Menopause: symptoms, stages, treatments, and essential care
Menopause is a natural phase of a woman’s life, but it is not always experienced in the same way. As the ovaries reduce estrogen production, the body undergoes various changes that, in most cases, begin even before the final menstrual period and persist for several years.
Changes in the menstrual cycle, hot flashes, sleep disturbances, vaginal dryness, fatigue, and mood swings are among the most common manifestations. However, their intensity varies from woman to woman. While some experience hardly any changes, others face symptoms that affect their daily lives, including their professional lives.
Throughout this article, we will discuss what menopause actually is, its stages, the symptoms that may arise, and the options available to alleviate the effects of hormonal changes.
What is menopause?
Menopause corresponds to the final spontaneous menstrual period. However, it can only be confirmed retrospectively, after 12 consecutive months without menstruation, provided there is no other cause for this absence.
Natural menopause generally occurs between the ages of 45 and 55. The average age is around 51 years, although there are individual differences. Menopause before the age of 45 is considered early. When ovarian function declines before the age of 40, it is referred to as premature ovarian insufficiency.
Menopause should be understood as part of a process that includes the menopausal transition, the final menstrual period, and the years that follow.
Perimenopause
Perimenopause is the transitional period preceding menopause that extends until 12 months after the last menstrual period.
During this phase, ovarian activity becomes more irregular. Menstrual cycles may become shorter, longer, heavier, or less frequent. Hot flashes, night sweats, sleep disturbances, and mood swings may also occur.
Perimenopause can last for several years. During this period, ovulation may still occur and pregnancy remains possible in many cases, which is why contraceptive precautions should be maintained.
Post-menopause
Postmenopause begins after those 12 months without menstruation and lasts for the rest of one’s life.
Some symptoms, such as hot flashes, may diminish over time. On the other hand, vaginal dryness and certain urinary symptoms may persist or worsen.
After menopause, the decline in estrogen levels is also associated with an increased risk of certain diseases and health conditions. Among the most common are osteoporosis, cardiovascular diseases, type 2 diabetes, and changes in muscle mass.
Why does menopause occur?
A woman is born with a limited number of follicles in her ovaries. These follicles contain oocytes, the female reproductive cells. Follicular reserve declines with age. During perimenopause, ovarian function becomes irregular. As a result, the production of estrogen and progesterone fluctuates and, later, decreases significantly.
Estrogens are hormones involved in regulating the menstrual cycle. In addition, they exert effects on the bones, blood vessels, skin, brain, vagina, and urinary tract. Progesterone, another hormone circulating in women’s bodies, helps regulate the cycle and protects the inner lining of the uterus during the reproductive years.
Understanding some of the functions of these hormones makes it clearer why hormonal fluctuations are associated with many perimenopause symptoms.
What are the most common symptoms of menopause?
Not all women experience the same symptoms. Intensity, duration, and the impact on daily life vary from woman to woman.
Menstrual changes
Menstrual changes are among the first signs of perimenopause. They may include:
- Shorter or longer cycles;
- Menstrual periods occurring closer together or further apart;
- Heavier or lighter menstrual flow;
- Minor bleeding between periods;
- Months without menstruation, followed by a new period.
Although these changes can occur during perimenopause, bleeding that is very heavy, prolonged, or frequent—or associated with pain—should be evaluated.
Hot flashes and night sweats
Hot flashes are sudden episodes of heat, often most intense in the face, neck, and upper torso. They may be accompanied by skin flushing, sweating, palpitations, or feelings of anxiety.
When they occur at night, they are known as night sweats. They can disrupt sleep and contribute to fatigue, irritability, or difficulty concentrating the next day.
Vasomotor symptoms can begin before menstrual periods end. Their duration and intensity vary greatly among women.
Sleep disturbances
Some women have difficulty falling asleep, wake up several times during the night, or wake up too early.
Hot flashes can contribute to these changes, but there are other possible causes. Anxiety, depression, sleep apnea, pain, restless legs syndrome, and the consumption of alcohol, caffeine, or certain medications can also affect sleep.
Mood swings and anxiety
Irritability, heightened emotional sensitivity, anxiety, or mood swings may arise during the menopausal transition.
Menopause alone does not explain every instance of depression or anxiety. Symptoms that are persistent or intense, or associated with a loss of interest in usual activities, require proper evaluation.
Difficulty concentrating and memory lapses
Some women report a reduced ability to concentrate, difficulty finding words, or mild forgetfulness.
These changes are usually temporary. However, progressive cognitive problems, disorientation, or changes affecting independence should be evaluated. Although the link between menopause and dementia is sometimes discussed, it is known that the vast majority of women who experience this well-known phase of “brain fog” will not develop dementia. Furthermore, hormone therapy is not currently considered indicated for preventing or treating dementia.
Vaginal dryness and intimate discomfort
A reduction in estrogen can cause the tissues of the vulva, vagina, and urinary tract to become thinner, drier, and more sensitive. This set of changes is known as genitourinary syndrome of menopause.
It can cause:
- Vaginal dryness;
- Burning or irritation;
- Pruritus;
- Pain during sexual intercourse;
- Minor bleeding after sexual contact;
- Urgency or discomfort upon urination;
- Recurrent urinary tract infections.
These symptoms may persist and require attention. Women do not have to accept them as an inevitable consequence of aging; they should prevent and manage them using products recommended by a healthcare professional.
Changes in sexuality
Dryness and pain can reduce comfort during sexual intercourse. Furthermore, libido (sexual desire) may be affected by hormonal changes, as well as by poor sleep, mood swings, body image issues, and even certain prescribed medications.
However, a reduction in sexual desire is not always due to menopause. The assessment must consider the physical, emotional, and relational context.
Skin and hair changes
The skin may become drier and lose some elasticity. Hair may become thinner or fall out more.
Changes in body composition
A change in body fat distribution frequently occurs, with greater accumulation in the abdominal area.
Hormonal changes do not automatically cause weight gain. Aging, a sedentary lifestyle, loss of muscle mass, sleep patterns, and diet also play an important role.
Muscle and joint pain
Some women report stiffness, joint discomfort, or muscle pain. As these symptoms also occur in rheumatological conditions, thyroid disorders, nutritional deficiencies, and other situations, their persistence should be investigated.
How is menopause diagnosed?
In healthy women over the age of 45, the diagnosis of perimenopause is usually based on age, symptoms, and menstrual changes. Hormone tests are not necessary in most cases because follicle-stimulating hormone (FSH) levels can fluctuate significantly during this phase.
Assessment via laboratory analysis may make sense:
- In women under 40 years of age;
- Between the ages of 40 and 45, when the diagnosis remains uncertain;
- When there are unusual symptoms or menstrual irregularities;
- When it is necessary to rule out pregnancy, thyroid disease, anemia, or other causes;
- When a woman uses hormonal methods that alter the menstrual pattern.
The clinical history should also consider medications, supplements, personal and family history, blood pressure, bone health, cardiovascular risk, and all age-appropriate screenings.
Treatments for menopause symptoms
Treatment must be tailored to the symptoms, the woman’s preferences, her medical history, and the impact on quality of life.
A woman with isolated vaginal dryness may require a different approach than one experiencing intense hot flashes, insomnia, and mood swings. For this reason, there is no one-size-fits-all solution.
Menopausal hormone therapy
Menopausal hormone therapy uses estrogens, either alone or in combination with a progestogen.
It is the most effective treatment for hot flashes and night sweats. It can also improve other symptoms associated with estrogen deficiency and helps prevent bone loss during use.
In women who retain their uterus, systemic estrogen should generally be combined with a progestogen to protect the endometrium. After a hysterectomy, estrogen alone can be used in many situations.
There are various formulations, such as tablets, patches, gels, and vaginal forms. The route of administration, dosage, and regimen depend on the clinical profile and the decision made between the doctor and the woman.
Before starting treatment, the doctor evaluates:
- Type and intensity of symptoms;
- Age and time elapsed since menopause;
- Presence or absence of a uterus;
- Hemorrhage pattern;
- Risk of cardiovascular disease and thrombosis;
- History of cancer;
- Liver diseases;
- Migraine, hypertension, and other conditions;
- A woman’s preferences.
The balance between benefits and risks tends to be more favorable in symptomatic women who are under 60 years of age or within the first ten years of menopause (provided there are no contraindications). The decision should be personalized on a case-by-case basis and reviewed over time.
Hormone therapy should not be initiated solely to prevent cardiovascular disease or dementia.
Are there hormone-free options?
Yes. The choice depends on the symptom you wish to relieve.
Cognitive-behavioral therapy can help reduce the impact of hot flashes and improve symptoms of anxiety, mood, and sleep.
There are also prescription non-hormonal medications for moderate to severe hot flashes. Choosing the right option requires medical evaluation, especially when the woman is taking antidepressants, medication for high blood pressure, or other treatments.
For vaginal symptoms, moisturizers and lubricants are non-hormonal options. When these measures are insufficient, the doctor may consider specific local treatments.
Products and solutions available at the pharmacy
Vaginal moisturizers
Vaginal moisturizers are intended for regular use. They help maintain moisture and can reduce dryness, burning, and discomfort.
They should be selected based on the active ingredients included and used regularly according to the product instructions.
Lubrificants
Lubricants work during sexual intercourse and help reduce friction and pain.
Water-based products are compatible with most condoms (an important consideration during perimenopause). Formulas containing fragrances, flavorings, or potentially irritating substances may cause discomfort for women with heightened sensitivity.
Dry skin care
Gentle facial cleansing products, emollient creams, and sun protection help preserve the skin barrier. Regular application of a good moisturizer is more beneficial than the occasional use of highly complex formulas.
Hair loss products
Diffuse, temporary hair loss may occur during periods of hormonal changes or stress. . Even so, if hair loss is severe, it is advisable to rule out anemia, thyroid disorders, nutritional deficiencies, scalp disease, or medication side effects.
Pharmaceutical counseling can help in selecting hair care products and identifying situations that warrant a consultation.
Calcium and vitamin D
Calcium or vitamin D supplements are not necessary for all women. Diet, sun exposure, kidney health, fall risk, medications, and—in some cases—levels detected in lab tests should be considered before starting supplementation with these substances.
Unnecessary supplementation can cause adverse effects or interactions. A pharmacist or doctor can help assess the need.
Other menopause supplements
There are products containing isoflavones and other plant extracts, vitamins, and minerals. Efficacy varies among products, and evidence remains limited or inconclusive for many options.
“Natural” does not mean risk-free. Some supplements can interfere with anticoagulants, antidepressants, cancer treatments, and other medications. Products with potential estrogenic activity require caution in women with a history of hormone-dependent cancers.
Supplements should not be presented as equivalent to hormone therapy or as a treatment for osteoporosis, depression, or cardiovascular disease.
Comparison table of menopause stages
| Phase | What it means | Common changes | Fertility |
|---|---|---|---|
| Premenopause | Reproductive period prior to the transition | Usually regular cycles | Present |
| Perimenopause | Transition period up to 12 months after the last menstrual period | Irregular cycles, hot flashes, sleep and mood changes | Reduced, but still possible |
| Menopause | Last menstrual period, confirmed after 12 months without a period | Marks the end of natural reproductive function | Ceases after confirmation |
| Postmenopause | Period after menopause | Some symptoms subside; genitourinary symptoms may persist | Absent |
These definitions are consistent with current clinical terminology and with documents from organizations such as the European Menopause and Andropause Society (EMAS), the Portuguese Society of Gynecology, and the European Society of Endocrinology.
Practical recommendations for a better menopause experience
Exercise regularly.
Combine aerobic exercise, strength training, flexibility, and activities that improve balance.
Strength training helps preserve muscle and bone. Aerobic exercise supports cardiovascular health. Furthermore, physical activity can improve mood, sleep, and daily life for women at this stage of life.
Adopt a balanced diet.
Prioritize vegetables, fruit, legumes, minimally refined grains, fish, olive oil, nuts and seeds, and adequate sources of protein.
Protein helps preserve muscle mass. Calcium-rich foods contribute to bone health. A Mediterranean-style diet also supports the control of blood pressure, cholesterol, and weight.
Protect your sleep
Maintain a regular schedule, cut back on caffeine later in the day, and avoid heavy meals before bedtime.
A cool room, lightweight clothing, and layered bedding can help when dealing with night sweats.
Identify factors that aggravate hot flashes.
Alcohol, very hot drinks, spicy foods, hot environments, stress, and tobacco can aggravate symptoms in some women.
A simple record of the episodes can help identify personal patterns.
Avoid tobacco and moderate alcohol consumption.
Tobacco increases the risk of cardiovascular disease and osteoporosis. It can also be associated with more frequent or intense hot flashes.
Alcohol consumption should be moderate, especially when it interferes with sleep, increases episodes of hot flashes, or interacts with medication.
Undergo the recommended screenings.
Menopause does not eliminate the need for screening for breast cancer, cervical cancer, or other diseases.
Blood pressure, cholesterol, blood glucose levels, bone health, and cardiovascular risk also warrant attention during this stage of a woman’s life.
Warning signs: when to seek evaluation
Schedule a medical appointment with:
- Postmenopausal vaginal bleeding;
- Very heavy, prolonged, or very frequent periods;
- Persistent bleeding during hormone therapy;
- Persistent pelvic pain;
- Pain or blood loss during sexual intercourse;
- Vaginal discharge with blood or an unusual odor;
- Unexplained weight loss;
- Severe hair loss, localized or accompanied by scalp changes;
- Deep sadness, intense anxiety, or significant behavioral changes;
- Symptoms that significantly affect sleep, work, or daily life;
- Menstrual changes or hot flashes before the age of 40.
Postmenopausal bleeding should always be investigated. When hormone therapy is used, minor bleeding may occur with certain treatment regimens. However, heavy or persistent bleeding, or bleeding that appears after a prolonged period without any blood loss, requires evaluation.
Chest pain, sudden shortness of breath, fainting, weakness on one side of the body, or sudden difficulty speaking require urgent medical attention.
In short, menopause is a natural transition, but the associated symptoms can affect various organs in a woman’s body and alter her daily life. Hot flashes, sleep difficulties, vaginal dryness, and mood swings are common. However, every woman experiences this phase differently.
There are lifestyle measures, pharmacy products, and medical treatments that can alleviate many symptoms. For this reason, the best approach depends on each woman’s needs, preferences, and health conditions.
Furthermore, new, intense, or persistent symptoms should not automatically be attributed to menopause. A personalized assessment helps rule out other causes and select safe options.
In this way, with credible information and appropriate support, it is possible to navigate menopause with greater comfort, confidence, and control over one’s own health.
Do you have questions about menopause symptoms or the products best suited for you? Speak with the team at Correia Rosa Pharmacies and receive personalized pharmaceutical advice.
FAQs – Frequently Asked Questions about Menopause
Natural menopause typically occurs between the ages of 45 and 55. However, the first symptoms of perimenopause can begin a few years earlier.
Irregular cycles, hot flashes, night sweats, sleep disturbances, and vaginal dryness may suggest perimenopause. Since these symptoms can also have other causes, you should seek an evaluation if they are intense, persistent, or unusual.
In most women over the age of 45 with typical symptoms, hormonal tests are not necessary. They may be useful before age 45 or when the diagnosis remains uncertain.
The duration varies. Some symptoms persist for a few months. Others last for several years. Vaginal dryness and urinary symptoms tend to persist or worsen if appropriate care is not taken.
Yes. Fertility declines, but ovulation can still occur. Contraception should be continued until the end of the fertile phase can be confirmed, in accordance with professional guidance.
Wearing lightweight clothing, keeping the environment cool, cutting back on alcohol, quitting smoking, managing weight, and identifying triggers can help. When hot flashes affect quality of life, hormonal and non-hormonal treatments are available.
Yes. Vaginal moisturizers and lubricants can relieve mild symptoms. If discomfort persists, the doctor can evaluate local treatments, such as vaginal estrogens or other options suited to the clinical profile.
It depends on the composition, dosage, the woman’s health, and the medications she is taking. Evidence regarding efficacy varies, and interactions may occur. Seek advice before starting a supplement.
It may offer a favorable benefit-risk balance for many symptomatic women, especially around the onset of menopause. However, it is not suitable for everyone. The decision requires medical assessment and monitoring.
Engage in appropriate strength and weight-bearing exercises, ensure a diet rich in protein and calcium, and avoid tobacco and excessive alcohol consumption. Bone densitometry is not a mandatory test for all women; therefore, the decision to undergo it depends on fracture risk and should be guided by your doctor.
Bibliographic references
European Menopause and Andropause Society. (2025). Health at Menopause and Beyond. EMAS.
International Menopause Society. (2025). Recommendations and Key Messages on Women’s Midlife Health and Menopause. IMS.
Lumsden, M. A., Dekkers, O. M., Faubion, S. S., et al. (2025). European Society of Endocrinology clinical practice guideline for evaluation and management of menopause and the perimenopause. European Journal of Endocrinology, 193(4), G49–G81. https://doi.org/10.1093/ejendo/lvaf206
National Institute for Health and Care Excellence. (2024). Menopause: identification and management. NICE guideline NG23. NICE.
Rees, M., Athanasiadou, K., Hillard, T., Lindén Hirschberg, A., Paschou, S., & Stute, P. (2025). EMAS CareOnline: Health at Menopause and Beyond. European Menopause and Andropause Society.
Sociedade Portuguesa de Ginecologia. (2021). Consenso Nacional sobre Menopausa 2021. Secção Portuguesa de Menopausa.
World Health Organization. (2024). Menopause. WHO.
