Menopause unfolds in three stages. Perimenopause is the transition, often starting in your 40s, with irregular periods and hot flashes. Menopause is marked by 12 months without a period, usually around age 51. Postmenopause is the years after, when hormone levels stay low and bone and heart health matter more.

It’s important to talk with your doctor if you have any questions about the symptoms you may be having, especially if they are affecting your ability to do everyday activities. You should also contact your doctor if you experience bleeding after menopause, which could have many causes, including vaginal atrophy, fibroids, a thickening of the uterine lining, also known as endometrial hyperplasia, or certain types of cancer.

More intense symptoms, especially during perimenopause, can last six months to two years. Even after you have not had a period for 12 months, you may still experience symptoms, although they should be milder.

A decrease in estrogen causes your body temperature to fluctuate—sometimes wildly. For some, hormone therapy can provide relief, but it’s important to speak with your doctor to determine if the benefits outweigh the risks. You can also try some practical ways to reduce your hot flashes, like: Dressing in layers so you can easily remove clothing when a hot flash begins Avoiding spicy foods, caffeine, alcohol, and other foods and beverages that may raise your body temperature Reducing stress levels Drinking cold water or fruit juice when a hot flash starts Keep an ice pack or a thermos of ice water next to your bed at night Wear cotton clothing and use cotton sheets or other materials that allow your skin to breathe Keep a journal of your symptoms to help identify triggers

While there are many different menopause symptoms, they vary between women. Some have fewer and less severe symptoms, while others have symptoms that disrupt their daily lives. Some of the most common menopause symptoms include: Hot flashes Night sweats Anxiety Vaginal atrophy Urinary incontinence Heart palpitations Excess facial hair growth Mood changes, including depression and irritability Brain fog Sleep disturbances

Menopause can begin anytime between the ages of 30 and 60, with 51 or 52 being the average age. In addition to natural menopause, it can also occur due to a medical or surgical procedure, including: Premature menopause usually occurs before the age of 40 and is known as primary ovarian insufficiency. Some causes of premature menopause include smoking and exposure to radiation or chemotherapy that damages the ovaries. Surgical menopause is the result of the removal of one or both ovaries or after radiation to the pelvis, which can damage the ovaries. Women who have had surgical menopause may experience more severe and sudden symptoms versus those who undergo menopause naturally.