenopause: The transition leading up to menopause. Periods may become irregular and symptoms can begin.
• Menopause: The point reached after 12 consecutive months without a menstrual period.
• Postmenopause: The years following menopause.

Perimenopause may begin several years before the final menstrual period. During this time, hormone levels can fluctuate considerably, which is why symptoms may come and go or vary from month to month.

At what age does menopause start?

There is no single age at which menopause starts for every woman.

The menopausal transition commonly begins during the 40s, while natural menopause most commonly occurs between 45 and 55 years of age. The average age of menopause in the United States is around 52.

So, if a woman is in her 40s and notices changes in her periods accompanied by symptoms such as hot flashes or sleep disturbances, perimenopause may be one possible explanation.

Is it possible to start menopause at 38?

Yes, menstrual and menopausal symptoms can occur before 40, but menopause at this age is not considered typical natural menopause.

Menopause before 40 is generally considered premature menopause, while menopause before 45 is considered early menopause. Primary ovarian insufficiency (POI) is another condition involving reduced or abnormal ovarian function before 40 and is not exactly the same as natural menopause because ovarian function can sometimes remain intermittent.

If periods become irregular or stop before 40, it is important to consult a gynaecologist rather than assuming it is simply menopause. Other causes need to be considered and appropriate evaluation may be recommended.

What are the symptoms of starting menopause?

Symptoms usually appear during perimenopause, rather than suddenly on the day menopause occurs.

Common symptoms include:

• Irregular periods
• Periods that become heavier or lighter
• Longer or shorter gaps between periods
• Hot flashes
• Night sweats
• Difficulty sleeping
• Mood changes or irritability
• Anxiety or low mood
• Vaginal dryness
• Discomfort during sex
• Urinary urgency or other bladder symptoms
• Reduced sexual desire
• Headaches
• Joint and muscle aches
• Breast tenderness
• Difficulty concentrating or memory lapses
• Dry skin
• Changes in body weight or body composition

Not every woman experiences all of these symptoms, and their severity can differ considerably.

What are the 7 signs of menopause?

If you are looking for the most recognisable signs, seven common ones are:

1. Changes in periods – cycles may become irregular, lighter, heavier, shorter or longer.
2. Hot flashes – sudden feelings of heat, sometimes accompanied by sweating.
3. Night sweats – episodes of sweating during sleep that may disturb rest.
4. Sleep problems – difficulty falling asleep or staying asleep.
5. Mood changes – irritability, anxiety, low mood or emotional fluctuations.
6. Vaginal dryness – reduced lubrication can cause discomfort, particularly during sex.
7. Urinary symptoms – increased urgency, frequency or recurrent urinary problems.

These symptoms suggest the menopausal transition but do not by themselves prove that menopause has occurred.

What is the root cause of menopause?

The underlying biological cause of natural menopause is the gradual decline in ovarian function.

As the ovaries age, the number and activity of ovarian follicles decline. Eventually, ovulation becomes less frequent and the ovaries produce substantially less oestrogen and progesterone. Menstrual cycles become irregular and ultimately stop.

Menopause can also occur earlier because of factors such as:

• Surgical removal of both ovaries
• Certain cancer treatments, including chemotherapy or radiation
• Some medical treatments
• Primary ovarian insufficiency
• Certain genetic or medical conditions

Smoking and a family history of early or premature menopause have also been associated with earlier menopause.

How can you confirm menopause?

For a woman aged 45 or older with typical symptoms, menopause can usually be identified clinically rather than through routine hormone testing. Menopause is confirmed retrospectively when there has been 12 consecutive months without a period, provided hormonal contraception or another medical cause is not responsible.

Hormone blood tests are not routinely required for diagnosing menopause in otherwise healthy women aged 45 or older.

However, testing may be considered in younger women. NICE recommends considering an FSH blood test when menopause is suspected in women aged 40–45 with symptoms and menstrual changes, or in women under 40 when premature ovarian insufficiency is suspected.

A doctor may also investigate other possible causes of irregular or absent periods, depending on age, symptoms, medical history and medications.

How to self-treat menopause?

There is no home treatment that permanently stops or reverses menopause. However, many women can reduce troublesome symptoms through lifestyle changes.

Helpful measures may include:

Stay physically active

Regular physical activity can support cardiovascular health, muscle strength, bone health, sleep and mood.

A combination of aerobic exercise, resistance training and activities that improve balance and flexibility can be useful.

Keep your bedroom cool

If hot flashes or night sweats are disturbing sleep, keeping the bedroom cool, wearing breathable clothing and using lighter bedding may help.

Identify your triggers

Some women notice that hot flashes become worse after:

• Spicy foods
• Alcohol
• Caffeine
• Hot environments
• Smoking
• Stress

Keeping a symptom diary can help identify individual triggers.

Prioritise sleep

Try to maintain a regular sleep and wake time. A dark, quiet and cool bedroom can also help.

Manage stress

Meditation, deep breathing, yoga, relaxation exercises and other stress-management techniques may help some women cope with symptoms.

Seek treatment when symptoms interfere with life

Lifestyle changes are useful, but you do not have to suffer through severe symptoms. Depending on your circumstances, treatment options may include hormone therapy, menopause-specific cognitive behavioural therapy and other non-hormonal treatments. NICE recommends individualised discussion of the benefits and risks of treatment.

How can you control menopause naturally?

You cannot naturally stop menopause from happening because it is a normal biological transition. What you can do is support your health and manage symptoms naturally.

Focus on:

• Regular exercise
• Adequate sleep
• A balanced diet
• Adequate calcium and vitamin D
• Plenty of fluids
• Maintaining a healthy weight
• Limiting alcohol
• Avoiding smoking
• Moderating caffeine if it triggers symptoms
• Managing stress
• Maintaining social connections

These measures are particularly important because declining oestrogen after menopause is associated with changes in bone health and cardiovascular risk.

Which drink is good for menopause?

Water is one of the best drinks during menopause.

Good hydration is important for general health, and drinking water regularly can help prevent dehydration, particularly if you experience heavy sweating or night sweats.

Other useful choices may include:

• Plain or sparkling water
• Milk or calcium-fortified alternatives
• Unsweetened soy beverages
• Caffeine-free herbal drinks

There is no specific drink that can cure menopause or restore declining ovarian hormone production.

If hot flashes are a problem, you may find it helpful to reduce drinks containing substantial amounts of caffeine or alcohol, as these can worsen symptoms for some women.

Is drinking lots of water good for menopause?

Staying adequately hydrated is a good habit during menopause, but drinking excessive amounts of water is not necessary.

Instead of forcing yourself to drink unusually large quantities, drink regularly throughout the day and respond to thirst. Water should be your main source of hydration.

If you have kidney, heart or other medical conditions that require fluid restriction, follow your doctor’s advice instead.

What vitamins help during menopause?

There is no single “menopause vitamin” that prevents all symptoms.

However, several nutrients are particularly important during and after menopause.

Vitamin D

Vitamin D helps the body absorb calcium and is important for bone health. Vitamin D deficiency should be corrected when present, but taking high-dose supplements without medical advice is not recommended.

Vitamin B12

Vitamin B12 is important for healthy nerves and blood cells. Women who follow vegetarian or vegan diets may need to pay particular attention to B12 because natural B12 is primarily found in animal foods, while fortified foods can provide a plant-based source.

Calcium

Calcium is technically a mineral rather than a vitamin, but it deserves particular attention during menopause because bone loss accelerates as oestrogen levels decline. Women over 50 generally have higher calcium requirements than younger adult women.

The best approach is to assess your diet and individual needs rather than automatically taking multiple supplements.

What foods should you avoid during menopause?

There is no universal list of foods that every woman must completely eliminate.

However, some foods and drinks may worsen particular symptoms.

Consider limiting:

• Alcohol, particularly if it triggers hot flashes or affects sleep
• Excess caffeine, especially if it causes anxiety, palpitations or sleep problems
• Very spicy foods, if they trigger hot flashes
• Highly processed foods high in added sugar and unhealthy fats
• Excessively salty foods
• Large meals immediately before bedtime

At the same time, focus on vegetables, fruits, whole grains, pulses, beans, nuts, seeds and adequate protein.

Foods containing phytoestrogens, such as soy, chickpeas, lentils and flaxseed, can be included as part of a balanced diet.

What not to do during menopause?

A few habits can make the transition harder.

Try not to:

• Ignore persistent or severe symptoms
• Smoke
• Rely heavily on alcohol to relax or sleep
• Consume excessive caffeine if it worsens symptoms
• Take unregulated hormone or herbal preparations without professional advice
• Stop prescribed medicines without discussing them with your doctor
• Avoid exercise because of menopause
• Assume every symptom is automatically caused by menopause

Unregulated hormone preparations and supplements can have uncertain safety and quality, and some complementary products can interact with medicines.

What are the worst menopause symptoms?

There is no single “worst” menopause symptom because experiences differ.

For some women, hot flashes and night sweats are the most disruptive. For others, insomnia, mood changes, vaginal symptoms, urinary problems or joint and muscle discomfort may have a greater effect on daily life.

Symptoms can also interact with one another. For example, repeated night sweats may disrupt sleep, and poor sleep can contribute to fatigue, irritability and difficulty concentrating.

If symptoms are significantly affecting your work, relationships, sleep or quality of life, speak with a healthcare professional. Effective treatment options are available.

What’s the worst age for menopause?

There is no medically recognised “worst age” for menopause.

A woman can experience substantial symptoms in her 40s, 50s or later, while another woman of the same age may experience very few symptoms.

The severity and duration of symptoms matter more than the number on the birthday cake.

Menopause occurring unusually early is a different issue. Menopause before 45 is considered early, while menopause before 40 requires assessment for premature menopause or primary ovarian insufficiency.

How long does menopause last?

Strictly speaking, menopause does not last for years.

Menopause is a specific point in time — the point at which a woman has gone 12 consecutive months without menstruating.

What can last for several years is the menopausal transition and associated symptoms. The National Institute on Aging notes that menopause-related symptoms can last between two and eight years, although experiences vary considerably.

Some symptoms may continue after menopause, particularly vaginal and urinary symptoms.

How to tell if a woman has menopause?

The strongest clue is a combination of age, menstrual changes and symptoms.

A woman may be approaching menopause if she notices:

• Periods becoming irregular
• Changes in menstrual flow
• Hot flashes or night sweats
• Sleep difficulties
• Mood changes
• Vaginal dryness
• Urinary symptoms

But symptoms alone cannot establish that menopause has occurred.

If she has had 12 consecutive months without a period, and there is no other explanation, she has reached menopause.

For women under 45, particularly under 40, medical assessment is important because other conditions can cause menstrual changes or early loss of ovarian function.

When should you see a doctor?

You should consider speaking with a healthcare professional if:

• Symptoms are interfering with everyday life
• Periods become unusually heavy
• You develop symptoms before 40
• Periods stop unexpectedly
• You have persistent vaginal or urinary symptoms
• You experience significant mood changes
• You are considering hormone therapy or supplements
• You have vaginal bleeding after menopause

Any vaginal bleeding after menopause should be assessed by a healthcare professional.

It is also worth discussing long-term health during menopause, particularly bone health, cardiovascular risk, nutrition, exercise and appropriate preventive healthcare.

Frequently asked questions about menopause

What is menopause in females?

Menopause is the permanent end of menstrual periods. It is diagnosed retrospectively after 12 consecutive months without a period, when there is no other cause for the absence of menstruation.

What age does menopause usually start?

The transition usually begins during the 40s. Natural menopause most commonly occurs between 45 and 55, although individual experiences vary.

Can menopause start at 38?

Symptoms of ovarian hormone decline can occur before 40. However, menopause before 40 is considered premature and warrants medical evaluation rather than being assumed to be normal menopause.

What are the first signs of menopause?

Changes in periods are often among the earliest signs. Hot flashes, night sweats, sleep problems, mood changes and vaginal symptoms may follow or occur alongside menstrual changes.

Can menopause be confirmed with a blood test?

Not usually in women aged 45 or older with typical symptoms. Menopause is generally identified from symptoms and menstrual history. FSH testing may be considered in certain younger women.

Is there a natural cure for menopause?

No. Menopause is a natural biological transition rather than a disease that needs to be cured. Lifestyle measures can help manage symptoms, while medical treatments can be considered when symptoms are troublesome.

Does menopause cause weight gain?

Hormonal changes, ageing, changes in muscle mass, sleep disruption and lifestyle can all contribute to changes in body weight and body composition around menopause. Regular physical activity and a balanced diet can help support healthy weight management.

Is menopause dangerous?

Menopause itself is a normal life stage. However, declining oestrogen is associated with longer-term changes in bone and cardiovascular health, making healthy lifestyle habits and appropriate preventive care important.

The bottom line

Menopause is a normal stage of a woman’s life, but the symptoms can be very real and sometimes disruptive. Understanding the difference between perimenopause, menopause and postmenopause can make the transition less confusing.

For most women, the transition begins during the 40s and natural menopause occurs between 45 and 55. Irregular periods, hot flashes, night sweats, sleep problems, mood changes, vaginal dryness and urinary symptoms are among the common signs.

There is no single food, drink, vitamin or home remedy that stops menopause. A balanced diet, regular exercise, adequate hydration, good sleep, stress management and avoidance of individual symptom triggers can help. When symptoms are severe, there are also evidence-based medical treatments worth discussing with a healthcare professional.

Most importantly, don’t assume that every new symptom is simply menopause. Particularly when symptoms occur unusually early, are severe, or involve abnormal bleeding, a medical evaluation is appropriate.