When Does Menopause Start—And How Long Does It Last?

Many people remember when they went through menopause, but everyone experiences menopause differently. As a result, the information about menopause can lead to a lot of questions and misconceptions.

Health spoke to a few different OB-GYNs to get a better understanding of when menopause actually starts, how long it lasts, and what you can do to help the transition.

What Is Menopause?

Menopause is a normal part of aging, and it's a point in time 12 months after the last period of a person who menstruates, according to the National Institute on Aging (NIA). During the years leading up to that point, a person may have changes in their monthly cycle, hot flashes, and other symptoms. This is called the menopausal transition, or perimenopause.

"During perimenopause, the number of eggs in a woman's ovaries start to dwindle down to a precious few," said Jonathan Schaffir, MD, an OB-GYN from The Ohio State University Wexner Medical Center. "Since ovulation, or the release of the egg, triggers periods, once the eggs dwindle, menstruation spaces out and then stops completely."

Additionally, the body's production of estrogen and progesterone (two hormones that are made by the ovaries) vary during perimenopause. A person's bones become less dense, and their body starts using energy differently. Fat cells also change: Individuals may find that they gain weight more easily than they did before.

While menopause typically happens naturally as a person who menstruates ages, it can also happen if a person has the ovaries surgically removed, said Arianna Sholes-Douglas, MD, author of The Menopause Myth: What Your Mother, Doctor, And Friends Haven't Told You About Life After 35, and the founder of Tula Wellness Center in Tucson, Ariz. "Symptoms can also occur even if a woman has her uterus removed but leaves her ovaries intact," Dr. Sholes-Douglas added.

Furthermore, menopause can be the result of using medications for chemotherapy or hormone therapy due to having breast cancer.

When Does Menopause Usually Start?

Every person who menstruates is different, but the menopausal transition usually starts between ages 45 and 55. Some people can start as early as 35, while others may not start it until they're 60, said Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School.

According to a July 2019 study, menopause can start based on several factors including ones that are environmental, lifestyle-related, hormonal, or genetic.

"Family history is a reasonable predictor," Dr. Minkin explained. "If everyone in the family went through menopause on the early side, there is a good chance you may too."

The timing of your first period could also help predict when you'll experience perimenopause.

Researchers of a January 2017 meta-analysis found that women who started their menstrual periods at 11 years old or younger had an 80% higher chance of reaching menopause before the age of 40, compared to those who got their first period at 12 or 13 years old. However, most of the studies in the analysis relied on women remembering the age of their first menstrual period, and memories are not always 100% accurate.

How Long Does Menopause Last?

The menopausal transition is not a quick process. It usually lasts about seven years, but it can take as long as 14 years. "If you go six months without a period and then get one, the clock gets reset so you have to go another 12 months without a period to say you are done," Dr. Minkin added. Furthermore, the length of time spent in menopause will also vary based on factors such as lifestyle (like if you smoke or not) and the age you were when menopause began.

What Are the Symptoms of Menopause, and What Can You Do About Them?

During perimenopause, people will usually notice irregular periods. "Close together, far apart, heavy, light—you name it," Dr. Minkin said. You might also experience hot flashes, vaginal dryness, incontinence, a lack of interest in sex, and trouble sleeping.

In general, the symptoms of perimenopause can be eased by estrogen therapy. "That's the first-line treatment," Dr. Schaffir explained. "It really is quite safe [and] it will help with just about everything," Dr. Minkin added. Low-dose birth control pills, for example, can be "quite helpful," Dr. Minkin also said, adding that those who struggle with heavy bleeding can benefit from a progesterone-coated IUD.

For people experiencing perimenopause who don't want to undergo estrogen therapy or who can't for health reasons, Dr. Schaffir said that healthcare providers will typically offer the antidepressant paroxetine (known by the brand name Paxil), which can help relieve some menopausal symptoms.

There are other options that can help, Dr. Minkin said, like:

• Vaginal moisturizers (like Replens and Revaree) for vaginal dryness
• Testosterone therapy or an over-the-counter product called Ristela, which increases pelvic blood flow to help with low libido. While many countries have used testosterone therapies for decades, testosterone is typically used off-label in the U.S. for menopausal indications. (Off-label use means the medicine is used for something other than what it was approved for.)
• Good nutrition and exercise to help with everything else

Meditation and yoga in the evening, decreasing your caffeine intake so that you don't have caffeine in your system by 3 p.m., watching how much sugar you eat, and trying to avoid drinking before bed can also help with sleep issues, Dr. Sholes-Douglas said.

A Quick Review

Menopause starts at different times for different people. Typically people who menstruate experience menopause between ages 45 to 55 years, but some start menopause at 35 and others at 60. The menopausal transition can last anywhere from about seven to 14 years.

If you think you may be going through perimenopause or your menopausal transition, or have already hit menopause, talk to a healthcare provider. Healthcare providers should be able to answer any specific questions you may have and guide you on next steps.