Menopause Overview

Menopause is the period of time when menstruation stops for at least 12 consecutive months because the ovaries are no longer producing estrogen, progesterone, and other hormones. Menopause usually occurs naturally between the ages of 45 and 56, but it can also be caused by surgical procedures or the treatments for certain conditions (e.g., chemotherapy).¹ Women will experience changes in their menstrual cycles long before menopause; the period from the onset of significant fluctuations in ovarian function to 1 year after a woman’s final menstrual period is known as perimenopause.^{1 , 2}

Common symptoms of menopause include vasomotor symptoms (e.g., hot flashes, night sweats), sleep and mood disturbances, and significant changes in the urogenital system.³ The prevalence and severity of menopause symptoms vary widely. For example, studies have reported a higher prevalence and a longer duration for vasomotor symptoms in Black women than in Asian, White, or Hispanic women.² The hormonal changes that occur during the menopausal transition and postmenopause can also increase the risk of cardiovascular disease, osteoporosis, diabetes mellitus, and certain cancers.^{1 , 3}

Not all women require treatment for menopause-related symptoms. When symptoms are more severe, they can often be managed using hormonal or nonhormonal therapies. Hormone therapy with oral or transdermal estrogen remains the most effective treatment for menopausal symptoms, and research suggests it may also provide metabolic and vascular benefits.^{3 , 4} Because the use of estrogen alone can increase the risk of uterine cancer, women with an intact uterus who receive estrogen should also receive a progestogen.¹ Women who experience menopause before age 40, a condition known as premature ovarian insufficiency or POI, can receive hormone therapy until the typical age of menopause to help prevent the health risks associated with premature menopause.⁵ Some nonhormonal therapies, such as certain antidepressants, gabapentin, oxybutynin, and neurokinin 3 receptor antagonists, have been shown to be effective in treating vasomotor symptoms.^{1 , 6}

More work is needed to address the gaps in menopause research. Researchers are still investigating the long-term effects of vasomotor symptoms on the cardiovascular system and the brain, better strategies for treating symptoms during perimenopause, the safety and efficacy of new hormone therapies, the effect of menopause on conditions such as endometriosis and uterine fibroids, and many more areas of interest.

The Study of Women's Health Across the Nation (SWAN) is a long-term study that is investigating the many ways that aging affects women's health. NIH-funded researchers are studying how menopause can affect a variety of health issues, including cardiovascular health and cognitive function.^{7 , 8}

The Intramural Research Program (IRP) of the National Library of Medicine supports research that develops and applies advanced approaches to complex problems in biology and human health. Recent IRP funded work that examined menopausal hormone therapy use after age 65 found that estrogen only therapy, most commonly prescribed as estradiol, was associated with meaningful reductions in mortality, several cancers, cardiovascular conditions, and dementia. For women using estrogen progestogen therapy (EPT), the study suggests that while combination therapy can increase the risk of breast cancer, this risk can be mitigated with low dose transdermal or vaginal EPT, particularly estradiol plus progestin.⁹ The published study, which was recently awarded the Menopause Best Paper Award by The Menopause Society, offers important insights into how individualized hormone therapy strategies could support healthier aging for postmenopausal women.