Perimenopause and menopause
Perimenopause and menopause, explained
The symptoms, stages and treatments of the menopause transition in plain language, what the evidence says, and the everyday changes that make these years easier.
24 articles
- 7 natural menopause treatments that really work, and the popular ones that do notFor hot flashes, the Menopause Society recommends cognitive behavioral therapy and clinical hypnosis, and weight loss for women carrying extra weight. For the body changes of menopause, strength training, protein at every meal, and calcium and vitamin D from food all have strong support. Supplements, herbal remedies, soy and paced breathing are not recommended for hot flashes. Hormone therapy remains the most effective treatment, so natural options work best alongside a conversation with your clinician.
Early perimenopause symptoms: the first signs at 40, 44 and 47The earliest sign is usually a change in your cycle: periods a little earlier or later than usual, a change in flow, or a skipped period. Other early signs include night sweats or hot flashes, poorer sleep, irritability or low mood, and heavier periods. At 40 these changes can be perimenopause or something else, so they are worth checking. By 44 to 47 they are very often perimenopause, which started at a median age of 47.5 in one large study.
Hormone balancing supplements for perimenopause: do any work?There is no good evidence that any supplement balances hormones in perimenopause. Hormone swings in the transition are normal, not a deficiency a pill can fix. The usual ingredients have been tested for symptoms: the Menopause Society does not recommend supplements, herbal remedies or soy extracts for hot flashes, and black cohosh was no better than placebo in a Cochrane review. Hormone therapy, prescribed by a clinician, is the treatment that actually changes hormone levels.
Hot flashes: why they happen, how long they last, and what worksHot flashes are sudden waves of heat in the face and upper body caused by the falling and fluctuating estrogen of perimenopause and menopause. In a large US study they lasted a median of 7.4 years. Hormone therapy is the most effective treatment. Without hormones, the Menopause Society recommends cognitive behavioral therapy, clinical hypnosis, several prescription medicines and, for women with extra weight, weight loss. It does not recommend supplements, herbal remedies or soy.
Is there a test for perimenopause? What blood and home tests can and cannot tell youNot a reliable single one. Hormone levels swing up and down during perimenopause, so one blood test can look normal on one day and menopausal the next. NICE advises doctors to identify perimenopause in women 45 and over from symptoms and cycle changes, without lab tests. An FSH blood test is reserved for women 40 to 45 with symptoms, or under 40 when early menopause is suspected. Home tests measure FSH in urine and share the same limits.
Menopause and depression: who is at risk, and what helpsNot in every woman. A 2024 Lancet review found no compelling evidence that depression rises for all women over the menopause transition. But some women are more vulnerable: those with severe hot flashes that disturb sleep, a long transition, stressful life events, or a past episode of depression. For low mood linked to menopause, NICE suggests clinicians consider hormone therapy or CBT. Diagnosed depression is treated with the usual depression treatments. Thoughts of self-harm need help the same day.
Menopause belly fat: why it appears and how to lose itBy losing fat overall while protecting muscle. After menopause, new fat is more likely to be stored as deep belly fat. A meta-analysis of 101 trials in postmenopausal women found exercise reduced waist size and visceral fat: aerobic training did most for fat and strength training most for muscle, so combining them works best. Add protein at every meal to hold on to muscle and trim sweet drinks, alcohol and refined snacks to create a modest calorie deficit.
Menopause fatigue: why you are so tired, and what helpsFatigue around menopause usually has several causes stacked together. In the SWAN study, hot flashes tended to cluster with sleep problems and fatigue, because night sweats break up sleep. Heavy periods in perimenopause can cause iron deficiency, a common cause of tiredness in women. Losing muscle makes everyday effort harder. Treating night sweats, checking iron and thyroid with your doctor, strength training and eating enough protein all help.
Menopause insomnia: why sleep breaks down and what fixes itStart with the two causes that feed each other. If night sweats wake you, treat them: hormone therapy is the most effective option, and there are non-hormone ones. For the insomnia itself, cognitive behavioral therapy for insomnia (CBT-I) is the first line treatment for all adults, according to the American College of Physicians. Sleeping pills are a short-term option to discuss with your doctor if CBT-I alone does not work.
Menopause symptoms: what to expect and how long they lastThe most common are hot flashes and night sweats, sleep problems, mood changes, vaginal dryness and more urinary infections, joint and muscle aches, and lower sex drive. Hot flashes usually fade over several years, with a median total of 7.4 years in a large US study. Vaginal and urinary symptoms tend to stay or worsen unless treated. Menopause also brings changes you do not feel, such as faster bone loss and muscle loss, which training, protein and calcium help counter.
Menopause weight loss pills: what works, what does notOver-the-counter menopause weight loss pills have little or no evidence. They are supplements, sold without FDA review of their effectiveness, and the best studied ingredient, berberine, averaged under 1 kg of weight loss. Prescription medicines are a different category: in the STEP 1 trial, semaglutide led to about 15 percent weight loss over 68 weeks. Whether a prescription medicine suits you is a conversation with your doctor. With any approach, high protein and strength training help protect muscle.
Menopause: what it is, when it happens, and what changes afterMenopause is the point when your periods stop for good because the ovaries stop making estrogen. It is confirmed after 12 months without a period. The average age in the US is about 51. The years before it are perimenopause, when symptoms such as hot flashes and cycle changes usually start, and everything after is postmenopause. Menopause speeds up bone and muscle loss, so strength training, protein and calcium matter more from here on.
Ovulation in perimenopause: do you still ovulate, and what are the signs?Often, but less and less predictably. In a study that tracked hormones in daily urine samples, cycles without ovulation became more common through perimenopause, and more than 60 percent of cycles in late perimenopause had none. But about a quarter of cycles longer than 60 days still included ovulation, and ovulation tended to happen later in the cycle. So the usual signs can come and go, and conception is still possible until your doctor confirms otherwise.
Perimenopause age: when it starts and how long it lastsPerimenopause usually starts in the mid to late forties. In a large Massachusetts study the median age at onset was 47.5, and it lasted nearly four years before the final period, which comes at about 51 on average in the US. It can start earlier: ACOG notes that estrogen can begin to fluctuate in your 30s and 40s. Smokers tend to reach it earlier. Menopause before 45 is called early and is a reason to see a doctor.
Perimenopause rage: why irritability spikes and what helpsYes. In a study that tracked women's moods daily, those in the early menopause transition reported more severe irritability, impatience and feeling out of control than women before it, and anger and irritability were worse in the days before a period. Poor sleep from night sweats, stress and a history of low mood can make it worse. Treating sleep and hot flashes helps, and mood changes that are severe or new deserve a doctor's visit.
Perimenopause supplements: which ones have evidence and which do notFor hot flashes, the Menopause Society's 2023 review does not recommend supplements or herbal remedies, and a Cochrane review of black cohosh found no difference from placebo. The supplements with real evidence in this period work on muscle and bone rather than symptoms: enough protein, creatine alongside strength training, and calcium and vitamin D when food does not cover them. Hormone therapy and prescription options are a conversation with your clinician.
Perimenopause symptoms: the full list, and what helps each oneThe first sign is usually a change in your periods: cycles get longer or shorter, flow changes, or periods are skipped. Other common symptoms are hot flashes and night sweats, sleep problems, mood changes, brain fog, joint and muscle aches, vaginal dryness, and changes in body shape as muscle falls and fat moves to the middle. Some women have few symptoms, others many. Treatments with good evidence exist, and hormone therapy is the most effective for hot flashes.
Perimenopause weight gain: why it happens and what actually helpsNot because metabolism collapses: a large study of people aged from newborns to 95 found energy use, adjusted for lean tissue, stays stable from 20 to 60. What changes in the transition is more specific. Muscle starts to decline, fat gain speeds up and shifts to the belly, energy use during sleep falls, and physical activity tends to drop in the years before the final period. Protein at every meal, strength training and slightly smaller portions answer each of those.
Prescription medicine for menopause: the options, explained simplyFor hot flashes and night sweats, hormone therapy is the most effective prescription treatment, and it also prevents bone loss. For women under 60 or within 10 years of menopause without reasons to avoid it, the Menopause Society says benefits outweigh risks. For vaginal dryness, low dose vaginal estrogen is recommended. Non-hormone options for hot flashes include certain antidepressants, gabapentin, fezolinetant and oxybutynin. Choose with your clinician.
Signs perimenopause is ending, and what comes nextThe clearest sign is longer gaps between periods. Researchers define the late stage of perimenopause as a gap of 60 days or more without a period, and at that point the final period is usually not far away. Perimenopause is over, and menopause confirmed, once you have gone 12 months without a period. Some symptoms, especially hot flashes, can continue for several years after that.
The menopause diet 5-day plan to lose weightEach day has three meals and one snack, built around a protein food at every meal, vegetables and fruit, and modest portions of whole grains and fats. Calculated from USDA data, the days come to about 1,450 to 1,650 calories, 110 to 130 g of protein and 1,075 to 1,725 mg of calcium. That is a moderate calorie deficit for most women, with protein kept high to protect muscle while you lose fat.
The menopause diet: what to eat, based on what actually changesThere is no special menopause diet, but the transition changes three things food can help with: muscle falls, fat shifts to the middle, and bone thins faster. So eat protein at every meal (about 25 to 30 g), get 1,200 mg of calcium and enough vitamin D after 50, fill half the plate with plants for fiber, and have a little less of everything else, because energy use drops. Diet changes have not been shown to stop hot flashes.
The menopause workout: what to do each week, and whyA mix of strength training and aerobic exercise. In a meta-analysis of 101 trials in postmenopausal women, aerobic training did most for fat loss and strength training did most for muscle, and combining them is the sensible plan. The WHO recommends muscle strengthening on two or more days a week and 150 to 300 minutes of moderate activity. Pair training with enough protein, about 25 to 30 g per meal, so the work turns into muscle.
Vitamins for menopause fatigue: which ones help, and only whenVitamins help fatigue only when you are deficient. Worth checking are iron, since heavy periods in perimenopause can cause iron deficiency and chronic fatigue, and vitamin B12, which affects 2 to 3 percent of US adults and is more common with age and some medicines. Vitamin D matters for bone. A blood test tells you what you need. If levels are normal, better sleep, movement and enough protein help more than extra vitamins.