Menopause: What It Is and How to Manage It

What is menopause?

Menopause marks the end of menstrual cycles. You reach menopause when you have gone 12 months without a menstrual period. Most women experience it between ages 45 and 55, with the average age around 52.¹

This happens because the ovaries stop releasing eggs and make less estrogen and progesterone. These hormones control your menstrual cycle and fertility.^1,2

What are the symptoms of menopause?

Menopause affects each person differently. While some women experience mild changes, others may have symptoms that significantly impact daily life. Menopause symptoms can begin years before periods stop and may continue afterward.

Common symptoms include:

• Hot flashes and night sweats: Sudden feelings of heat, flushing, and sweating that can occur during the day or disrupt sleep at night.^1,2
• Sleep changes: Difficulty falling asleep, staying asleep, or waking too early, sometimes related to night sweats but not always.^1,2
• Mood and emotional changes: Increased irritability, anxiety, or depression, even in women who haven't experienced these symptoms before.^1,2
• Vaginal and urinary changes: Vaginal dryness, discomfort during sex, urinary urgency, or leakage, which can worsen over time without treatment.²
• Changes in memory and focus: Difficulty concentrating or feeling mentally “foggy,” which is common during the menopause transition.^1,2

Other changes may include weight gain (especially around the abdomen), joint or muscle aches, headaches, and fatigue.

If symptoms interfere with quality of life, effective treatment options are available. Make sure to discuss concerns with your health care provider.

How is menopause confirmed?

True menopause isn't confirmed until you've gone 12 months without a menstrual period. Your doctor may confirm menopause based on symptoms and menstrual history. Blood tests for hormone levels are sometimes used but not always needed.¹

Always be sure to report unusual bleeding or severe symptoms to your health care provider or OBGYN.

What can cause early menopause?

Menopause is a natural part of aging, but it can also occur early due to:²

• Surgery to remove ovaries (oophorectomy).
• Cancer treatments like chemotherapy and radiation.
• Certain health conditions affecting ovarian function (also called primary ovarian insufficiency).

Menopause that happens early (before age 45) or very early (before age 40) can increase health risks.²

What health risks are linked to menopause?

Menopause is a natural stage of life. However, the drop in estrogen can increase your risk for certain health conditions over time. These risks vary by individual and are influenced by:

• Genetics
• Lifestyle
• Overall health

Note: Not all women will experience these risks. Many risks can be reduced with early identification, preventive care, lifestyle changes, and treatment. Always discuss your symptoms and health concerns with your health care provider to develop a prevention plan that fits your needs.

Heart Disease and Stroke³

Heart disease is the leading cause of death for women. Your risk of getting a cardiovascular disease, such as heart disease or stroke. greatly increases after menopause. This is due to cholesterol levels changing and changes to the way your blood vessels function.

Bone Loss and Osteoporosis⁴

Up to 1 in 2 women over age 50 will experience osteoporosis. Estrogen plays a key role in maintaining bone density. After menopause, bone loss accelerates and fracture risk increases (especially of the hip, spine, and wrist). 

Urinary and Sexual Health Changes¹

Declining estrogen can put you at a higher risk for things like:

• Repeated urinary tract infections
• Urinary incontinence
• Painful intercourse
• Long-term vaginal discomfort.

Unlike hot flashes, these symptoms do not resolve on their own and may worsen without treatment. It is important that you discuss any of these symptoms with your provider.

Metabolic Changes and Weight Gain¹

Menopause is associated with increased abdominal (visceral) fat, reduced muscle mass, and insulin resistance.

Mental Health and Cognitive Changes

According to a Mayo Clinic study, 13% of working women reported considering quitting, leaving, or changing jobs, with mental or cognitive menopause symptoms being a main reason.⁵

These symptoms include:

• Anxiety
• Depression
• Poor concentration
• Memory issues
• Emotional volatility
• Sleep issues
• Brain fog

How do you manage menopause symptoms?

There are several effective ways to manage menopause symptoms. Treatment choices depend on symptom type, severity, personal health history, and individual preferences.

Many women benefit from a combination of lifestyle, home-based strategies, and medical treatments.

Note: Treatment decisions, including the use of supplements, should be made with a health care provider. Supplements or “natural” remedies may be ineffective or unsafe.

Home Remedies⁶

Simple environmental and behavioral adjustments can help reduce the frequency or intensity of symptoms, especially hot flashes and sleep challenges:

• Layered clothing that can be easily removed during hot flashes
• Using a fan or cooling devices
• Keeping rooms cool, especially during sleep
• Cooling pillows, sheets, or mattress toppers
• Breathable fabrics (such as cotton or moisture-wicking materials)
• Cold water or ice packs for fast relief during hot flashes
• Avoiding common triggers, such as spicy foods, alcohol, caffeine, and hot beverages
• Paced breathing or relaxation techniques

These strategies are low risk and may be helpful for those with mild symptoms or in addition to medical treatment.

Lifestyle Tips⁶

Healthy habits support symptom management and long term health:

• Regular physical activity during menopause improves mood, sleep, and bone health
• Balanced diet and nutrition support cardiovascular and metabolic health
• Stress management may reduce anxiety and improve sleep quality
• Consistent sleep routines can improve fatigue and cognitive symptoms

Lifestyle strategies alone may not fully control moderate to severe symptoms but remain foundational.

Hormone Therapy

Hormone therapy is the most effective treatment for moderate to severe menopause symptoms. It's especially helpful for hot flashes, night sweats, and urinary or vaginal symptoms. This type of hormone therapy is sometimes called menopause hormone therapy (MHT).⁷

Estrogen therapy (with or without progesterone) can:⁷

• Significantly reduce hot flashes and night sweats
• Improve sleep
• Relieve vaginal dryness and discomfort
• Prevent bone loss and reduce fracture risk

Do you need progesterone in addition to estrogen?⁷

• Most individuals need estrogen plus a progesterone to protect the uterine lining.
• Those without a uterus may use estrogen alone.

Is hormone therapy safe?

For healthy women under age 60 or within 10 years of menopause onset, evidence shows the benefits of hormone therapy generally outweigh the risks when appropriately prescribed and monitored by a provider.⁸

Treatment is individualized, using the lowest effective dose, with regular provider visits to monitor progress.

There may be limitations to the use of hormonal therapy based on your health history. It is important to discuss your options with your provider. 

Non-Hormonal Medications³

Women who cannot or choose not to use hormone therapy can benefit from:

• Certain antidepressants
• Some blood pressure medications
• Other evidence-based therapies

These may reduce hot flashes or support mood symptoms, though they are generally less effective than hormone therapy.

Bone Health Support³

Because bone loss accelerates after menopause, some women may benefit from:

• Calcium and vitamin D, when appropriate.
• Prescription therapies to reduce fracture risk, based on bone density and individual risk.

Vaginal and Urinary Symptom Management³

For vaginal dryness or discomfort, women can benefit from:

• Vaginal moisturizers and lubricants for symptom relief.
• Low-dose vaginal estrogen (very little of which enters the bloodstream).

When should you talk to a health care provider?

Menopause is a normal life stage, but it can affect your health and well-being. Understanding symptoms, risks, and treatment options can help you manage this transition confidently.

If you notice that symptoms are affecting your sleep, mood, or daily life, talk to your health care provider about safe and effective treatment options.

¹ What Is Menopause?, National Institute on Aging, reviewed October 16, 2024, https://www.nia.nih.gov/health/menopause/what-menopause

² Menopause – Symptoms and Causes, Mayo Clinic, August 7, 2024, https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

³ About Women and Heart Disease, CDC, May 15, 2024, https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html

⁴ What Women Need to Know, Bone Health & Osteoporosis Foundation, accessed March 20, 2026, https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/what-women-need-to-know/

⁵ Impact of Menopause Symptoms on Women in the Workplace, Mayo Clinic, April 26, 2023, https://www.mayoclinicproceedings.org/article/S0025-6196(23)00112-X/abstract

⁶ How to Get Relief from Hot Flashes, Mayo Clinic Press, November 27, 2023, https://mcpress.mayoclinic.org/women-health/how-to-get-relief-from-hot-flashes/

⁷ Menopause – Diagnosis and Treatment, Mayo Clinic, August 7, 2024, https://www.webmd.com/menopause/understanding-menopause-treatment

⁸ Hormone Therapy: Is it right for you?, Mayo Clinic, April 18, 2025, https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372

This information is for educational purposes only. It isn't medical advice and does not replace care from a physician. Cigna Healthcare isn't responsible for issues due to the use, misuse, interpretation or application of this information. Always ask your provider for appropriate examinations, treatment, testing, and care recommendations.

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