What is Menopause?

Are you having intense hot flashes, mood swings, or loss of sleep? Or is your body going through changes like irregular periods or loss of bladder control? Then you may be experiencing menopause.

Know that you are not alone. Many women have similar menopause symptoms, but they aren’t all created equal. Understanding what menopause is, its symptoms, and what options you have to treat it can be life-changing.

According to the National Institute on Aging, menopause affects over 1 million women in the United States (US) every year.[1] Menopause begins 12 months after a woman’s last period. However, there’s another stage before menopause. It’s called perimenopause, and it’s the period between when a woman starts having symptoms and the 12 full months of not having a period.[2] Perimenopause averages about seven years but ranges from 4 to 14 years for some women.[3]

Menopause occurs due to the natural decline in reproductive hormones as you age. These hormones include estrogen and progesterone. Lower levels lead to a loss of regular menstruation and a decline in fertility. When a woman starts to experience menopause varies.

Can Menopause Symptoms Start at 40?

If you ask your family or friends when they started having symptoms of menopause, you may receive several different answers. The typical age at which a woman starts menopause is between 45-55 years old.[4]

For some women in their mid to late 30s, there’s a decline in their reproductive hormones without symptoms of menopause or perimenopause. Other women may start showing signs of menopause at 40. With perimenopause lasting for nearly seven years, on average, women could be well into their 50s or 60s before they notice a change.

When do menopause symptoms start?

When menopausal symptoms start relies on several factors.[4] Some of these you can control, such as your smoking history, use of oral contraceptives, or physical activity. Others, like your family history or age at the onset of your period, you cannot control. Other environmental factors, including lead exposure, education levels, and socioeconomic status, affect how early or late a woman starts menopause.

When do menopause symptoms end?

Any time after your full 12 months of no menstrual cycle is over, you enter what is known as postmenopause. During this time, you may notice a decline or stop of the symptoms you have been experiencing. In the postmenopause phase, you are no longer able to get pregnant. You may be at an increased risk of other health conditions, such as:[4]

  • Osteoporosis or thinning of the bones, making them easier to break
  • Cardiovascular disease, which increases the risk of heart attacks or strokes
  • Mental health conditions like anxiety or depression
  • Vaginal health changes such as dryness or discomfort

What are the Symptoms of Menopause?

The symptoms women experience during the early to late stages of menopause are similar. Some symptoms are mild and do not require treatment other than lifestyle changes like lowering caffeine intake or having a fan. Others are more severe, leading you to seek treatment options like medications or supplements.

Common symptoms include[2][4]

  • Changes in menstruation
  • Hot flashes or night sweats
  • Mood swings
  • Sleep disturbances
  • Body changes
  • Memory issues
  • Loss of bladder control
  • Vaginal dryness
  • Decreased sex drive
  • Thinning dry skin and hair
  • Can menopause symptoms come and go?

    Menopause symptoms

    Menopause symptoms may come and go. For example, as hormone levels change, your period may stop for several months and then return. Their flow and the length of your period could also fluctuate. Similarly, hot flashes may start off mild and change their intensity. In the postmenopausal phase, your symptoms will start to fade or go away altogether.

    Are menopause symptoms like pregnancy symptoms?

    Often menopause symptoms are mistaken for pregnancy symptoms. This is common when going through early menopause at 40. Similar symptoms include a change in your period, cramping, fatigue, or weight gain.

    Remember, although periods are irregular, you can still get pregnant while in perimenopause. If you don’t want to get pregnant, speak with your healthcare provider about contraceptive options.

    What Menopause Symptoms Does Estrogen Help?

    Estrogens are a group of hormones vital to women’s reproductive and sexual health. Most of the estrogen found in your body is produced by your ovaries. Estrogen acts as a chemical messenger in the body, influencing your sexual, bone, and heart health. Changes in estrogen levels are natural and a part of the aging process.

    As part of the transition to menopause, your ovaries make less estrogen. Decreased estrogen lowers your body’s ability to regulate your period, vaginal secretions, libido, or mood. As a result, you experience irregular periods, vaginal dryness, decreased sex drive, and even signs of depression or anxiety. Additionally, lower estrogen levels are linked to an increased risk of bone fractures and heart disease.

    Boosting estrogen levels through lifestyle changes, medications, or supplements can help ease certain menopause symptoms.[5]

    What Menopause Symptoms Does Progesterone Help?

    Like estrogen, progesterone is another natural hormone that impacts female reproductive and sexual health. Progesterone is produced by your ovaries and brain and helps regulate estrogen’s effects in your body. Menopause causes a decline in progesterone. This affects your ability to become and stay pregnant. Decreased progesterone may also cause women to experience changes in their mood and energy. Replacing progesterone can help reduce these symptoms during menopause.

    Doctors often combine progesterone with estrogen during hormone replacement therapy. Combination products are the preferred choice for women with a uterus to reduce the risk of endometrial cancer.

    What are the Treatments for Menopause Symptoms?

    Treating symptoms of menopause will need to be tailored to fit your needs. For example, you can use hormones, non-hormonal treatments, or even lifestyle changes to improve your symptoms.[6][9] Any treatments need to be discussed with your doctor to weigh the risks and benefits to your health.

    1. Hormone therapy

    Hormone therapy

    Hormone therapy is available only through prescription and delivers estrogen alone or an estrogen-progesterone combination to treat symptoms. These medications are considered safe and effective. But, using the correct dose and type can help lower the risk of using these products.

    Deciding which option is right for you depends on your hormone levels and if you have had your uterus removed. For women without a uterus, estrogen-only products may work better. Estrogen-only products include patches, gel/sprays to put on the skin, implants, and tablets for women with a uterus. Progesterone-only or estrogen-progesterone products in a patch, intrauterine devices (IUDs), or tablets are available.

    Your formulation depends on your preference, risk of heart disease, or other health histories. For example, using an estrogen patch is helpful for those at risk of heart disease. Low-dose birth control pills help with mood swings and hot flashes. They also regulate your periods. An IUD is helpful if you prefer the convenience of not remembering to take medication daily.

    Women suffering from vaginal discomfort or dryness often need products that work directly in the vagina. These estrogen products can be creams, tablets, capsules, or rings.

    2. Bioidentical hormones

    Bioidentical hormones are artificial hormones made from plants designed to mimic human hormones.

    These are often compounded specifically for your needs based on your healthcare provider’s prescription. Since they are custom products, they aren’t approved by the US Food and Drug Administration.[10] However, they do follow an FDA-approved development process.

    Many women feel these are much safer than the FDA-approved hormone replacement options. But, the evidence to support this is lacking.

    3. Non-hormone medicines

    Non-hormone medicines do not contain estrogen or progesterone. They’re a good option for women who don’t wish to use hormone-based treatment options. They are mainly used in women experiencing hot flashes/night sweats, or mood swings. Yet, they may be helpful for other health conditions as well.

    4. Antidepressants

    Research shows that some medications treat both symptoms of anxiety and depression and hot flashes and mood swings. For example, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)[8] decrease the severity and number of hot flashes women experience while on these medications. Women who can tolerate these medications may also improve their mood.

    Selective serotonin reuptake inhibitors (SSRIs) Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft)
    Serotonin-norepinephrine reuptake inhibitors (SNRIs) Desvenlafaxine (Pristiq), Venlafaxine (Effexor), Trazodone

    5. Gabapentin

    Gabapentin is often used to treat seizures and nerve pain. In a study comparing gabapentin with estrogen use among women with hot flashes, researchers found gabapentin is as effective and well-tolerated.[11]

    However, the dose used to treat hot flashes is much lower than the doses needed to treat seizures or other nerve-related issues. Ask your doctor before using gabapentin if you have a history of seizures or take other medications for seizures, as doses may need to be adjusted.

    6. Clonidine

    Clonidine lowers blood pressure and prevents migraines. It also reduces hot flashes and night sweats.

    Compared to other non-hormonal treatments, it’s not preferred because of its side effects.[12] You may experience drops in blood pressure causing dizziness, palpitations, or chest pain/discomfort.

    7. Lifestyle changes

    Simply making lifestyle changes is enough to improve symptoms for many women. For example, following a balanced diet rich in calcium or quitting smoking prevents osteoporosis and heart disease. Additionally, adequate physical activity, such as 30 minutes of exercise at least five days per week, prevents weight gain and unwanted body changes. Lastly, using stress management tools like meditation or yoga helps to manage menopause.[13]

    What Supplements Can Treat Menopause Symptoms?

    Supplements are another way to treat your menopause symptoms. The US Food and Drug Administration doesn’t regulate supplements as they do with medications. So, it’s essential to understand the active ingredients of any supplement you are taking. Choosing options that are third-party tested will also help ensure the product descriptions are accurate. You will often find many supplements combined into one product. Common supplements available include:

    • Estrovera
    • Femquil
    • Menoquil
    • Nature’s Way AM/PM Formula
    • Nutrafol Menopause Support
    • Remifemin Menopause Relief

    What Menopause Symptoms Does Black Cohosh Help?

    Black cohosh is a supplement that has estrogen-like properties, which can help to improve menopause symptoms like hot flashes/night sweats, mood swings, and vaginal dryness. But it shouldn’t be used as a substitute for estrogen. Clinical studies reviewed black cohosh for treating menopausal symptoms at various doses.[14] They note an improvement in symptoms, but some evidence is conflicting.

    The American Family of Physicians supports black cohosh use as a non-hormonal therapy option for hot flashes caused by menopause.[15] It’s often combined with other natural ingredients that help support you during menopause. Black cohosh is one of the main ingredients in Menoquil, providing you with the recommended daily serving.

    If you have a history or family history of liver disease, exercise caution when using black cohosh. Studies of women with a history or family history of hormone-responding cancers such as breast, ovarian, or uterine cancers may not benefit from black cohosh as well.16 Side effects include dizziness, headache, nausea, and vomiting. Before starting on any black cohosh supplement, please speak with your healthcare provider to ensure it’s safe.

    How Long Does it Take for Black Cohosh to Work for Menopause?

    Relief of menopause symptoms is not immediate when using supplements like black cohosh. It can take up to 4 weeks before you start to see changes. Studies reviewing the use of black cohosh for menopause do not provide a duration for how long it is safe to use black cohosh. Health professionals recommend using it no longer than six months to a year.[15][16]


    Menopause is a natural occurrence for all women. The age you enter menopause depends on several factors, some of which you can and cannot control. No matter when you enter menopause, recognizing you have treatment options is important.

    Hormone replacement options are safe and effective. They also come in a variety of forms to fit your needs best. There are options for non-hormonal medications and natural supplements. Menoquil includes several supplements known for improving your symptoms, such as black cohosh.

    If you are starting to experience menopause symptoms, speak with your healthcare provider about your options. This new stage in your life doesn’t have to be controlled by menopause.