Menopause is a natural process which marks the end of monthly menstruation. It occurs when the ovaries stop releasing eggs for fertilization. Menopause typically begins between the ages of 45 and 55.
 
Menopause broadly occurs in three stages: perimenopause, menopause and post-menopause:

• Perimenopause is the period leading up to menopause and can last several years. During perimenopause, the ovaries gradually stop working, while menstruation can become heavier than usual and begin to occur irregularly. It is still possible to become pregnant during perimenopause, but the likelihood gradually decreases.
• Menopause is reached following the absence of a period for 12 consecutive months. Menopause can occur naturally or, in some cases, can be induced by surgery, illness or medication. At that point, pregnancy becomes improbable without interventions such as in vitro fertilization using donor eggs.
• The post-menopause stage signals the end of an individual’s reproductive years. Post-menopause can be divided into two stages; the first, lasting about five years after the last period, is when menopausal symptoms are most likely to occur. Following this period, symptoms begin to decrease. However, some women will have symptoms for many years.

All women experience menopause, typically between the ages of 45 and 55, as a natural part of the biological ageing process. By 2050, women over 50 are expected to make up about 35 per cent of the global population due to improvements in health outcomes, lifestyle and increasing life expectancies worldwide.

If menopause occurs before the age of 40, it is referred to as premature menopause. Premature menopause may occur in up to 8.6 per cent of women, while early menopause (from 40 to 44 years) in up to 9.4 per cent of women. While more research is needed, the consequences of earlier menopause may include an increased risk of neurological impairment, glaucoma, cardiovascular disease, osteoporosis and general mortality.

Transgender men, non-binary people, intersex people and people with variations in sex characteristics may also experience menopause. Gender-diverse people have unique health needs that health providers should be aware of, and should have access to specialist care when necessary.

There is no one experience of menopause. Symptoms vary significantly from person to person; while some women hardly feel the effects, others experience severe symptoms which can have negative consequences on their quality of life. For some individuals, symptoms can last for several years, or even decades.

The hormonal changes associated with perimenopause, menopause and postmenopause can affect physical, emotional, social and mental well-being. Associated symptoms include:

• Hot flushes/flashes and night sweats. Hot flushes refer to a sudden feeling of heat in the face, neck and chest, often accompanied by flushing of the skin, perspiration, palpitations and acute feelings of physical discomfort which can last several minutes;
• Changes in the regularity and flow of the menstrual cycle, culminating in cessation of menstruation;
• Low libido
• Vaginal dryness, pain during sexual intercourse and incontinence;
• Difficulty sleeping/insomnia
• Brain fog; memory loss, difficulty concentrating
• Changes in mood, depression, anxiety
• Weight gain and slowed metabolism
• Pain in general, joint or bone pain, low mass density (osteoporosis)
• Increased frequency of urination and/or urinary tract infections.

Given the broad spectrum of menopausal symptoms, with many women facing multiple challenges simultaneously, individuals tend to adopt a variety of strategies to manage their symptoms effectively. These approaches can range from simple lifestyle adjustments, such as ensuring cooler room temperatures, engaging in regular exercise, and choosing lighter clothing to stay comfortable, to more structured stress management techniques like mindfulness, relaxation practices or acupuncture. In other cases, many women turn to medical interventions, such as hormone replacement therapy, supplements, vaginal estrogen or other medications such as antidepressants to alleviate their symptoms and improve their overall well-being.

Unmanaged menopausal symptoms can lead to long-term negative health effects. It is crucial that all women have access to quality care and information to maintain a good state of physical health throughout the menopausal transition.

As estrogen levels drop, the risk of cardiovascular issues such as stroke increases due to changes in blood vessel function and lipid metabolism. The risk of developing cardiovascular disease increases during post-menopause, particularly among women who experience early menopause (before the age of 45). One study showed that women who had frequent or persistent hot flashes during early menopause had a 50 to 80 percent increased risk of cardiovascular events, including heart attacks, strokes, and heart failure. These findings highlight the importance of monitoring cardiovascular health during and after menopause, particularly in women who experience early onset of symptoms.

Additionally, the reduction in estrogen weakens bones, accelerating bone loss and significantly increasing the likelihood of developing osteoporosis, which raises the risk of fractures, particularly in the spine, hips and wrists. The hormonal changes associated with menopause also heighten the risk of cognitive decline, as estrogen plays a protective role in brain function, making women more vulnerable to neurodegenerative conditions like Alzheimer's Disease.

Estrogen loss also has a considerable impact on vaginal health. The tissue of the vaginal walls becomes thinner, drier and more fragile in a condition known as vaginal atrophy or genitourinary syndrome of menopause (GSM). This not only causes discomfort during sexual activity but also increases the risk of microtears, making women more susceptible to sexually transmitted infections (STIs). The weakened tissues, particularly in the vaginal and urethral areas, further predispose women to urinary tract infections (UTIs) by allowing bacteria easier access to the bladder. In addition, the loss of estrogen alters the pH balance of the vagina, diminishing its natural defenses against harmful bacteria, which further compromises overall vaginal health.

These changes can exacerbate the consequences of sexual violence: research indicates post-menopausal women experience “more frequent and more severe genital injuries from sexual assault than younger women”.

Once menopause begins, sex can be painful as a result of low estrogen, mood swings and fatigue from disrupted or lack of sleep. However, women can and do remain sexually active while and after experiencing menopause. Treatments for menopausal symptoms can help to improve sexual desire, while vaginal estrogen or water-based lubricants can alleviate vaginal dryness. Remaining sexually active sustains blood flow to the vagina and can ease conditions such as thinning vaginal walls. Exercises to strengthen pelvic floor muscles can also alleviate vaginal dryness, painful sex and frequent urination.

Although the need for pregnancy prevention may end during menopause, contraception is recommended to avoid unintended pregnancy until after 12 consecutive months without menstruation. Even when the need for pregnancy prevention has ended, other sexual and reproductive health services continue to remain necessary.

During menopause and perimenopause, it is still possible to acquire sexually-transmitted infections (STIs), including HIV, through unprotected sexual contact, including oral, anal and vaginal sex. The thinning of the vaginal wall after menopause increases the chance of lesions and tears, thereby increasing the risk of HIV transmission (including the transmission of other STIs) during vaginal sex. This means that sexually active women aged 50 and older are at high risk of acquiring HIV, among other STIs.

People aged 50 and older generally have a low perception of their own risk of acquiring HIV and HIV awareness. Older persons who are sexually active should continue to use condoms to prevent HIV and other STI transmission.

Recent research has shown that symptoms of menopause may vary depending on race and ethnicity. According to a large multi-site, longitudinal study undertaken in the United States since 1996, Black and Hispanic women begin menopause two years earlier than white women on average, and experience symptoms for twice as long. Black and Hispanic women also experience heavier bleeding during perimenopause.

Menopausal symptoms may also vary by region. The most common symptom reported by women in the Philippines, for example, is diffuse achiness, while in the United States, women most often report night sweats, hot flashes and insomnia. But within the United States, hot flashes are reported most often by Black women and least often by Asian women.

These disparities can partly be attributed to the effects of “weathering”, a process by which the effects of discrimination, including violence, experienced over the course of an individual’s life come to affect their overall health. Such findings illustrate the need for a holistic, life-cycle approach to treating menopause.

Human rights are rights that every human being has by virtue of being human. The experience of menopause intersects with many parts of a woman’s life, including health, work, social participation and general well-being. It is therefore directly related to our ability to exercise and enjoy many of our human rights.

When women experiencing menopause cannot access quality health services or accurate information on their symptoms, they can suffer both physical, emotional and mental distress. Women often encounter reluctance to discuss their symptoms from others in their social circles, and even from health-care professionals. This can lead to confusion, feelings of isolation and increased anxiety for women who are not aware that symptoms they are experiencing are related to menopause. One study from the United Kingdom found consistent integration of mental health screening into menopausal care was lacking, with women reporting: dismissive or negative attitudes from health-care professionals; poor treatment management, symptom information and misattribution; poor health-care professional knowledge; and the need for self-advocacy.

Some women may even experience ostracization during menopause; one study from China showed that menopausal women were regarded as “abnormal” and were often ostracized as a result, even in the privacy of their own homes. Women around the globe have reported experiencing feelings of “invisibility” once their reproductive years have ended. A lack of information can also lead to the perpetuation of harmful stereotypes and taboos about older women (see How does menopause affect mental health?).

There can also be economic consequences. The Fawcett Society reports that one in ten women have left their jobs because of menopause.

Below is a list of universally agreed human rights that can be undermined by a woman’s experience of menopause:

• The right to health – Women may experience negative health consequences when they lack adequate information and facilities to manage the symptoms of menopause. Stigma associated with menopause may also drive women to avoid seeking treatment, increasing the risk they will develop long-term health issues.
• The right to work – Menopause-related needs, such as increased bathroom breaks, may be penalized, leading to unequal working conditions. Some women lose income due to taking time away from work during menopause, or as a result of increased health-care needs.
• The right to non-discrimination and gender equality – Social stigma related to menopause and barriers in access to adequate health services can lead to discrimination and perpetuate gender inequalities. Menopausal women may face unique forms of discrimination related to their age and their gender.
• The right to information and education – Many women lack access to accurate, comprehensive information on what to expect during the menopausal transition. Access to education empowers women to make informed decisions about their health and well-being.

Navigating menopause involves more than managing physical symptoms; it requires a holistic approach that includes emotional, social and sexual health support. Menopause does not mark the end of an individual’s sexual life or reproductive rights. While women no longer need to prevent pregnancy, they must have access to a full spectrum of sexual health services to address their evolving needs.

Many sexual and reproductive health programs focus solely on maternity and family planning, but UNFPA advocates for a life-cycle approach that encompasses all women’s health needs from pre-menarche to post-menopause. During this phase, women should feel supported by their communities and empowered to make informed decisions that prioritize their health and well-being, ensuring they can live fulfilling lives.

During menopause, changing hormone levels can affect an individual’s mental health. As ovulation becomes irregular, decreasing levels of progesterone and estrogen can cause mood swings, low mood and anxiety. Loss of sleep due to insomnia can also lead to increased stress levels. While mood shifts during perimenopause and menopause are usually mild, women who have struggled previously with depression or anxiety might experience a resurgence of symptoms.

Stigma associated with women’s ageing may contribute to feelings of invisibility and lead some older women to feel disempowered and isolated. Menopausal women have often been portrayed, or treated, as irrational, hysterical or purposeless, attitudes that can deter women from discussing their symptoms and experiences, even with medical professionals.

Just as menopause can affect mental health, mental health can also affect menopause. There may be a link between chronic stress and early menopause, and early menopause brings with it its own health risks.

Access to quality mental health care for women experiencing menopause is crucial to ensure that women’s overall health needs are met.

There are many taboos and myths surrounding menopause and those who are experiencing it. Around the world, misconceptions about menopause have led to the ostracization and exclusion of older women, and deterred them from seeking support. Below is a non-exhaustive list of myths about menopause.

Myth: You cannot become pregnant during menopause.

It is possible for an individual to become pregnant during perimenopause, the first stage of menopause. Perimenopause is defined as the period from when menopausal symptoms are first observed until one year after the final menstrual period. Contraception is recommended to avoid unintended pregnancy until after 12 consecutive months without menstruation.

Myth: You cannot acquire sexually transmitted infections (STIs) during or following menopause.

It is still possible to acquire sexually transmitted infections, including HIV, through unprotected sexual contact, whether oral, anal or vaginal sex, no matter your age or reproductive stage. In fact, the thinning of the vaginal wall after menopause increases the chances of lesions and tears, thereby increasing the risk of HIV transmission during vaginal sex.

Myth: Only severe menopause symptoms need treatment.

While many women manage their symptoms of menopause at home, consultation with a health provider is important to ensure all people who experience menopause have what they need for a healthy transition. Even common symptoms of menopause such as hot flashes and night sweats can be linked to poor memory performance and alterations in brain structure, function and connectivity. Regular health check-ups and access to quality, accurate information on the specific risks menopausal women face should be accessible to every person who will experience or is experiencing menopause.

Myth: Only women experience menopause.

Transgender men and gender-diverse individuals also experience menopause and have unique health needs. There is an urgent need for more data in this area and for health providers to understand the specific needs of gender-diverse individuals related to menopause and the ageing process.

Myth: Post-menopausal women have no purpose in society.

The idea that women lose their value once their reproductive years have ended is rooted in misogyny and is untrue. The post-menopausal years of a woman’s life are just as valuable as other stages, and can offer a unique time to focus on oneself, to contribute to family and community, to help others grow and learn and to take up new interests.

Beyond its biological effects, menopause has profound societal, emotional and psychological impacts that can shape the experience of women and all people who menstruate. Women’s experiences of living through the menopausal period are significantly impacted by sociocultural factors such as race, ethnicity, social class and sexual orientation. Studies suggest that a woman’s pre-menopausal state of emotional and physical health, as well as her community’s attitude towards menopause and female ageing, serve as predictors for her quality of life during the menopausal transition.

For all women, leaving their reproductive years behind marks both an important change and a time for growth. Regardless of differences in how it is experienced, the menopausal transition can provide a time to reassess one’s health, lifestyle and goals. In many cultures, menopause is viewed and celebrated as part of the ritual of fertility. In some indigenous communities, menopausal women participate in sweat lodge ceremonies to gain physical and emotional healing and to seek guidance for this new stage of life. Celebrating menopause gives women the freedom to feel empowered by this stage of life, which can signal greater financial independence, increased empowerment and self-care, and higher levels of confidence.

When we recognize women as full human beings and members of society, rather than viewing their only purpose as reproduction, we can ensure that older women remain valued and feel deserving of care and support.

For women and gender diverse individuals with functioning ovaries, menopause cannot be avoided. However, the symptoms and side effects of menopause can be managed with the help of a health provider.

When women have access to quality health services throughout their life, they can better plan for menopause through healthy lifestyle choices, nutrition and understanding the needs of their bodies. This can make the menopausal transition easier, and mitigate some of the symptoms.

While menopause can present challenges, it also marks a new and positive phase in life for many women. Many report relief from managing periods and the need for contraception, allowing for greater freedom and spontaneity.

For others over 65, the post-menopausal period often corresponds with the end of menopause symptoms, as well as retirement or reduced work pressure. With children living independently, this period can become a time for renewal, where individuals can redirect their energy toward personal interests and new purposes.

This transition offers an opportunity to reassess lifestyle, health and goals. Many women use this time for personal growth, exploring hobbies and even pursuing new career paths. Embracing a life-cycle approach to health ensures individuals feel supported throughout their lives, fostering a positive attitude toward aging and well-being.

The term andropause or “male menopause” is often used to refer to age-related hormonal changes which take place in men. Such changes may include loss of sex drive, erectile dysfunction, mental health issues and other physical and emotional symptoms in the late 40s to early 50s. This term can be misleading as it suggests that symptoms result from a sudden drop in testosterone in middle age, similar to the drop in estrogen women experience during menopause. While hormonal changes do occur in men, they typically occur over a longer timeframe.

Older men should attend regular health check-ups. Regular exercise, quality sleep and a balanced diet help to maintain healthy testosterone levels. In some cases, testosterone replacement therapy, or TRT, can improve physical and emotional symptoms.

UNFPA is at the forefront of advocating for the integration of health services related to menopause in wider sexual and reproductive health and rights programming as an essential aspect of comprehensive health care for women and all people who menstruate. Integrating menopause into sexual and reproductive health programmes acknowledges the unique health-care needs of women and all people who menstruate as they age, promoting intersectional gender sensitivity in health-care delivery, and reducing the stigma surrounding menopause.

UNFPA is also developing educational resources and advocating for workplace policies that support menopausal women. And above all, UNFPA is working to break the silence around menopause to ensure that women receive the support they need and continue to have a voice during this life stage.