What Are the Symptoms of Menopause? When They Start and How Long They Last

In brief:

• Menopause is diagnosed retrospectively after 12 consecutive months without a period (WHO).
• Symptoms vary greatly from person to person; some women have almost none.
• After menopause, the risks of bone density loss and cardiovascular disease increase.
• Any bleeding after menopause needs medical attention, even if it happens only once and is light.

What are menopause and perimenopause?

Menopause is the permanent end of periods as ovarian function slows and stops. According to the World Health Organization (WHO), it is diagnosed retrospectively, looking back at the last period, after 12 consecutive months without a period and with no other cause. Most women reach natural menopause between ages 45 and 55.

Perimenopause is the transition that starts with the first symptoms and continues until one year after the last period; it can last several years (WHO). Most symptoms begin during this time. For more, see What Is Perimenopause? What Changes in Your 40s?.

What are the symptoms of menopause?

The NHS lists the following symptoms. You do not need to have all of them.

Changes in periods

Periods may become more or less frequent, and bleeding may be heavier or lighter than usual. For most women, this is the first noticeable change.

Hot flushes and night sweats

A sudden feeling of heat in the face, neck and chest, followed by sweating and chills. It can happen during the day or while sleeping. Night sweats may interrupt sleep and increase tiredness.

Sleep problems

Difficulty falling asleep or staying asleep. Night sweats may also disrupt sleep.

Mood changes, forgetfulness and brain fog

Mood swings, low mood and anxiety; forgetfulness and difficulty concentrating. The NHS also calls this brain fog.

Weight gain

Weight gain may be more noticeable around the abdomen and upper body. We discuss ways to support metabolism during this time in How Can We Maintain Metabolism and Energy During Menopause?.

Vaginal dryness and painful sex

Vaginal dryness, burning, irritation or itching, which can make sex painful. You can read about changing intimate-care needs in Why Do Intimate-Care Needs Change During Menopause?.

Frequent urinary tract infections

Urinary tract infections may become more frequent, or similar symptoms such as frequent urination and burning may occur.

Other symptoms

The NHS also lists palpitations, urinary leakage, headaches or worsening migraines, muscle and joint pain, thinning or loss of hair, dry and itchy skin, reduced sex drive, and sensitive teeth and gums.

When do symptoms start, and how long do they last?

Symptoms often start during perimenopause while you are still having periods. According to the NHS, they usually last 7–9 years, sometimes longer; their type and severity can change during this time.

Menopause before 45 is called early menopause, and before 40 it is called premature menopause (NHS). In these cases, symptoms start earlier than expected and medical assessment is important.

Which health risks increase after menopause?

According to the WHO fact sheet, as oestrogen levels fall:

• Bone density decreases, an important factor in the increased frequency of postmenopausal osteoporosis and fractures.
• Women's advantage of having a lower cardiovascular disease risk than men gradually diminishes.
• Structures supporting the pelvic floor may weaken, increasing the risk of organ prolapse.

Menopause is therefore also a good time for regular check-ups. You can find information about recommended tests in Tests Every Woman Should Have Once a Year.

What can help with symptoms?

For hot flushes and night sweats, the NHS recommends:

• Wear light clothing and keep your bedroom cool at night.
• Take a cool shower, use a fan or have a cold drink.
• Look for ways to reduce stress.
• Reduce triggers such as spicy foods, caffeine, hot drinks, smoking and alcohol.
• Exercise regularly and maintain a healthy weight.

Depending on symptom severity, lifestyle changes, hormone therapy or other options may be considered. You and your doctor decide what suits you. We compare the advantages and disadvantages in Hormone Therapy or Natural Supplements During Menopause?.

When should you see a doctor?

The NHS recommends seeing a doctor if:

• You think you have menopause symptoms and want to understand your options
• You have palpitations
• You are still having periods and bleeding is heavier than before
• You have any vaginal bleeding after 12 months or more without a period
• You have bleeding after menopause, even if it happens once, is light or is only spotting, and even if you are not sure it is blood
• You are using hormone therapy and still have irregular or heavier bleeding after six months

Frequently asked

At what age do menopause symptoms start?

Most women reach menopause between ages 45 and 55, and symptoms usually begin beforehand, during perimenopause (WHO, NHS). They can also start earlier.

How many years do menopause symptoms last?

According to the NHS, usually 7–9 years and longer for some women. Symptoms may come and go or change in severity during this time.

Is bleeding after menopause normal?

No. Any bleeding after 12 months without a period needs medical attention, even if it happens once or is only spotting (NHS).