One cool fall day, Ellen and Sue were watching their teenagers play soccer when all of a sudden Ellen flushed and seemed to be sweating. Sue asked if Ellen was okay. “Oh, it’s a hot flash,” Ellen said. “This is happening to me several times a week now—even at night. At first, I didn’t know what was going on, but my doctor told me these are symptoms of menopause.” Sue laughed and said, “Yes, I remember hot flashes, but they’re over now.” 
 
 Menopause, or the “change of life,” is different for each woman. For example, hot flashes and sleep problems may trouble your sister. Meanwhile, you are enjoying a new sense of freedom and energy. And your best friend might hardly be aware of a change at all. 
 
 What Is Menopause? 
 
 Menopause is a normal part of life, just like puberty. It is the time of your last menstrual period. You may notice changes in your body before and after menopause. The transition usually has three parts: perimenopause, menopause, and postmenopause. 
 
 Changes usually begin with perimenopause. This can begin several years before your last menstrual period. Changing levels of estrogen and progesterone, which are two female hormones made in your ovaries, might lead to symptoms. Menopause comes next, the end of your menstrual periods. After a full year without a period, you can say you have been “through menopause,” and perimenopause is over. Postmenopause follows perimenopause and lasts the rest of your life. 
 
 The average age of a woman having her last period, menopause, is 51. But, some women have their last period in their forties, and some have it later in their fifties. 
 
 Smoking can lead to early menopause. So can some types of operations. For example, surgery to remove your uterus (called a hysterectomy) will make your periods stop, and that’s menopause. But you might not have menopause symptoms like hot flashes right then because if your ovaries are untouched, they still make hormones. In time, when your ovaries start to make less estrogen, menopause symptoms could start. But, sometimes both ovaries are removed (called an oophorectomy), usually along with your uterus. In this case, menopause symptoms can start right away, no matter what age you are, because your body has lost its main supply of estrogen. 
 
 What Are the Signs of Menopause? 
 
 Women may have different signs or symptoms at menopause. That’s because estrogen is used by many parts of your body. As you have less estrogen, you could have various symptoms. Here are the most common changes you might notice at midlife. Some may be part of aging rather than directly related to menopause. 
 
 Change in your period. This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed less than usual or more. These are all normal changes, but to make sure there isn’t a problem, see your doctor if: 
 
 Your periods come very close together 
 
 You have heavy bleeding 
 
 You have spotting 
 
 Your periods last more than a week 
 
 Your periods resume after no bleeding for more than a year 
 
 Hot flashes. Many women have hot flashes, which can last a few years after menopause. They may be related to changing estrogen levels. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Flashes can be very mild or strong enough to wake you from your sleep (called night sweats). Most hot flashes last between 30 seconds and 10 minutes. 
 
 Vaginal health and bladder control. Your vagina may get drier. This could make sexual intercourse uncomfortable. Or, you could have other health problems, such as vaginal or bladder infections. Some women also find it hard to hold their urine long enough to get to the bathroom. This loss of bladder control is called incontinence. You may have a sudden urge to urinate, or urine may leak during exercise, sneezing, or laughing. 
 
 Sleep. Around midlife, some women start having trouble getting a good night’s sleep. Maybe you can’t fall asleep easily, or you wake too early. Night sweats might wake you up. You might have trouble falling back to sleep if you wake up during the night. 
 
 Sex. You may find that your feelings about sex are changing. You could be less interested. Or, you could feel freer and sexier after menopause. After 1 full year without a period, you can no longer become pregnant. But remember, you could still be at risk for sexually transmitted diseases (STDs), such as gonorrhea or even HIV/AIDS. You increase your risk for an STD if you are having sex with more than one person or with someone who is having sex with others. If so, make sure your partner uses a condom each time you have sex. 
 
 Mood changes. You might find yourself more moody or irritable around the time of menopause. Scientists don’t know why this happens. It’s possible that stress, family changes such as growing children or aging parents, a history of depression, or feeling tired could be causing these mood changes. 
 
 Your body seems different. Your waist could get larger. You could lose muscle and gain fat. Your skin could get thinner. You might have memory problems, and your joints and muscles could feel stiff and achy. Are these a result of having less estrogen or just related to growing older? Experts don’t know the answer. 
 
 What About My Heart and Bones? 
 
 Two common health problems can start to happen at menopause, and you might not even notice. 
 
 Osteoporosis. Day in and day out, your body is busy breaking down old bone and replacing it with new healthy bone. Estrogen helps control bone loss, and losing estrogen around the time of menopause causes women to lose more bone than is replaced. In time, bones can become weak and break easily. This condition is called osteoporosis. Talk to your doctor to see if you should have a bone density test to find out if you are at risk. Your doctor can also suggest ways to prevent or treat osteoporosis. 
 
 
 
 Heart disease. After menopause, women are more likely to have heart disease. Changes in estrogen levels may be part of the cause. But, so is getting older. As you age, you may gain weight and develop other problems, like high blood pressure. These could put you at greater risk for heart disease. Be sure to have your blood pressure and levels of triglycerides, fasting blood glucose, and cholesterol, including LDL and HDL, checked regularly. Talk to your healthcare provider to find out what you should do to protect your heart. 
 
 How Can I Stay Healthy After Menopause? 
 
 Staying healthy after menopause may mean making some changes in the way you live. 
 
 Don’t smoke. If you do use any type of tobacco, stop—it’s never too late to benefit from quitting smoking. 
 
 Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals. 
 
 Make sure you get enough calcium and vitamin D—in your diet or with vitamin/mineral supplements if recommended by your doctor. 
 
 Learn what your healthy weight is, and try to stay there. 
 
 Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health. 
 
 Other things to remember: 
 
 Take medicine if your doctor prescribes it for you, especially if it is for health problems you cannot see or feel—for example, high blood pressure, high cholesterol, or osteoporosis. 
 
 Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort. 
 
 Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed. 
 
 The National Institute on Aging (NIA) has publications on many of these topics. See For More Information to learn how to order your free copies. 
 
 Menopause is not a disease that has to be treated. But you might need help if symptoms like hot flashes bother you. Here are some ideas that have helped some women: 
 
 Try to keep track of when hot flashes happen—a diary can help. You might be able to use this information to find out what triggers your flashes and then avoid those triggers. 
 
 When a hot flash starts, try to go somewhere cool. 
 
 If night sweats wake you, sleep in a cool room or with a fan on. 
 
 Dress in layers that you can take off if you get too warm. 
 
 Use sheets and clothing that let your skin “breathe.” 
 
 Have a cold drink (water or juice) when a flash is starting. 
 
 You could also talk to your doctor about whether there are any medicines to manage hot flashes. A few drugs that are approved for other uses (for example, certain antidepressants) seem to be helpful to some women. 
 
 What About Those Lost Hormones? 
 
 These days you hear a lot about whether or not you should use hormones to help relieve some menopause symptoms. It’s hard to know what to do, although there is some information to help you. 
 
 During perimenopause, some doctors suggest birth control pills to help with very heavy, frequent, or unpredictable menstrual periods. These pills might also help with symptoms like hot flashes, as well as prevent pregnancy. 
 
 If you are bothered by symptoms like hot flashes, night sweats, or vaginal dryness, your doctor might suggest taking estrogen (as well as progesterone, if you still have a uterus). This is known as menopausal hormone therapy (MHT). Some people still call it hormone replacement therapy or HRT. Taking these hormones will probably help with menopause symptoms. It also can prevent the bone loss that can happen at menopause. 
 
 Menopausal hormone therapy has risks. That is why the U.S. Food and Drug Administration suggests that women who want to try MHT to manage their hot flashes or vaginal dryness use the lowest dose that works for the shortest time it’s needed. 
 
 Right now, there is a lot still to learn about taking hormones. See For More Information to find out how to get a copy of NIA’s free, more detailed tip sheet, Hormones and Menopause. It has the most current information on menopausal hormone therapy. 
 
 Do Phytoestrogens Help? 
 
 Phytoestrogens are estrogen-like substances found in some cereals, vegetables, legumes (including soy), and herbs. They might work in the body like a weak form of estrogen. Researchers are trying to discover whether phytoestrogens relieve some symptoms of menopause and if they might also carry some risks. Be sure to tell your doctor if you decide to try eating a lot more foods that contain phytoestrogens or to try using an herbal supplement. Any food or over-the-counter product that you use for its drug-like effects could change how other prescribed drugs work or cause an overdose. 
 
 How Do I Decide What to Do? 
 
 If you are having bothersome symptoms, talk to your healthcare provider for help deciding how to best manage menopause. You can see a gynecologist, geriatrician, general practitioner, or internist. Make sure the doctor knows your medical history and your family medical history. This includes whether you are at risk for heart disease, osteoporosis, and breast cancer. 
 
 It may be helpful to remember that your decision is never final. You can—and should—review it with your doctor during your yearly checkup. Your needs may change over time and so might what we know about menopause. 
 
 For More Information 
 
 Menopause FAQs What’s the average age of menopause? The average age of menopause is 51. Learn more about onset of menopause. Can I get pregnant after menopause? Even though your monthly periods are not regular anymore, you can get pregnant during the menopausal transition. Learn more about pregnancy and menopause. What can I do about hot flashes after menopause? There are some practical steps you can try to ease hot flashes and/or night sweats: Sleep in a cool room. 
 
 Dress in layers, which can be removed at the start of a hot flash. 
 
 Have a drink of cold water or juice when you feel a hot flash coming on. 
 
 Use sheets and clothing that let your skin “breathe.” 
 
 Don’t smoke. 
 
 Talk to your doctor. Symptoms that might seem like menopause, even hot flashes, night sweats, and irregular periods, may have other causes. Learn more about hot flashes and other menopausal symptoms. Can I have periods after menopause? No, menopause is your final menstrual period. Learn more about signs of the menopausal transition, the time when menopause is approaching. How do I know if I am starting menopause? The first thing many women notice is a change in their periods. Learn more about signs of the menopausal transition. 
 
 Here are some helpful resources: 
 
 American Congress of Obstetricians and Gynecologists 
 
 P.O. Box 70620 
 
 Washington, DC 20024-9998 
 
 1-800-673-8444 (toll-free) 
 
 www.acog.org 
 
 
 
 National Institutes of Health 
 
 Menopausal Hormone Therapy Information 
 
 www.nih.gov/PHTindex.htm 
 
 
 
 National Library of Medicine 
 
 MedlinePlus 
 
 www.medlineplus.gov 
 
 
 
 North American Menopause Society 
 
 5900 Landerbrook Drive 
 
 Suite 390 
 
 Mayfield Heights, OH 44124 
 
 1-440-442-7550 
 
 www.menopause.org 
 
 
 
 For more information on osteoporosis, exercise, nutrition, urinary incontinence, sexuality, menopausal hormone therapy, and other resources on health and aging, contact: 
 
 National Institute on Aging 
 
 Information Center 
 
 P.O. Box 8057 
 
 Gaithersburg, MD 20898-8057 
 
 1-800-222-2225 (toll-free) 
 
 1-800-222-4225 (TTY/toll-free) 
 
 www.nia.nih.gov 
 
 
 
 To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health. 
 
 National Institute on Aging 
 
 National Institutes of Health 
 
 U.S. Department of Health and Human Services 

 “If you don’t have hot flashes until you’ve stopped menses, then you won’t have them as long,” said Nancy Avis, a professor of social sciences and health policy at Wake Forest Baptist Medical Center and the study’s first author. “If you start later, it’s a shorter total duration and it’s shorter from the last period on.” 
 
 Hot flashes, which can seize women many times a day and night — slathering them in sweat, flushing their faces — are linked to drops in estrogen and appear to be regulated by the hypothalamus in the brain. Studies have found that women with hot flash symptoms also face increased risk of cardiovascular problems and bone loss. 
 
 Researchers followed the women in the study, who came from seven American cities, from 1996 to 2013. All of them met the researchers’ definition for having frequent symptoms: hot flashes or night sweats at least six days in the previous two weeks. 
 
 Image Mary Hairston found that acupuncture helped with her hot flashes. Credit Karen Tam for The New York Times 
 
 None had had a hysterectomy or both ovaries removed, and none were on hormone therapy. (If they started taking hormone therapy during the study period, their data stopped being included, Dr. Avis said.) 
 
 Although some smaller studies have also found that symptoms can last many years, the new research drew praise from experts because, among other things, it included a larger and much more diverse group of women. One-third of them were African-Americans in Pittsburgh, Boston, Chicago and Ypsilanti, Mich. It also included women of Japanese descent in Los Angeles; women of Chinese descent in Oakland, Calif.; and Hispanic women in Newark — about 100 in each group. 
 
 “It’s such a real-world study of women we are seeing day in and day out,” said Dr. Risa Kagan, an obstetrician-gynecologist at the University of California, San Francisco, and the Sutter East Bay Medical Foundation in Berkeley. “There is no other study like this.” 
 
 Researchers found significant differences between ethnic groups. African-Americans reported the longest-lasting symptoms, continuing for a median of 10.1 years — twice the median duration of Asian women’s symptoms. The median for Hispanic women was 8.9 years; for non-Hispanic whites, 6.5 years. 

 Frequent hot flashes typically last around seven years, but women vary greatly, new research shows. (Photo: Sam Ward) 
 
 Science now has an answer for midlife women wondering how long their menopausal heat waves can persist. 
 
 The answer: a long time. The typical duration of frequent hot flashes and night sweats is seven years, and for some women, symptoms persist for a dozen years or more, says a study published Monday in JAMA Internal Medicine. 
 
 That's much longer than the six months to two years long thought typical. It is also longer than the time limits many doctors put on treating the symptoms with hormones. 
 
 The findings suggest a need for better, longer-lasting treatments, and they also should reassure some women, says lead researcher Nancy Avis, a professor of public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, N.C. 
 
 "There's a lot of variability," Avis says. "If you experience symptoms for a long period of time, that doesn't mean there's anything wrong." 
 
 Avis and colleagues followed 3,302 midlife women for up to 17 years, including the years just before and just after their menstrual periods ended. 
 
 Hot flashes and night sweats can start at any point in that transition. A hot flash is a sudden, intense feeling of warmth, often accompanied by sweating and followed by chills. A night sweat is similar and often disrupts sleep. 
 
 Previous research showed that about 80% of U.S. women have at least some hot flashes. The cause is unclear, but it is thought that hormonal changes disrupt the body's thermostat. 
 
 The new research focuses on the 1,449 women in the study who reported frequent overheating — on at least six days in two weeks — at any annual checkup. It leaves out nearly 1,000 women who never reported frequent symptoms and others who took hormones or had hysterectomies. 
 
 Among those who had frequent episodes, the median duration was 7.4 years, meaning half had symptoms longer and half had them for less time. Some were still having hot flashes after 13 years. 
 
 The median was 10.1 years for African-American women, 8.9 years for Hispanic women, 6.5 years for non-Hispanic white women, 5.4 years for women of Chinese descent and 4.8 years for women of Japanese descent. 
 
 The reasons for the racial and ethnic differences, seen in several studies, are unknown, Avis says. Differences in genes, diet, childbearing histories and other factors could be at work, she says. 
 
 Symptoms persisted longer if they started before a woman's last period. They also lasted longer if a woman was stressed, depressed or anxious before they began. 
 
 The relationship between hot flashes and emotional distress clearly goes both ways, says JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston. 
 
 "Certainly if you have these symptoms several times a day and you are not sleeping well, that is going to lead to stress," says Manson, who co-wrote an editorial accompanying the study. 
 
 There are treatments. Hormone therapy with low doses of estrogen, sometimes combined with progesterone, is the most effective, but it is associated with risks of breast cancer, stroke and blood clots that increase with time and age. For healthy post-menopausal women with moderate to severe symptoms, many doctors still recommend it for up to four or five years, Manson says. 
 
 Women still having periods can take low-dose birth control pills, both to control hot flashes and to prevent pregnancy, she says. 
 
 Brisdelle, a low-dose version of the antidepressant Paxil, also is approved for hot flash treatment by the Food and Drug Administration. 
 
 Women looking to over-the-counter supplements are out of luck: none have panned out in rigorous studies, Manson and Avis say. 
 
 But lifestyle changes can help. The National Institute on Aging has these tips: 
 
 • Avoid any hot flash triggers (such as spicy food, alcohol and caffeine). 
 
 • Sleep in a cool room. 
 
 • Dress in layers that can be removed easily. 
 
 • Have a cold drink of water when you fee a hot flash coming on. 
 
 • Don't smoke. 
 
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 Importance The expected duration of menopausal vasomotor symptoms (VMS) is important to women making decisions about possible treatments. 
 
 Objectives To determine total duration of frequent VMS (≥6 days in the previous 2 weeks) (hereafter total VMS duration) during the menopausal transition, to quantify how long frequent VMS persist after the final menstrual period (FMP) (hereafter post-FMP persistence), and to identify risk factors for longer total VMS duration and longer post-FMP persistence. 
 
 Design, Setting, and Participants The Study of Women’s Health Across the Nation (SWAN) is a multiracial/multiethnic observational study of the menopausal transition among 3302 women enrolled at 7 US sites. From February 1996 through April 2013, women completed a median of 13 visits. Analyses included 1449 women with frequent VMS. 
 
 Main Outcomes and Measures Total VMS duration (in years) (hot flashes or night sweats) and post-FMP persistence (in years) into postmenopause. 
 
 Results The median total VMS duration was 7.4 years. Among 881 women who experienced an observable FMP, the median post-FMP persistence was 4.5 years. Women who were premenopausal or early perimenopausal when they first reported frequent VMS had the longest total VMS duration (median, >11.8 years) and post-FMP persistence (median, 9.4 years). Women who were postmenopausal at the onset of VMS had the shortest total VMS duration (median, 3.4 years). Compared with women of other racial/ethnic groups, African American women reported the longest total VMS duration (median, 10.1 years). Additional factors related to longer duration of VMS (total VMS duration or post-FMP persistence) were younger age, lower educational level, greater perceived stress and symptom sensitivity, and higher depressive symptoms and anxiety at first report of VMS. 
 
 Conclusions and Relevance Frequent VMS lasted more than 7 years during the menopausal transition for more than half of the women and persisted for 4.5 years after the FMP. Individual characteristics (eg, being premenopausal and having greater negative affective factors when first experiencing VMS) were related to longer-lasting VMS. Health care professionals should counsel women to expect that frequent VMS could last more than 7 years, and they may last longer for African American women.
– No woman looks forward to menopause, especially the accompanying hot flashes. Which is why a new study published in JAMA Internal Medicine may not bring relief to those hoping for a quick demise to the excessively warm, sweaty stage: A 17-year review of 1,449 women from a variety of ethnic, racial, and geographic groups (said to be the largest such study to date) found that hot flashes can last up to 14 years for some women—and that the earlier they start, the longer they may last, the New York Times reports. "If you don't have hot flashes until you’ve stopped menses, then you won't have them as long," study co-author Dr. Nancy Avis tells the Times. African-American women had the longest-lasting hot-flash symptoms with a median of 10.1 years, which was nearly double that of Asian women; the median number of years for Hispanic women was 8.9, while for non-Hispanic whites it was 6.5. What causes those differences could be anything from genes and diet to how many kids a woman has had, Avis tells the Times. Those who have the flashes for longer also tend not to be as well educated, to have more perceived stress, and to experience more depression and anxiety (though it's not clear if such stress and emotional problems may help expedite hot flashes or if the hot flashes help bring those on). There are ways to alleviate symptoms, USA Today points out: A woman in perimenopause (before menstruation fully stops) could take low-dose versions of birth control pills or even certain antidepressants. Additional suggestions from the National Institute on Aging: not smoking, sipping cool drinks when a flash is coming on, and dressing in layers. One North Carolina woman who's been dealing with hot flashes for six years carries portable fans with her, telling the Times, "I'll be so glad when they stop—if they ever stop."