In the years leading up to menopause, which are known as the perimenopause, menopausal transition, pre-menopause, or “the change”, the balance of hormones in a woman’s body changes. These changes can lead to symptoms such as hot flushes, abnormal sleep patterns, and mood swings. However, there are various ways to alleviate these symptoms.

At a glance

  • In the years leading up to menopause, the balance of hormones in a woman’s body changes. Hormones control many processes in the body.
  • The hormonal changes that occur before menopause can cause symptoms such as hot flushes, abnormal sleep patterns, or mood swings – although not all women experience these.
  • Every woman’s experience of the menopausal transition is unique.
  • Only a small number of women experience severe symptoms over an extended period of time.
  • There are various ways to relieve the symptoms.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

The menopause: middle-aged woman wearing sporty clothing slapping palms against another woman’s palms.

What is menopause?

Menopause marks the end of a woman's monthly menstrual cycles. In the years leading up to menopause, the balance of hormones in a woman’s body changes. Hormones are substances produced by the body that control many bodily processes. It takes time for the body to adjust to the hormonal changes associated with menopause.

Every woman’s experience of this life stage is unique. The menopausal transition can lead to symptoms such as hot flushes, abnormal sleep patterns, and mood swings. Only a small number of women experience severe symptoms over an extended period of time. There are various ways to relieve symptoms if they occur.

A woman's body gradually produces decreasing levels of estrogen from her mid-40s onwards. Due to the decreased production of estrogen, her monthly menstrual cycles (periods) become irregular. Finally, they stop altogether.

The very last period is called menopause. The term “menopause” is somewhat misleading, as it refers to a permanent end to rather than a temporary pause in a woman’s menstrual cycles. A woman can no longer become pregnant once she has had her final period.

The average age at which women reach menopause is 51 – although some do so much earlier, and some later. Many women are happy to no longer have to worry about contraception or experience period-related symptoms once they reach menopause. However, the knowledge that they cannot have any more biological children can feel like a major turning point in some women’s lives.

For many women, other significant life changes coincide with the menopausal transition.

  • If they have children, these are becoming increasingly independent and may even have reached the age of moving away from home.
  • Their relationship with their life partner may also be changing.
  • Some women become more focused on their careers. Others work less and devote more time to caring for aging parents.
  • They also have to deal with the emotional aspect of getting older.

This means that the menopausal transition is not only a time of hormonal adjustment, but also represents a new phase of life that brings many internal and external changes.

What symptoms occur during menopause?

Hot flushes and sweats are the most common symptoms – up to one third of all women experience these in the lead-up to menopause. If these occur at night, they often affect a woman's sleep.

Some women are largely unaffected by hot flushes. Other women go through phases when hot flushes occur so often and are so intense that they make daily life difficult. On average, a hot flush lasts around three minutes. The frequency, duration, and intensity of hot flushes can also vary from one day to the next.

Anzeichen dafür, dass Frauen in die Wechseljahre kommen: Hitzewallungen, Schweißausbrüche, Schlafprobleme, Gewichtszunahme, Scheidenschleimhaut weniger feucht, Stimmungsschwankungen.

If women are affected by hot flushes and sweats, the symptoms usually last longer than one year. However, without treatment, they tend to stop occurring on their own after about four to five years, although some women continue to experience them for longer.

The mucous membrane of the vagina changes during the menopausal transition. After menopause, it is usually thinner and drier than before.

During the years leading up to menopause, women may also experience difficulty falling asleep and staying asleep at night, as well as mood swings or a persistent low mood. Some women experience a decline in their sex drive. Many women put on weight during this time.

What causes menopause?

During a woman's fertile years, her ovaries produce the two female sex hormones estrogen and progesterone. Both of these prepare the woman's body for a possible pregnancy. They also affect the skin and mucous membranes.

Every month, a new follicle (egg sac) develops in the ovaries. This follicle also produces hormones. If the mature egg is not fertilized following ovulation, the woman will get her monthly period.

As soon as the menopausal transition begins, the ovaries gradually begin to produce fewer hormones. Menopause, i.e., the end of menstrual cycles, occurs once the ovaries stop releasing eggs.

How does menopause progress?

For some women, the effects of menopause are so slight that they don't even notice them. Others experience strong physical symptoms from the start.

For some women, their periods are occasionally heavier and occasionally lighter during menopausal transition. For others, the intervals between periods become irregular.

The average age at which women have their last period is 51. A woman can still become pregnant up to this point.

The menopause: on average, women have their last period at the age of 51.

A woman can only know that menopause has occurred in hindsight. As a rule of thumb, a woman's most recent period is most likely to have been her final period if it occurred more than 12 months ago. If the final period occurs before the age of 40, this is known as premature menopause.

The medical term “climacteric” is sometimes used to describe the menopausal transition – this word comes from the Latin “climacter”, meaning the rung of a ladder, which, in antiquity, was used to represent a critical point in life.

There are some indications that the age at which a woman reaches menopause is genetically determined. In other words, mothers and daughters will have their final period at roughly the same age.

It is likely that other factors also play a role, such as the number of children a woman has had. This could explain why women in developing countries, where birth rates are higher, reach menopause at an earlier age.

Menopause may also occur earlier in heavy smokers. Being overweight or underweight and the length of a woman’s monthly cycle may also help determine when the menopausal transition begins. However, these are only theories that have yet to be proven by conclusive evidence.

How is menopause diagnosed?

Women who want to know for sure whether their transition towards menopause has begun can ask their gynecologist to check their hormone levels by means of a blood test.

Estrogen levels gradually decline during the menopausal transition. This means that the amount of estrogen decreases compared to other sex hormones in the body. The body reacts to declining estrogen levels by increasing its production of another hormone – follicle-stimulating hormone (FSH). These changes are typical during menopause.

However, checking hormone levels is not of much practical value because the results cannot determine whether a woman can still become pregnant or whether she should continue to use contraception if she doesn’t want this to happen. A blood test also cannot tell the doctor if treatment would be beneficial if the woman has symptoms that may be related to menopause.

How can menopausal symptoms be treated?

There are various ways to relieve the symptoms that occur during the menopausal transition. In almost all women, symptoms like hot flushes, sweats, and mood swings become less frequent over time, and eventually disappear without treatment. The menopausal transition is not an illness – these years are simply a normal phase in the life of a woman.

To date, the most effective treatment for menopausal symptoms has been hormone replacement therapy (HRT) using a combination of estrogen and progestin (synthetic progesterone). For women who have had a hysterectomy (removal of the uterus), estrogen-only therapy is the most suitable option. However, these treatments are not without risk. Women considering embarking on hormone replacement therapy should carefully discuss the benefits and risks with their doctor first.

If a woman stops HRT, menopausal symptoms usually return. In addition, breast tenderness, nausea, and spotting may occur during the initial months of HRT. If HRT continues for several years, the risk of developing various serious illnesses, such as cardiovascular diseases and breast cancer, may also increase.

Hormone medication that affects the entire body is also available in the form of patches, nasal sprays, tablets, and injectable solutions. The lining of the vagina can also be treated locally with hormonal preparations such as creams, vaginal suppositories, or rings containing hormones. Hormone-free lubricants, creams, and plant oils are available for treating vaginal dryness.

In some cases, the hormones testosterone and dehydroepiandrosterone (DHEA) are used to treat menopausal symptoms. Anti-depressant medication is also sometimes prescribed. It is unclear whether these treatments are effective in relieving the symptoms. However, some have significant side-effects. In addition, most of them have not been approved for the treatment of menopausal symptoms.

Important: Many herbal remedies and food supplements are available that claim to relieve the symptoms associated with menopausal transition. However, their effectiveness has yet to be proven. The best researched products are those that contain plant-based estrogens (phytoestrogens). These include soy-based products. However, it is unclear whether these products actually alleviate menopausal symptoms. The same applies to products containing red clover or black cohosh (cimicifuga racemosa). There is also a lack of evidence to back up theories that certain foods may make symptoms better or worse.

More detailed information, for example on how to relieve menopausal symptoms, is available at

What else is important to know about the menopausal transition?

Many women try various relaxation techniques, breathing exercises, meditation, yoga, or tai-chi to help them cope with this sometimes difficult phase of their lives. While it is unlikely that these relieve symptoms like hot flushes, they may improve a woman’s overall feeling of well-being and promote restful sleep.

The same is true of sport and exercise, which have positive effects on the cardiovascular system and bones. They also improve overall fitness, muscle strength, and mobility. In addition, they can help women to maintain a normal weight or to lose weight if they are overweight.

Even though the often negative perceptions of menopause are gradually changing, it is still associated first and foremost with growing old and the negative effects it may have.

However, many women view the menopausal transition in a positive light and as the beginning of a new chapter in their lives. It is also the case that some women simply don't experience typical menopausal symptoms or other issues during these years. Women often discover new freedoms and opportunities during this phase of life.

You can read some accounts of personal experiences of the menopausal transition at

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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