Menopause: what it is, when it happens, and what changes after

Menopause is talked about as if it were a long phase, but medically it is a single point in time. Understanding the stages around that point makes it much easier to know where you are and what is worth doing now.

What menopause is

Menopause is the time when your periods stop for good, because the ovaries stop making estrogen. It marks the end of the reproductive years.¹

It is identified looking back: NICE, the UK guideline body, says menopause can be identified once someone has not had a period for at least 12 months and is not using hormonal contraception. In otherwise healthy women aged 45 or over with typical symptoms, NICE says this can be done without laboratory tests.²

The three stages

Researchers use a more detailed staging system, called STRAW+10, which splits the transition into early and late stages based on changes in bleeding patterns. It applies regardless of age, ethnicity or body size.⁵

When menopause happens

The average age of menopause is 51.¹ In the SWAN study, which followed more than 3,000 US women from five racial and ethnic groups, the median age at the final period was 52.5, and ethnic groups did not differ once other factors were taken into account.³ In an earlier Massachusetts study, menopause came at 51.3 on average, and current smokers reached it about 1.8 years earlier than non-smokers.⁴

The perimenopause before it began at a median of 47.5 and lasted nearly four years in that study.⁴ Perimenopause age goes into the timing in detail, and signs perimenopause is ending covers how to tell you are near the end.

Menopause before 45 is called early, and before 40 premature. Both are reasons to see a doctor, and NICE recommends offering psychological support to women distressed by early menopause.²

What changes after menopause

Low estrogen affects more than periods.

• Bone. Women lose bone rapidly for the first 4 to 8 years after menopause, which raises the risk of osteoporosis.¹ What osteoporosis is explains why this matters.
• Heart. Estrogen offers some protection against heart attack and stroke before menopause. After it, much of that protection is lost, at an age when blood pressure and cholesterol also tend to rise.¹
• Muscle and body shape. In the SWAN study, lean mass began to fall during the transition while fat gain sped up.⁶
• Vagina and bladder. Tissue becomes thinner and drier, which can cause discomfort and more urinary infections.¹

Menopause symptoms covers everything you might notice.

What to put in place now

NICE advises clinicians to talk about bone health with people going through menopause, and to explain the importance of keeping muscle mass and strength through physical activity.² Those two are linked: the same habits protect both.

The protein goal comes from the Dietary Guidelines for Americans 2025 to 2030, which also tell adults to prioritize protein at every meal.⁷ Breakfast is where most women fall short. Protein Buddy works out a daily target from a short quiz on your weight, age, activity and goal, and Home shows how many grams are left today as you log. Typing meals in by hand is free with no limit. Protein through the menopause transition has the numbers, and an app to track protein after menopause keeps them in view.

Prescription medicine for menopause lays out the options before your appointment.

Treatment

Hormone therapy is the most effective treatment for hot flashes and night sweats, relieves vaginal dryness, and protects against the bone loss of early menopause. It also carries risks that depend on your age, health and history.¹ Whether it is right for you, and which of the non-hormone options might suit you instead, is a conversation to have with your clinician.