Menopause: Symptoms, Stages & Treatment Options

24 min read
Menopause: Symptoms, Stages & Treatment Options

Menopause is a natural stage of life, but the experience of getting there can be very different from one person to another.

Some people barely notice the transition. Others deal with hot flushes, disrupted sleep, brain fog, mood changes, changing periods, vaginal or genital dryness, joint aches or a feeling that their body simply isn’t behaving the way it used to.

In Australia, natural menopause usually occurs between the ages of 45 and 55, with an average age of around 51.

There are effective hormonal and non-hormonal treatments, complementary approaches that some people find helpful and plenty of practical ways to make this stage more comfortable.

Menopause is most commonly discussed in relation to women, but trans men, non-binary and gender diverse people who have ovaries can also experience natural or surgical menopause. People using testosterone may experience some menopause-like symptoms too, although stopping periods because of testosterone isn’t the same thing as reaching natural menopause.

Key takeaways

  • Menopause is your final period and is confirmed once 12 months have passed without another period, provided there is no other explanation.
  • Perimenopause is the transition around menopause and often begins in the 40s. It can last anywhere from around 2 to 10 years.
  • Not everyone has troublesome symptoms. Some people have very few, while others find symptoms significantly affect everyday life.
  • Menopausal hormone therapy (MHT) is the most effective treatment for hot flushes and night sweats and is safe and effective for most healthy people when appropriately prescribed.
  • Non-hormonal prescription medicines, CBT and other options are available if MHT isn’t suitable or isn’t what you want.
  • Vaginal, genital and urinary symptoms can continue after hot flushes have eased, but effective treatments are available.
  • Starting testosterone doesn’t itself mean a trans man or transmasculine person has reached menopause.
  • Removal of both ovaries causes surgical menopause.
  • Pregnancy can still be possible during perimenopause and testosterone itself isn’t contraception.
  • Any vaginal bleeding after menopause should be checked by a doctor, even if it only happens once.

On this page

What is menopause?

Menopause is your final menstrual period.

You only know that a period was your final one once 12 months have passed without another period and there is no other medical reason for your periods stopping.

Natural menopause happens as ovarian function changes with age. The ovaries stop regularly releasing eggs and eventually produce much lower levels of hormones including oestrogen and progesterone.

Menopause itself is a point in time. The years of hormonal, menstrual and physical changes around it are known as the menopause transition.

It’s a natural life stage rather than an illness, but that doesn’t mean difficult symptoms have to be endured without treatment.

What age does menopause happen?

In Australia, natural menopause usually occurs between ages 45 and 55 but some people experience it earlier or later. The average age is around 51.

Menopause before age 45 is considered early menopause. Loss of normal ovarian function before age 40 is known as premature ovarian insufficiency, or POI.

If your periods become very irregular or stop before age 45, particularly before 40, talk with your GP rather than assuming it is simply early menopause.

What are the stages of menopause?

You’ll commonly hear the menopause transition divided into perimenopause, menopause and postmenopause.

Perimenopause

Perimenopause is the transition leading up to your final period and the time until menopause can be confirmed 12 months later. It often begins in your 40s but can start earlier or later.

On average it lasts around 4 to 6 years, although approximately 2 to 10 years can fall within the usual range.

Oestrogen and progesterone don’t simply decline in a straight line during perimenopause. Levels can fluctuate considerably, which is one reason symptoms and periods can feel unpredictable.

Your periods might:

  • come closer together
  • be further apart
  • be heavier or lighter
  • last for a different number of days
  • occasionally disappear for a month or more and then return

Symptoms such as hot flushes, night sweats, sleep disruption, brain fog and mood changes often begin during perimenopause rather than waiting until periods stop. Pregnancy is also still possible because ovulation can continue, even when periods are irregular.

Read our guide to vaginal health in perimenopause for more about the changes that can happen during this stage.

Menopause

Menopause is your final period. In practice, you can only confirm that you’ve reached it after 12 consecutive months without another period, assuming there is no other explanation.

Postmenopause

Postmenopause describes the years after menopause and lasts for the rest of your life.

Some symptoms, including hot flushes and night sweats, may gradually become less frequent. That doesn’t happen for everyone though. Some people continue having vasomotor symptoms for years. Vaginal, vulval, genital and urinary symptoms caused by lower oestrogen can persist or become more noticeable over time if they aren’t treated.

How is menopause diagnosed?

For most people over 45 with typical symptoms and changing periods, perimenopause is usually identified from age, symptoms and menstrual history rather than a hormone blood test.

Hormone levels can fluctuate considerably during perimenopause, so one FSH or oestrogen result may not tell you much about where you are in the transition.

Blood tests can be useful in particular situations, including when periods stop at a younger age or when medical treatment, surgery or hormone therapy makes the diagnosis less straightforward.

If you’re using hormonal contraception, testosterone or another hormone therapy that changes or stops periods, your bleeding pattern may not be a reliable way of working out whether natural menopause has occurred.

What are the symptoms of menopause?

Menopause is experienced differently by everyone. Some people have few or no noticeable symptoms. Others experience symptoms that significantly affect their sleep, work, relationships, exercise or general quality of life.

Common symptoms can include:

  • hot flushes
  • night sweats
  • sleep problems
  • brain fog or difficulty concentrating
  • low mood or mood changes
  • anxiety
  • joint and muscle aches
  • headaches
  • dry or itchy skin
  • changes in menstrual bleeding during perimenopause
  • vaginal or genital dryness, burning or irritation
  • pain or discomfort during sex
  • changes in sexual desire
  • urinary urgency or frequency
  • light bladder leakage
  • changes in body composition, including more fat being stored around the abdomen

Symptoms can come and go and may change as you move through perimenopause and into postmenopause. They can last for several years and, for some people, considerably longer.

Not every change that happens in your 40s or 50s is caused by menopause. Low iron, thyroid problems, sleep disorders, medication side effects and other health conditions can produce similar symptoms.

If something feels new, unusual or particularly disruptive, it’s worth discussing it with your GP rather than automatically blaming hormones.

Menopause and mental health

Changes in hormones, sleep and life circumstances can all affect emotional wellbeing during the menopause transition. Some people notice irritability, anxiety, lower mood, feeling overwhelmed or simply feeling less like themselves. That isn't to say every emotional change is caused by menopause, but hormonal changes can be part of the picture.

Read more in our guide to how hormones can affect mental health.

What about trans men and people using testosterone?

Menopause can also be relevant to trans men, non-binary people and other gender diverse people who have ovaries. Whether and how it is experienced depend on age surgical history and the user of hormone replacement therapy (HRT). 

Does testosterone cause menopause?

No, starting masculinising testosterone doesn’t automatically mean you have entered menopause.

Testosterone commonly causes periods to become lighter and eventually stop, but this is hormone-related menstrual suppression rather than proof that the ovaries have reached natural menopause.

If the ovaries remain in place, ovarian activity may continue even when there is no menstrual bleeding.

This is one reason the usual rule of “12 months without a period equals menopause” can’t simply be applied to someone whose periods have stopped because of testosterone.

If you want a more detailed look at what happens to menstruation after starting testosterone, including how long periods may take to stop, breakthrough bleeding, pregnancy risk, genital dryness and period-product choices, read our guide to periods, testosterone and transition for trans men and transmasculine people.

Can testosterone cause menopause-like symptoms?

It can cause some changes that overlap with symptoms commonly associated with menopause.

People using testosterone may experience genital or vaginal dryness, tissue thinning, discomfort during penetration or pelvic examinations and changes in sexual comfort.

Some people also report hot flushes or other menopause-like symptoms.

If these symptoms are troublesome, talk with your gender-affirming hormone prescriber or GP. Treatment can be tailored to your body, the hormones you use and which organs you have.

What if both ovaries are removed?

Surgical removal of both ovaries causes surgical menopause because the body suddenly loses its main source of ovarian oestrogen and progesterone.

This can happen as part of gender-affirming surgery, cancer treatment or surgery for another health condition.

Someone already using testosterone may experience the hormonal change differently from someone who isn’t using gender-affirming hormone therapy, but removal of both ovaries is still considered surgical menopause.

A hysterectomy alone is different. Removing the uterus stops periods permanently, but if the ovaries remain they can continue producing hormones.

Can trans men use vaginal oestrogen?

Sometimes, yes.

Low-dose local vaginal oestrogen may be used to treat dryness, irritation and tissue changes associated with testosterone or lower local oestrogen levels.

Because it is used in a low dose directly on the affected tissue, very little is absorbed into the bloodstream and it generally doesn’t interfere with the masculinising effects of testosterone.

For someone who doesn’t use the word vagina for their anatomy, the same treatment may be described as local genital oestrogen or according to the specific body part being treated.

A gender-affirming GP or hormone prescriber can talk through what feels appropriate for you.

Cervical screening for trans and non-binary people

If you have a cervix, cervical screening can still be relevant regardless of your gender or whether you use testosterone.

Australia’s National Cervical Screening Program includes women and people with a cervix aged 25 to 74 who have ever had sexual contact.

Self-collection is available for routine HPV screening and can be a more comfortable option for some people.

What causes menopause?

Natural menopause occurs as ovarian function changes with age.

Over time, the ovaries stop regularly releasing eggs and production of oestrogen and progesterone becomes very low.

Menopause can also happen earlier as the result of surgery or medical treatment.

Surgical menopause

Removing both ovaries causes immediate surgical menopause because the main source of ovarian oestrogen and progesterone is removed.

This is different from hysterectomy.

A hysterectomy removes the uterus. If the ovaries remain, they can continue producing hormones, so having a hysterectomy doesn’t automatically cause menopause.

If the uterus has been removed, however, there are no longer periods to use as a sign of the menopause transition.

Cancer treatment

Chemotherapy, radiotherapy and some hormone-blocking cancer treatments can affect ovarian function and may cause temporary or permanent menopause.

When hormone levels change suddenly rather than gradually, symptoms can sometimes feel more intense.

How can you manage menopause symptoms?

The best approach depends on which symptoms are bothering you, how much they affect your life, your health history, the hormones you already use and what feels right for you.

Some people only need a few practical changes. Others feel dramatically better once they find the right medical treatment.

And plenty of people use a mixture of medical treatment, lifestyle changes and complementary practices.

Lifestyle and everyday support

Healthy habits support your overall health through menopause, although they shouldn’t be presented as a substitute for treatment when symptoms are significant.

Sleep

A regular sleep routine and a comfortable, cool bedroom can make nights easier.

If hot flushes or night sweats repeatedly wake you, though, treating the underlying symptoms may make more difference than endlessly tweaking your bedtime routine.

Movement

Regular physical activity supports cardiovascular health, bones, muscle strength, mood and sleep.

Walking, swimming, cycling, strength training, yoga and other forms of movement can all be useful.

There isn’t one special “menopause workout” everybody needs to follow.

Food

A varied diet with adequate protein, calcium and other nutrients supports general and bone health.

You don’t need a restrictive menopause diet.

Some people notice that alcohol, spicy food, caffeine or hot drinks seem to trigger hot flushes. Triggers vary, so there’s no reason to automatically eliminate foods or drinks that don’t bother you.

Cooling strategies

Layers, breathable sleepwear, a fan or a cooler bedroom can make hot flushes and night sweats more comfortable, even if they don’t prevent them.

Smoking and alcohol

Smoking affects cardiovascular, bone and general health and may also influence menopausal symptoms.

If you drink alcohol, noticing whether it worsens your sleep or hot flushes can be more useful than assuming everyone needs the same rule.

Menopausal hormone therapy (MHT)

Menopausal hormone therapy, or MHT, was traditionally called hormone replacement therapy or HRT.

It is the most effective treatment available for menopausal hot flushes and night sweats and can also help with several other symptoms associated with declining hormone levels.

Current Australian guidance describes MHT as safe and effective for most healthy people when it is appropriately prescribed.

MHT can be given in different ways, including:

  • skin patches
  • gels
  • tablets
  • vaginal treatments for local vaginal and urinary symptoms

The right formulation depends on your symptoms, medical history and preferences.

Do you need progesterone with MHT?

If you still have a uterus and use systemic oestrogen, you generally also need a progestogen to protect the lining of the uterus.

If you’ve had your uterus removed, oestrogen-only MHT may be suitable.

Low-dose vaginal oestrogen used specifically for vaginal and urinary symptoms is different from systemic MHT and generally doesn’t require a progestogen at standard local doses.

Is MHT safe?

For most healthy people around the usual age of menopause, the overall risks of MHT are small and the benefits can be substantial when symptoms are affecting quality of life.

The balance depends on factors including your age, how long it has been since menopause, your medical history and the type and route of MHT used.

Patches and gels can have a different risk profile from oral oestrogen, which is one reason treatment can be individualised rather than treating all MHT as the same.

MHT may not be appropriate for some people, including those with certain hormone-sensitive cancers, unexplained vaginal bleeding or particular cardiovascular or clotting risks.

That’s something to discuss with your doctor rather than assuming MHT is automatically either safe or unsafe for you.

What about bioidentical hormones?

The term “bioidentical” can be confusing.

Some regulated prescription MHT products contain hormones that are chemically identical to hormones produced by the body.

That is different from custom-compounded “bioidentical hormone therapy”, which Australian health organisations don’t recommend because the dose, quality and safety aren’t tested or regulated in the same way as approved medicines.

Non-hormonal treatments

MHT isn’t the only option.

If you can’t use hormones or simply don’t want to, there are prescription non-hormonal treatments that can help particular symptoms.

Fezolinetant

Fezolinetant, sold in Australia as Veoza, is a non-hormonal prescription medicine for moderate to severe hot flushes and night sweats associated with menopause.

It works on temperature-regulating pathways in the brain rather than replacing oestrogen.

Fezolinetant has liver safety precautions and monitoring requirements, so your doctor will need to discuss whether it is suitable for you.

Other medicines

Some antidepressants and some other prescription medicines can reduce hot flushes or help with related symptoms for certain people.

They aren’t generally as effective for vasomotor symptoms as MHT, but they can be useful alternatives.

Cognitive behavioural therapy

Cognitive behavioural therapy, or CBT, can help reduce the impact of hot flushes, night sweats, sleep disruption, low mood and anxiety.

CBT doesn’t mean menopause symptoms are imaginary or “all in your head”. It can provide practical tools that change how disruptive symptoms feel and help with sleep and coping.

Clinical hypnosis is another non-drug option recognised in current Australian menopause guidance for some symptoms.

Complementary therapies, supplements and traditional approaches

Many people explore acupuncture, acupressure, yoga, mindfulness, herbal remedies, traditional medicines or supplements during perimenopause.

And some genuinely feel these approaches make a positive difference to how they sleep, relax or cope with symptoms.

That personal experience is worth acknowledging even when clinical research is mixed or incomplete.

At the same time, evidence varies substantially between approaches and a supplement or therapy shouldn’t be assumed to treat hormonal changes simply because it is described as natural.

For example, research into acupressure during menopause has produced some encouraging findings around sleep, while evidence for other symptoms is less clear.

If you enjoy a complementary practice and find it supportive, it can sit alongside medical treatment rather than having to compete with it.

For complementary medicines, check the label and tell your pharmacist or doctor what you take because herbs and supplements can interact with prescription medicines.

Vaginal, genital, bladder and pelvic health

Lower oestrogen can affect the vulva, vagina, bladder and urinary tract.

In menopause care, this group of changes is often called genitourinary syndrome of menopause, or GSM.

Symptoms can include:

  • vaginal or genital dryness
  • burning or irritation
  • pain during sex or penetration
  • urinary urgency or frequency
  • recurrent urinary tract infections

Similar local tissue changes can also occur in some people using masculinising testosterone.

These symptoms are common and treatable.

Moisturisers and lubricants

A vaginal or intimate moisturiser can be used regularly for ongoing dryness, while a personal lubricant provides temporary slip during sex or insertion.

Some people use both.

Our guide to vaginal dryness explains the difference and the treatment options in more detail.

Local oestrogen

Low-dose vaginal oestrogen can be very effective when genital, vaginal or urinary symptoms are related to lower local oestrogen levels.

It acts mainly on the local tissue and has very low systemic absorption at recommended doses.

It may also be an option for some transmasculine people experiencing testosterone-associated dryness or tissue changes without reversing the desired masculinising effects of testosterone.

Talk with your GP or hormone prescriber if moisturisers and lubricants aren’t doing enough.

Pelvic floor changes

Midlife changes can also coincide with bladder leakage, pelvic heaviness, prolapse symptoms or pelvic floor tension.

Pelvic floor treatment shouldn’t automatically mean doing more Kegel exercises. Some people need strengthening while others need help relaxing overactive muscles.

Read our pelvic floor guide or use our directory to find a pelvic health physiotherapist.

Do you still need contraception?

If pregnancy is possible and you don’t want to become pregnant, contraception may still be needed during perimenopause.

Ovulation becomes less predictable, but it can still happen.

If you aren’t using hormonal contraception, Australian guidance generally recommends continuing contraception:

  • for 2 years after your final period if it occurred before age 50
  • for 1 year after your final period if it occurred at age 50 or older

Hormonal contraception can change or stop bleeding, so your last period may not tell you whether menopause has occurred.

MHT isn’t contraception.

What if you use testosterone?

Testosterone also isn’t reliable contraception.

Periods may stop and ovulation may be suppressed, but pregnancy can still be possible if you have a uterus and ovaries and have sex in a way that could result in pregnancy.

If avoiding pregnancy is important to you, talk with a gender-affirming healthcare professional about contraception that works alongside testosterone.

For more on periods stopping or returning, ovulation, contraception, genital dryness and period care while using testosterone, see our guide to periods and testosterone for trans men and transmasculine people.

See our guide to contraception in Australia for more information about contraceptive options.

Looking after your health after menopause

Menopause doesn’t suddenly make you unhealthy, but midlife is a useful time to take stock of some areas that become increasingly important with age.

Bone health

Lower oestrogen after menopause contributes to bone loss, which can increase the risk of osteoporosis and fractures.

Strength and weight-bearing exercise, adequate calcium, vitamin D and avoiding smoking all support bone health.

People who have their ovaries removed before the usual age of menopause may need particular attention to bone health and hormone management.

Your need for a bone-density scan depends on your age and individual risk factors, so ask your GP if you’re unsure.

Heart health

Cardiovascular risk increases with age and is affected by many factors including blood pressure, cholesterol, smoking, diabetes, family history, activity and body composition.

Menopause is part of that picture rather than the sole cause.

Regular blood-pressure, cholesterol and general health checks can help you understand your own risk.

Cervical screening

Menopause doesn’t automatically mean cervical screening stops.

In Australia, women and people with a cervix aged 25 to 74 who have ever had sexual contact are generally invited to have a Cervical Screening Test every 5 years.

This includes trans men and non-binary people who have a cervix.

The Cervical Screening Test replaced the old Pap smear and checks for HPV, which causes almost all cervical cancers.

You can choose either clinician collection or self-collection for routine HPV screening.

See our guide to self-collected cervical screening for more information.

Screening is for people without symptoms. If you have unexpected bleeding, don’t wait until your next screening test to have it checked.

When should you see a GP?

Talk with your GP whenever menopause-related or menopause-like symptoms are worrying you or interfering with sleep, work, exercise, relationships, sex or your general quality of life.

You don’t need to wait until symptoms become severe before discussing treatment.

It’s also worth seeking medical advice if:

  • your periods become extremely heavy
  • you bleed between periods
  • you bleed during or after sex
  • you develop persistent pelvic pain
  • you have unusual vaginal or genital discharge
  • your periods become irregular or stop before age 45 without an expected explanation such as hormone therapy
  • you have questions about MHT, testosterone or other hormone treatments

Bleeding after menopause

Any vaginal bleeding after natural menopause should be checked by a doctor, even if it is very light, happens only once or looks like spotting.

There are many possible causes and most aren’t cancer, but postmenopausal bleeding still needs assessment rather than being assumed to be part of menopause.

If you take hormones that affect bleeding, including testosterone or some forms of MHT or contraception, your doctor can help determine what bleeding pattern is expected for you and what needs investigation.

Seek urgent medical care if bleeding is very heavy, you feel faint or you feel seriously unwell.

Our guide to talking to a doctor about vaginal concerns can help you prepare for an appointment.

Frequently asked questions

What is the average age of menopause in Australia?

The average age is around 51, with most people reaching natural menopause between ages 45 and 55.

How long does perimenopause last?

Perimenopause commonly lasts around 4 to 6 years but can last anywhere from approximately 2 to 10 years. Symptoms may continue into postmenopause and some vaginal or urinary symptoms can persist unless treated.

Do you need a blood test to diagnose menopause?

Usually not if you’re over 45 and have typical symptoms and menstrual changes. Hormone levels fluctuate during perimenopause, so one blood test may not be useful. Testing may be appropriate if symptoms or periods change at a younger age or if hormone therapy, surgery or another health condition makes the diagnosis unclear.

Can I still get pregnant during perimenopause?

Yes. Ovulation becomes unpredictable but can still occur. If you don’t want to become pregnant, continue using appropriate contraception until a healthcare professional advises that it is safe to stop.

Does testosterone cause menopause?

No. Testosterone commonly causes periods to stop, but this doesn’t automatically mean natural menopause has occurred. If the ovaries remain, ovarian activity may continue. Menopause in people using testosterone is still an under-researched area, so age, symptoms, surgery and hormone use all need to be considered together. Our guide to periods and testosterone explains this in more detail.

If I have my ovaries removed as part of gender-affirming surgery, is that menopause?

Yes. Removal of both ovaries causes surgical menopause because ovarian hormone production stops. If you are already using testosterone, your experience may differ from someone who isn’t on gender-affirming hormone therapy, but the surgery still causes the loss of ovarian function.

Does a hysterectomy cause menopause?

Not necessarily. A hysterectomy removes the uterus. If the ovaries remain, they can continue making hormones. Removing both ovaries causes surgical menopause.

Does MHT work?

Yes. MHT is the most effective treatment for menopausal hot flushes and night sweats and can also improve several other symptoms. The right formulation and dose vary between people.

Is MHT safe?

Current Australian guidance describes MHT as safe and effective for most healthy people. Risks vary depending on your age, medical history, how long it has been since menopause and the type and route of MHT used, so treatment should be individualised rather than viewed as either universally safe or universally risky.

Does MHT make you gain weight?

MHT itself isn’t considered a cause of midlife weight gain. Ageing, lifestyle, sleep, health and other factors all contribute to changes in weight. Menopause-related hormonal changes can alter where fat is stored, with more tending to accumulate around the abdomen.

Is menopause always difficult?

No. Experiences vary enormously. Some people notice very little change, while others have symptoms that significantly affect everyday life. Neither experience is more “normal” than the other.

Can complementary treatments help?

Some people find acupuncture, acupressure, yoga, mindfulness or other complementary approaches genuinely helpful for relaxation, sleep or general wellbeing. Clinical evidence varies depending on the therapy and symptom, so it’s reasonable to use approaches you find supportive while being realistic about what has and hasn’t been demonstrated in research.

Does menopause cause vaginal dryness?

It can. Lower oestrogen can make vaginal and vulval tissue thinner, drier and more sensitive. Lubricants, vaginal moisturisers and low-dose vaginal oestrogen are among the options that can help. Similar tissue changes can also affect some people using testosterone.

Can trans men use vaginal oestrogen?

Yes, local low-dose oestrogen may be appropriate for some trans men and transmasculine people experiencing dryness or tissue changes while using testosterone. It has very low systemic absorption and generally doesn’t reverse the desired masculinising effects of testosterone. Talk with your hormone prescriber or GP about whether it suits you.

Do I still need cervical screening after menopause or while using testosterone?

If you have a cervix and fall within the Australian screening program, yes. Routine Cervical Screening Tests are generally offered every 5 years between ages 25 and 74 regardless of whether you are postmenopausal, transgender or using testosterone.

Is bleeding after menopause normal?

No. Any vaginal bleeding after natural menopause should be checked by a doctor, even if it is light or only happens once.

There is no one right way to do menopause

Menopause is sometimes talked about as though it's a set script every one follows but it isn't.

You may sail through it with few symptoms. You may have a couple of frustrating years. You may find the changes significant enough that they affect your sleep, mood, work, relationships or sense of self.

If you’re trans or gender diverse, your experience may look different again depending on whether you use testosterone, which reproductive organs you have and whether you’ve had gender-affirming surgery.

You can use medical treatment, complementary therapies, lifestyle changes or a mixture of all three. What is important is finding options that help you feel comfortable, healthy and like yourself. If symptoms are getting in the way of your life, seek support.

Related reading

Sources and further reading

This article provides general educational information and isn’t a substitute for individual medical advice.