How long does menopause last?

From the moment the first hot flash hits or periods become as unpredictable as the weather, most women have one question running through their minds: How long does menopause last? Is this going to be something that will be over relatively quickly or will I need to deal with this for a decade (or longer)? Everyone’s menopause experience is unique, but for many women, symptoms linger for years. That said, knowing what to expect — and what you can do to feel more comfortable — can help keep this time from feeling like an eternity.

When does menopause start?

First things first: Let’s clear up some confusion around the term menopause and what that even means. Menopause is defined as the moment a year has passed since your last period. And exactly when that will happen varies from person to person (just like how some girls get their first period when they’re 11 and others don’t get it until they’re 15). The median age of menopause is roughly 51 to 52 years old, according to Dr. Monica Christmas, M.D., an OB/GYN at UChicago Medicine and the associate medical director of The Menopause Society, but it can happen earlier or later. “The average range that 95% of people fall into is between the ages of 45 and 55,” she says.

When a lot of people ask when menopause starts, though, they mean: When do menopause symptoms like irregular periods and hot flashes start? Those are signs of a phase known as perimenopause, which is the time leading up to menopause, and that can last anywhere from five to 10 years. For that reason, “it is completely normal for someone to start to experiencing changes in their late 30s or early 40s,” says Christmas. “But definitely by the mid 40s, many people are experiencing symptoms related to hormonal fluctuations.”

Duration of the menopausal transition

The entire menopausal transition — from the very first symptom of perimenopause to postmenopause — can take well over a decade. “You start to experience changes related to hormonal fluctuations up to 10 years before you actually reach menopause and your cycle stops,” says Christmas. Then once you go a full year without your period, you’ll enter what’s known as postmenopause and your symptoms might linger for a few more years (and for some, even longer). That means all in all, the transition can last anywhere from 10 to 15 years. And research has found that this can be even longer for women of color for a variety of reasons — some known and some unknown.

Perimenopause

Perimenopause is the phase that begins with your first symptom or irregular period, which is “when you start to have more than a seven-day difference in your cycles,” says Christmas. So one month your period may come after 33 days, then the next after just 24. During this time, your estrogen and progesterone levels are going down, but it’s not a steady decline. It looks more like the stock market during a recession, with lots of peaks and valleys. This phase can last between seven and 10 years, and over that time your periods can get really spread out and your symptoms may fluctuate wildly. Perimenopause continues until you have gone 12 months after your final period.

Perimenopause symptoms

In early perimenopause, most people don’t experience any symptoms besides irregular periods. This changes over time, with late perimenopause being the most intense stage. Your hormone levels are beginning to bottom out and can fluctuate wildly as your ovaries start to close shop. “Hot flashes, night sweats, mood swings, sleep issues, and vaginal dryness are common and can be intense for some women,” says Dr. Kecia Gaither, M.D., an OB/GYN and director of perinatal services and maternal fetal medicine at NYC Health + Hospitals in New York City. Here’s a snapshot of the most frequent menopause symptoms:

• Hot flashes and night sweats: These may start in early perimenopause but they will likely intensity in the late perimenopause phase and can linger for five years after menopause (or much longer). “Some people have just very mild hot flashes and night sweats, and some might not have any at all,” says Christmas. “And then you'll have people that get them multiple times a day and they're highly disruptive to their day-to-day function as well as their sleep.”
  
  
• Vaginal and urinary issues: These include vaginal dryness, itching, and irritation, and can lead to pain and bleeding with vaginal penetration. “Even urinary symptoms like urgency, frequency, and recurrent urinary tract infections typically happen,” says Christmas.
  
  
• Mood changes: Hormone levels are fluctuating during perimenopause, and as a result, “mood-related symptoms tend to be highly prevalent,” says Christmas. Why: Estrogen helps regulate the production of feel-good neurotransmitters, and lower levels can contribute to a depressed mood, increased anxiety, irritability, or anhedonia, which is “just not having the energy or motivation to do things that you easily did in the past,” she says.
  
  
• Poor sleep: Night sweats can keep you from getting a good night’s sleep, but insomnia on its own is also normal in this stage, happening to roughly half of women.
  
  
• Brain fog: Women tend to have more issues with memory and concentration during perimenopause, possibly due to sleep issues and mood swings as well as the drop in hormones.

Menopause

Menopause is used to refer to the entire transition, but in medical terms it’s basically a single moment that occurs when you’ve gone 12 months without getting your period. There’s no major change in your body on that day, but it signifies the switch from perimenopause to postmenopause.

Postmenopause

The moment after you hit menopause, you’re officially in postmenopause, and hormones like estrogen and progesterone are much lower than they were when you were younger. “It’s just the next phase of life,” says Christmas. Some people use this phrase — postmenopause — as a way of saying that they’re not experiencing symptoms anymore, but that’s not quite right since symptoms tend to continue into postmenopause.

Remember, “many of those symptoms, specifically hot flashes and night sweats, typically are most intense those last couple of years before the menstrual cycle ends and the first couple of years after the final menstrual period,” says Christmas. “But then for many people they go away.” As a result, even if someone has been in postmenopause for years, they might not say they are “done with menopause” until their symptoms are fully gone, which is about four to five years after menopause on average.

Hormone replacement therapy (HRT) for symptom relief

Hormone replacement therapy, which is also called menopause hormone therapy (MHT), is a way to supplement your estrogen and/or progesterone levels via a pill, patch, injection, cream, or gel. It can be used whether you’re in perimenopause or postmenopause, says Gaither. It can help relieve a host of symptoms associated with menopause, like hot flashes, night sweats, mood swings, vaginal dryness, and sleep issues — and can even help prevent osteoporosis, the risk of which rises after menopause. In fact, HRT is so effective that it’s considered a first-line treatment for these issues.

Generally speaking, the best candidates for HRT are women with moderate to severe menopausal symptoms, especially those in later perimenopause and early stage of menopause. There are some people who should avoid HRT. For instance, in some cases the ovaries malfunction and produce too much estrogen in perimenopause. “Giving them hormone therapy actually may make their bleeding symptoms worse, and potentially might not actually even help improve the other symptoms they're experiencing,” says Christmas.

Other tips for managing menopause symptoms

HRT is one way to improve symptoms, but it's not the only way. Here are some lifestyle tweaks that can help you feel more comfortable.

• Exercise regularly: Gaither recommends weight-bearing activities for bone health (since your risk of osteoporosis goes up with menopause), but all exercise has been found to help alleviate the intensity of vasomotor symptoms like night sweats and hot flashes — and can be beneficial for your overall health.
  
• Look at what you’re eating: Having a balanced diet — one that prioritizes low-fat protein, whole grains, and fruits and vegetables and minimizes red meat, sodium, and added sugar, for example — can both improve your overall health during menopause and also reduce the potential for symptoms. A program like WeightWatchers can help take the mental burden out of making healthier food choices.
  
  
• Get enough sleep: This can be easier said than done, especially if your hot flashes love to make an appearance around midnight. “If your night sweats are keeping you up at night, you probably feel groggy the next day,” says Christmas, who stresses that there are many medications out there for night sweats (talk to your doctor about your options).
  
  
• Try cognitive behavioral therapy (CBT): Research has found that CBT seems to help with many menopause symptoms, including hot flashes, mood swings, sleep issues, and sexual concerns. While the exact reason CBT works for menopause symptoms isn’t totally clear, “it seems that there’s a neurological component [to some symptoms like hot flashes], and so these treatment avenues help to calm the central nervous system down,” says Christmas. “It's a way to have a more positive mindset about what's going on.” CBT can help for both mood and sleep issues, too, says Gaither.
  
  
• Use vaginal estrogen: The general vaginal symptoms that arise during menopause, like dryness and itchiness, “can actually be managed with low-dose local vaginal estrogen therapy,” says Christmas. (This often comes as a topical cream.) And research shows that vaginal estrogen seems to help alleviate urinary urgency and incontinence, too.
  
  
• Avoid alcohol, caffeine, and other triggers: For some people, certain foods can trigger hot flashes and night sweats — alcohol being a really common offender, according to Christmas. “Caffeine is very similar,” she says. Sometimes added sugar and diets high in ultraprocessed foods can have more triggers too. To identify them, keep a symptom diary and jot down when you experience these symptoms; then, look for any patterns.