The first sign that you’re 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, Dr. 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,” Dr. 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’s 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, “symptoms tend to ramp up, so if they were annoying in the early transition, they get a little worse,” she said.
Hot flashes, sometimes accompanied by night sweats, are among the most common menopausal symptoms, experienced by as many as 80 percent of women. In one 2015 study of about 1,500 US 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,” Dr. 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, respectively), and Black women had the longest, with an average of 10.1 years. In a study published in February, Dr. 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.”