Select a condition Absence seizures Acne ADHD Age-related macular degeneration AIDS Alzheimer's disease AMD Amebic dysentery Anal tears Angina, stable Angina, unstable Ankle sprain Anorexia Anxiety Appendicitis Arthritis Asthma in adults Asthma in children Athlete's foot Atrial fibrillation Attention deficit hyperactivity disorder (ADHD) Autism Back pain Bacterial vaginosis Bad breath Bedsores Bedwetting Bell's palsy Benign prostatic hyperplasia Bipolar disorder Bladder infection in women Blood pressure Breast cancer Breast pain Bronchiectasis Bronchiolitis Bronchitis Bulimia Bunions Burning mouth syndrome Burns and scalds Canker sores Cardiac arrest Carpal tunnel syndrome Cataracts Cellulitis and erysipelas Chickenpox Childbirth, heavy bleeding Childbirth, tear or cut Chlamydia Chronic bronchitis Chronic fatigue syndrome Chronic obstructive pulmonary disease Chronic prostatitis Chronic tension type headache Cold sores Colic in babies Colon and rectal cancer Colon and rectal cancer screening Colonic diverticular disease Common cold Conjunctivitis Constipation in adults Constipation in children COPD Crib death Deep vein thrombosis Dementia Depression in adults Depression in children Diabetes, type 1 Diabetes, type 2 Diarrhea in adults Diarrhea in children Diverticular disease Ear infection, middle ear Ear infection, outer ear Ear infection with discharge Ear infection with fluid Ear pain during air travel Ear wax Eczema Emphysema Endometriosis Enlarged prostate Epilepsy Episiotomy Erection problems Essential tremor Febrile seizures Fertility problems Fibroids Flu Gallstones Genital herpes Genital warts GERD GERD in children Glaucoma Gonorrhea Gout Group B streptococcus H. pylori infection Halitosis Hay fever Headache, chronic tension type Head lice Heart and circulation problems in diabetes Heart attack Heartburn Heart failure Heavy periods Heel pain Hemorrhoids Hepatitis B Hepatitis C Hernia Herpes, genital Herpes simplex eye infection High blood pressure High blood pressure in pregnancy High cholesterol HIV infection Hyperactivity IBS Incontinence in women Infection in newborn babies Infertility Influenza Insomnia in adults Irritable bowel syndrome Jaundice in newborn babies Jet lag Kidney infection Kidney stones Leg cramps Leg ulcers Lewy body dementia Lung cancer Lyme disease Macular degeneration Malaria prevention Manic depression Mastalgia Measles, mumps and rubella: prevention Melanoma Meniere's disease Meningococcal disease Menopause Migraine in adults Migraine in children MMR prevention Morning sickness Multiple sclerosis Nail infection, fungal Neck pain Nicotine addiction Non-Hodgkin's lymphoma Nosebleeds in children Obesity Obsessive-compulsive disorder OCD Oral thrush Osteoarthritis Osteoporosis Ovarian cancer Painful periods Pancreas cancer Panic attacks Parkinson's disease PCOS Pelvic inflammatory disease Perineal care Peripheral vascular disease Pneumonia Polycystic ovary syndrome Postpartum depression Postpartum hemorrhage Post-traumatic stress disorder Preeclampsia Pregnancy, nausea Premature birth Pressure sores Prostate cancer Prostatitis, chronic Psoriasis PTSD Raynaud's disease Rectal cancer screening Recurrent cystitis Reflux in children Rheumatoid arthritis Scabies Schizophrenia Seasonal allergy Shoulder pain Sickle cell anemia Sickle cell disease SIDS Sinusitis Skin cancer (melanoma) Skin cancer (squamous cell) Sleep apnea Sleep problems in children Slipped disk Smoking Sore throat Stomach ulcers Stress headache Stress incontinence Stroke, emergency care Stroke prevention Sudden infant death syndrome Swimmer's ear Tennis elbow Tension headache Testicular cancer Thrush (oral) Tic douloureux Tinnitus Tonsillitis Toxoplasmosis in pregnancy Trigeminal neuralgia Underactive thyroid Urinary tract infections in children Varicocele Varicose veins Vascular dementia Warts Whiplash Wisdom teeth, impacted Wrinkles Yeast infection, vagina

Select treatment area Bladder & Kidneys Blood Brain & nervous system Cancer Children's health Diabetes Digestive system Ear, nose & throat Eating & weight Eyes Fertility Heart and circulation Hormones Infections Lungs & breathing Men's health Mental health Mouth Muscles & bones Pregnancy & childbirth Sexual health Skin Sleep Staying healthy Travel health Women's health

Menopause is when your periods stop for good. After you've gone through menopause, you can't get pregnant. These changes don't happen overnight. You can get symptoms of menopause for several years.

Menopause is not an illness. It's a normal part of every woman's life. But for some women, the symptoms of menopause can be distressing. Hot flashes can be uncomfortable and cause sleepless nights. A dry vagina can make sex painful. You may get urinary infections. And you may feel depressed.^{1 2 3 4}

If your symptoms are making life miserable, you don't have to put up with them. There are treatments that can help, although some have side effects. You will need to weigh the pros and cons of treatment and decide with your doctor what's right for you.

• Menopause isn't an illness. It's a natural part of your life.
• It happens when your body stops making certain hormones.
• The symptoms of menopause can be distressing, but you don't have to put up with them. You can get help.
• The main treatment for menopause is hormone replacement therapy (HRT). But if you don't want to take this, there are other treatments that also may help.
• There are things you can do yourself to help relieve symptoms of menopause. See Self-help for common menopausal symptoms.

Your periods are part of your menstrual cycle.⁵ This regular monthly set of events gets your body ready for pregnancy. It's controlled by many different hormones, including two made by your ovaries: estrogen and progesterone.

Estrogen is not one hormone but a group of hormones made by your body. But most people refer to all these hormones as estrogen.

Your hormones make an egg come out of one of your ovaries every month. They also make the lining of your womb (endometrium) get thicker and softer in case you get pregnant.

At the end of the monthly cycle, if you're not pregnant, your hormone levels drop and you have your period. A period is your body's way of getting rid of the thickened lining of your womb. After your period, your hormone levels start to rise and the whole cycle begins again.

Your menstrual cycle begins during puberty. On average, each cycle lasts about 28 days, but it can be shorter or longer.

To learn more, see What happens every month.

It's also helpful to know something about the parts of your body involved in getting pregnant and having periods.

Together, this is called your reproductive system. It includes your ovaries, your fallopian tubes, your womb and your vagina.

To find out more about these parts of your body, see Your reproductive system.

Strictly speaking, menopause begins at the end of your very last period.⁴ Of course you can't know when you're having your last period. So it's impossible to know at the time if you are going through menopause. You are said to be "menopausal" if you haven't had a period for 12 months and you have symptoms such as hot flashes.¹

But menopause doesn't happen out of the blue. The changes in your body that lead to it start much earlier, even as early as 10 years before your last period.⁶

During the lead up to menopause, your ovaries start to make less of two important hormones: estrogen and progesterone. You make less of these hormones because, as you grow older, you start losing the eggs that are stored in your ovaries.^{7 8} When you are born, there are hundreds of thousands of these young eggs stored in your ovaries. Only a few hundred ever get released during your lifetime. The rest begin to shrivel up and disappear as you get older.

It's these young eggs that stimulate your ovaries to produce the hormones estrogen and progesterone. So, as you lose these eggs, your ovaries make less of these hormones, too.

Researchers still don't completely understand why the ovaries stop working as part of the aging process.⁹ When and how quickly your ovaries stop working may be partly something you inherit from your mother.

In the years before you reach menopause, you may notice that your periods aren't so regular, or there may be a change in your patterns of bleeding. This is often one of the first signs that your hormone levels are changing.

Doctors call this stage perimenopause. It usually begins in your 40s and it can last for several years.¹ Some of the most common symptoms of menopause, such as hot flashes and problems sleeping, can begin at this time.

Changes in your hormone levels can have lots of different effects on your menstrual cycle.⁷ For example, when your ovaries start making less progesterone, you may have heavier periods. The job of progesterone is to help prepare the womb for a fertilized egg. It also helps the womb to shed this lining if an egg is not fertilized. If the ovaries don't make enough progesterone, the lining of your womb may continue growing. This is why many women have such heavy periods during perimenopause.⁷

Some of the things that may happen are listed below.

• You may have lighter or heavier bleeding than normal.
• You may bleed for fewer days or more days than usual.
• Your menstrual cycle may get shorter or longer.
• You may skip a period.

All of these changes in bleeding patterns are normal during perimenopause, and they're nothing to worry about. But you should talk to your doctor if you have any of the following changes in your bleeding, because you may have another condition that needs to be treated.¹⁰

You should let your doctor know if:

• Your periods are very heavy (you need to change a tampon or pad every hour or two)
• Your periods last more than six days
• The time between the start of one period and the start of the next is shorter than 21 days
• You get bleeding or "spotting" between periods
• You bleed after having sex.

Several things can cause this abnormal bleeding. The most common causes are:

• Polyps. These are growths in the lining of the womb or neck of the womb (cervix). They aren't cancer
• Fibroids. These are growths in the wall of the womb. They aren't cancer
• Endometrial hyperplasia. This is a thickening of the lining of the womb. It isn't cancer, but it could turn into cancer if it isn't treated.

All these things can be treated. However, some kinds of cancer can also cause abnormal bleeding, although this is less common. So it's important to see your doctor.

Eventually your ovaries make so little estrogen and progesterone that your menstrual cycle and your periods stop. This is when you have reached menopause.

But, your ovaries don't always stop producing estrogen completely, even after you've been through menopause. Although levels of one form of estrogen (called estradiol) drop, you will still make a weaker kind of estrogen (called estrone). And another part of your body, your adrenal glands, will keep making estrone, too.⁴

It's worth remembering that, until you're sure you've reached menopause (that is, you haven't had a period for a year) you can still get pregnant. This is because your hormone levels go up and down, and your ovaries may still be releasing eggs (ovulating), even if it's only once in a while. And if your periods are irregular, it may be more difficult to predict when you are likely to release an egg.

It's worth talking to your doctor about birth control if you are having sex and don't want to get pregnant.

Most women will go through menopause between the ages of 45 and 55, but some women have an early or premature menopause. Doctors say a woman has an early menopause when it happens before she is 40. Having surgery or other treatment for some diseases such as cancer are the most common reasons why women go through menopause early.

To find out more, see Early menopause.

Some women still have periods even when they're over 55. These women are said to have a delayed or late menopause. Having a late menopause usually runs in families, but it can also happen if you are overweight.

In the United States, the average age that women go through menopause is 51.⁸ But researchers don't know very much about the things that affect exactly when a woman will go through it.⁸

This is what we know from studies.

• Smokers are likely to go through menopause one to two years earlier than nonsmokers.^{11 12}
• If you've used the birth-control pill or have had children, you might go through menopause a little later than other women.
• The age at which you go through menopause may be linked to the age at which your mother and grandmother went through it.