CNN
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Menopause is a nearly universal experience for women who live into middle age. An estimated 1.3 million women in the United States go through menopause each year. About 90% of women experience menopausal symptoms, such as hot flashes, sleep problems, mood changes, and weight gain.
The symptoms can be experienced by any woman who had ovaries during puberty, but many report not having enough information about it. About 94% of women in the United States reported never being taught about menopause in school, according to a 2023 survey. Nearly half said they felt completely ill-informed about the menopause.
We spoke with CNN health expert Dr. Leana Wen to find out the facts. What is menopause and when does it occur? How is it diagnosed and what are the typical symptoms? How can you best manage your symptoms? And where else can you get reliable, accurate information? Dr. Wen is an emergency physician and adjunct associate professor at George Washington University. She previously served as Baltimore City’s health commissioner.
CNN: Can you explain what menopause is and why it happens?
Dr. Leana Wen: Menopause is the time in a woman’s life when menstruation stops. For most women, this natural biological process occurs as part of midlife when the ovaries stop producing certain reproductive hormones.
In some cases, menopause is induced by surgery or treatment. For example, cancer patients may need to have their ovaries removed, or undergo chemotherapy or radiation treatments that have the same effect as shutting down the ovaries.
One effect of menopause is a decrease in blood levels of two important hormones, estrogen and progesterone. The decline in estrogen in particular is thought to be responsible for many common menopausal symptoms.
CNN: At what age does menopause occur, and how long does it typically last?
Wen: The timing of menopause varies greatly from person to person. According to the North American Menopause Society, most women reach menopause between the ages of 40 and 58, with the average age at which women experience menopause being 51.
Some women reach menopause earlier due to the medical and surgical conditions mentioned above. There are also other factors – for example, women who smoke often reach menopause two years earlier than non-smokers. There is also a genetic component – women whose mothers or sisters went through menopause early are more likely to do so.
Menopause usually lasts about 7 years, but can last up to 14 years. The duration varies depending on factors such as race, smoking, and the age at which menopause begins.
CNN: Is there a way to diagnose menopause? If I’m having irregular periods or feeling fatigued, should I get tested to see if I’m in menopause?
Wen: No special testing is needed for menopause. The diagnosis is generally made later and is defined as not having a period for 12 months. This means that if you’re still having periods, you’re not in menopause yet. You could have premenopausal syndrome, or there could be another reason for your irregular periods and fatigue.
Testing may be justified in some circumstances. If you’re under 40 and your period has stopped, you can consider testing. Testing may also be justified to rule out other illnesses. For example, a medical professional may want to rule out anemia or hypothyroidism in someone who is feeling fatigued. Also, just because a woman is going through menopause doesn’t mean that all her symptoms are due to menopause.
CNN: You mentioned menopause. What is that?
Wen: Menopause generally doesn’t happen suddenly, unless it’s induced by surgery or illness. Four to eight years before menopause, there’s a period called perimenopause. During this time, many women start to experience irregular periods and menopausal symptoms.
CNN: What are the classic symptoms of menopause?
Wen: The most common symptom associated with menopause is hot flashes, a sudden feeling of heat that may be accompanied by sweating, flushed skin, and increased heart rate.
Related to this are night sweats, which are hot flashes that occur during the night. Women may wake up covered in sweat, which can make it difficult to get back to sleep, leading to sleep disorders and irritability.
Another common symptom is dry, thinning vaginal tissue, which can cause discomfort during sex. Menopausal women may also experience more frequent urinary tract infections. Some women may also experience mood changes, dry skin, and weight gain.
Be aware that these symptoms can be serious: About 25% of women who experience hot flashes experience symptoms that are so severe they seek medical care. About 1 in 3 women experience 10 or more hot flashes in a day.
It is also important to note that after menopause, the incidence of chronic diseases such as cardiovascular disease and osteoporosis increases, which is thought to be due to the protective effect of estrogen against these diseases.
CNN: How can women better manage their symptoms?
Wen: I think it’s really important for women to know that they don’t have to suffer from these conditions. There are a variety of treatments available.
Let’s start by talking about hormone therapy, which was the standard treatment for menopausal symptoms until an unfortunately misleading study was published. Prescriptions for hormone therapy fell and many women found no relief.
Earlier this year, some of the original study authors wrote a paper in JAMA that provided a new analysis and thorough explanation of how and when to use hormone therapy, clarifying that combined estrogen and progesterone therapy is safe, effective, and appropriate for treating women with hot flashes and other bothersome menopausal symptoms when started before age 60 in women with no contraindications (such as estrogen-responsive cancer).
In addition to hormones taken as pills, there are patches that provide a similar effect. Women over 60 who experience vaginal symptoms can also opt for vaginal creams or suppositories that deliver the hormones.
There are non-hormonal treatments, too. Last year, the U.S. Food and Drug Administration approved a drug called fezolinnetant specifically to reduce hot flashes. Women with osteoporosis can take medications specifically for that condition. Also, lifestyle changes such as improved diet and exercise, quitting smoking, yoga, and acupuncture can help.
CNN: Where else can you advise women to go for reliable, accurate information?
Wen: Questions should be directed to your primary care physician or gynecologist (if you have one), but research shows that many doctors aren’t trained to offer a full range of menopause treatment options.
If your doctor can’t give you the answers you need, I highly recommend the North American Menopause Society. Among their many resources is a database of clinicians with special training in treating women going through menopause and who have a special interest in guiding women through this important change in their lives.
