(Science Times: Ask Well)
How long does menopause actually last? And how do you know when (or if) you are done?
The “pause” in the term “menopause” might suggest that this phase of life is brief or temporary, little more than an annoying interruption. But in reality, the symptoms associated with menopause can last for a decade or more, and at least one symptom may never get better.
Technically, menopause begins after a woman’s final menstrual period, said Dr. Stephanie Faubion, director of Mayo Clinic Women’s Health. But because there’s no sounding trumpet to mark your final period, and menstrual cycles are often irregular during this time, health providers won’t usually diagnose menopause until you’ve gone a full year with no periods, Faubion explained. “Then, you’re postmenopausal for the rest of your life,” which may be as much as one-third to one-half of a woman’s life span, she noted.
In the United States, the average age of the final menstrual period is 52, according to the U.S. Department of Health and Human Services. But anything older than 45 is considered normal, and about 95% of women reach this milestone by age 55, said Faubion, who is also medical director of the North American Menopause Society.
However, the symptoms of menopause can begin several years before a woman’s final period and continue for years afterward. The intensity and duration of symptoms can vary a great deal, Faubion noted; some women experience little bother and others find that symptoms interfere significantly with their lives and work.
The first sign that you are entering the menopausal transition is usually a change in your menstrual cycles; periods can become closer together or further apart, and bleeding may be lighter or heavier, said Siobán Harlow, director of the Center for Midlife Science at the University of Michigan School of Public Health. These changes can be unpredictable and unnerving, and in women who experience heavier periods, it’s possible to have a dangerous amount of blood loss, warranting medical care, Harlow said.
At the same time, fluctuations in estrogen can cause someone to “start having hot flashes and night sweats, or get a migraine headache, or not sleep well, or feel super irritable,” Faubion said. Then, they might have a few normal cycles and a respite in symptoms, followed by a resurgence, she said. An array of other symptoms can also occur with the menopausal transition, including depression, anxiety, brain fog, changes to skin and hair, joint pain and vaginal dryness.
Once you go 60 days without bleeding, you’re in what is known as the late menopausal transition; from here, most women will have their final period within two years, said Dr. Nanette Santoro, a professor of obstetrics and gynecology at the University of Colorado School of Medicine. In this stage, she said, “symptoms tend to ramp up, so if they were annoying in the early transition, they get a little worse.”
Hot flashes, sometimes accompanied by night sweats, are among the most common menopausal symptoms, experienced by as many as 80% of women. In one 2015 study of about 1,500 U.S. women who experienced frequent hot flashes or night sweats, these symptoms lasted for an average of 7.4 years in all, usually beginning several years before their final period and continuing for an average of 4.5 years afterward. Women who began experiencing hot flashes earlier in the menopausal transition — before they hit the milestone of 60 days without a period — had to put up with these symptoms for longer, a total of 11.8 years on average. “If it begins early, it can be a very long, annoying menopause,” Santoro said, and given this, “you may want to seek help sooner rather than later.”
Of several racial and ethnic groups included in the 2015 study, women of Japanese and Chinese descent had the shortest duration of hot flash symptoms (an average of 4.8 and 5.4 years), and Black women had the longest, with an average of 10.1 years. In a study published in February, Harlow and her colleagues reviewed evidence that Black women in the United States also had, on average, earlier menopause and a greater incidence of depression and sleep disturbance associated with menopause when compared with white women. The authors proposed that these disparities could be linked, at least in part, to greater financial strain and life stress, experiences with discrimination and less physical activity — all of which, the authors noted in the study, “have roots in systemic racism.”
Most menopausal symptoms will eventually subside after an average of seven to nine years, but about a third of women will have symptoms for a decade or longer, Faubion said. A health care provider who is well versed in menopause can help you navigate treatment options, including hormone therapy, which can make symptoms much more manageable, she added.
One symptom that typically doesn’t get better is vaginal dryness, which can also be accompanied by painful sex, greater urinary urgency and more frequent urinary tract infections, Faubion said. These symptoms worsen with time, so it’s worth seeking treatment promptly. This may include over-the-counter lubricants or moisturizers or prescription vaginal estrogen treatments, she said.
Once you hit menopause, Santoro said, you’re technically in it for life. But you’ll know you’re done with the changes of menopause when its other symptoms improve. “They just go away,” and some women describe a feeling of “postmenopausal zest” at this stage, Santoro said. The hormonal fluctuations settle, and by the time women reach age 65 or 70, they are dealing more with the changes of aging than with changes in reproductive hormones, Harlow said.
And there are several upsides to going through menopause. Painful conditions like fibroids and endometriosis often improve, for example, and you no longer need to worry about periods or getting pregnant, Faubion said; though she emphasized that sexually transmitted infections remain a risk and a reason to keep condoms in your life.
In this sense, menopause is truly a midlife passage — and while it can be longer and stormier than expected — you can look forward to relief on the other side.
(This article originally appeared in The New York Times.)