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. 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.
  • Menopause can but does not always involve symptoms such as hot flushes, sleep disorders or mood swings.
  • 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.

A sporty, middle-aged woman gives a high ten to another woman.

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 messenger 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.

The menopausal transition is not an illness but a normal phase in life. Women have very different experiences of it: the menopausal transition can but does not always involve symptoms such as hot flushes, sleep disorders or 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. Eventually, they stop entirely – at an average age of 51. The very last period is called the menopause. A woman can then no longer become pregnant.

Many women are happy to no longer have to worry about contraception or experience period-related symptoms after the 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, the menopause involves many other important changes, for example in their career, their partnership, their relationship with their children or their approach to aging.

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 have few hot flushes. Others go through phases when hot flushes occur so often and so intensely that they make daily life difficult. On average, a hot flush lasts about three minutes. The frequency, duration and intensity can also vary from one day to the next.

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.

Possible menopausal symptoms: hot flushes, sweats, vaginal dryness, sleep disorders, mood swings, weight gain

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, menstruation occurs.

As soon as the menopausal transition starts, 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.

On average, women undergo menopause at 51 years of age.

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 a year ago. If the final period occurs before the age of 40, this is known as premature menopause.

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?

If a woman wants to know for definite whether the menopausal transition has begun, she can have a gynecologist test the hormone levels in her blood.

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 has little practical value because the results cannot determine whether a woman can still become pregnant or for how long she should continue to use contraception. Furthermore, a blood test cannot tell the doctor if treatment would be beneficial if the woman has menopause-related symptoms.

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. 

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 upon hormone treatment should therefore discuss the benefits and risks with their doctor first and carefully weigh these up.

If hormone treatment stops, menopausal symptoms usually return. In addition, breast tenderness, nausea, and spotting may occur during the initial months of HRT. If hormone treatment continues for several years, the risk of developing various serious conditions, such as blood clots, heart attacks 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 menopause-related symptoms. However, their effectiveness has yet to be proven. The best researched products are those that contain plant-based estrogens, also known as phytoestrogens. These include soy-based products. However, it is unclear whether these products actually help. The same applies to products containing red clover or black cohosh. There is also a lack of evidence to back up theories that certain foods may make symptoms better or worse.

More detailed information 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.

Accounts of personal experiences of the menopausal transition can be found 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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