What to know about menopause, according to a doctor

By Katia Hetter, CNN

(CNN) — Menopause is a nearly universal experience for women who live to middle age. In the United States, an estimated 1.3 million women enter menopause every year. Around 90% of women experience menopausal symptoms, which can include hot flashes, sleep disturbances, mood alterations and weight gain.

This condition happens in every woman who had ovaries when she went through puberty, yet many report not having enough information about it. Some 94% of US women reported never being taught about menopause at school, according to a 2023 study. Nearly half said that they did not feel informed at all about it.

I wanted to get the facts by speaking with CNN wellness expert Dr. Leana Wen. What is menopause, and when does it occur? How is it diagnosed, and what are typical symptoms? How can people best manage their symptoms? And where else can they go to find reliable, accurate information? Wen is an emergency physician and adjunct associate professor at George Washington University. She previously was Baltimore’s health commissioner.

CNN: Can you explain what menopause is and why it happens?

Dr. Leana Wen: Menopause is the period in a woman’s life when her menstrual periods stop. For most women, this natural, biological process occurs as a part of going through midlife when the ovaries stop producing certain reproductive hormones.

In some situations, menopause is induced by surgery or medical treatment. For instance, someone with cancer may need to have their ovaries removed, or they may go through chemotherapy or radiation that has the same effect of stopping ovarian function.

One of the consequences of menopause is the decrease in blood levels of two key hormones: estrogen and progesterone. It’s believed that the decrease in estrogen, in particular, is responsible for common menopausal symptoms.

CNN: At what age does menopause occur? And how long does it generally last?

Wen: There is significant variation in when menopause occurs. Most women go into menopause between ages 40 and 58, with the average age of experiencing menopause being 51, according to the North American Menopause Society.

Some women can enter menopause much earlier due to the medical and surgical circumstances mentioned above. There are also other factors. Women who smoke, for example, often reach menopause two years before nonsmokers. And there is a genetic component, too. Women whose mothers or sisters experience menopause earlier tend to follow in their footsteps.

Menopause usually lasts about seven years, but the duration can be as long as 14 years. The duration varies depending on factors such as race, smoking and age of menopause onset.

CNN: Is there a way to diagnose menopause? If someone is having irregular periods and fatigue, should they take a test to see if they are in menopause?

Wen: Menopause does not require any specific testing. This diagnosis is generally made in retrospect and is defined as 12 months without having a period. That means someone who is still having periods is not yet menopausal. They could be in perimenopause, or they could have another reason for having irregular periods and fatigue.

In some circumstances, testing could be warranted. Someone who is under 40 and has stopped having periods could consider testing. Also, testing may be warranted to exclude other conditions. For example, a health care professional might want to rule out anemia and hypothyroidism in someone with fatigue. And just because a woman could be entering menopause doesn’t mean that all symptoms can be attributed to it.

CNN: You mentioned perimenopause. What’s that? 

Wen: Except in situations where menopause is induced by surgery or medical conditions, menopause generally does not occur suddenly. A period of time called perimenopause exists four to eight years before menopause. Many women have irregular periods during this time and start experiencing menopausal symptoms.

CNN: What are typical menopausal symptoms?

Wen: The most common menopause-related symptom is hot flashes. Someone experiences a sudden sensation of heat that can be accompanied by sweating, skin flushing and rapid heartbeat.

Related to this is night sweats, where the hot flashes occur at night. Women can wake up drenched in sweat. They may find it hard to fall back asleep, leading to sleep disturbances and irritability.

Another common condition is drying and thinning of the vaginal tissues that can result in discomfort during sex. Menopausal women also may start having more frequent urinary tract infections. And some women may experience mood changes, dry skin and weight gain.

It’s important to flag that these symptoms can be severe. About 25% of women who have hot flashes experience such significant symptoms that they seek medical care. About 1 in 3 women have more than 10 hot flashes a day.

It’s also important to note that the rate of chronic conditions such as cardiovascular disease and osteoporosis increases after menopause. This uptick is thought to be due to the protective effect of estrogen against these diseases.

CNN: How can women best manage their symptoms?

Wen: I think it’s crucial for women to know that they don’t have to suffer through these symptoms. A variety of treatments are available.

First, we need to discuss hormone treatment. Hormone treatment was the standard of care for menopause-related symptoms until a study came out that unfortunately was misinterpreted. The number of prescriptions for hormonal treatment declined, and many women were unable to get relief for their symptoms.

Earlier this year, some of the original study authors wrote a paper, published in JAMA, that provided a new analysis and thorough explanation of when and how to use hormone treatment. It makes clear that hormone treatment with a combination of estrogen and progesterone is safe, effective and appropriate for treating women with hot flashes and other bothersome menopausal symptoms if started before age 60 and in women without contraindications (such as an estrogen-responsive cancer).

In addition to hormones taken as pills, there are patches that can deliver similar effects. Women over 60 experiencing vaginal symptoms also could opt for vaginal creams and suppositories that deliver hormones.

Nonhormonal treatments exist as well. Last year, the US Food and Drug Administration approved a medication, fezolinetant, specifically for use in reducing hot flashes. Women experiencing bone loss can take medications specifically to address osteoporosis. There are also many lifestyle changes that can help, such as improved diet and exercise, smoking cessation, and even yoga and acupuncture.

CNN: Where else would you advise that women go to find reliable, accurate information?

Wen: Your primary care provider and your gynecologist, if you have one, should be people you direct questions to. However, studies have shown that many providers are not trained to provide the full range of options for menopause treatment.

If you don’t get the answers you need from your own providers, I highly recommend the North American Menopause Society. Among its many resources is a database of clinicians who have extra training to treat women going through menopause and demonstrate a specific interest in guiding women going through this important change in their lives.

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