Reviewed by:
Dr. Myrna Assaf — Gynecologist specializing in menopause and hormonal disorders, with a focus on intimate health.
Dr. Patricia Núñez de Aysa — Medical expert in Longevity, specialist in Rehabilitation and Traumatology without surgery.
Dr. Joel Cuesta Gascón — Medical expert in sports medicine, rehabilitation, and nutrition.
Last updated: May 2026.
In 30 seconds
- Menopause is not a specific day; it's a stage. Changes begin years earlier, in perimenopause, and continue through postmenopause.
- The most common symptoms are hot flashes, sleep disturbances, mood swings, brain fog, dryness, and body changes.
- Not all women experience it the same way: some barely notice symptoms, while others need support for years.
- Habits (sleep, strength exercise, nutrition, stress management) and well-planned natural remedies can make a big difference.
What is menopause (and why it's not what you think)
Menopause is, technically, the day you complete 12 months without a period. That is, a specific moment in time. What most of us call "menopause" is actually a much longer stage, divided into three phases:
Perimenopause
The transitional phase. It can start between 40 and 47 years old, although some women begin earlier. This is the phase with the most hormonal variability: estrogen levels rise and fall irregularly, cycles shorten or lengthen, and the first symptoms appear. It usually lasts between 4 and 8 years.
Menopause
The exact point: 12 consecutive months without menstruation. The average age in Spain is around 51 years.
Postmenopause
The entire life after that date. Hormone levels stabilize at low values, and many symptoms tend to improve over the years, although others (dryness, bone health, cardiovascular health) require continuous attention.
Important: most women who say they are "in menopause" are actually in perimenopause. And this significantly changes the approach.
Why symptoms appear
The underlying cause is the progressive decline in estrogen and progesterone. But it's not just a hormonal issue: the brain, nervous system, metabolism, and cardiovascular system also change as the hormonal environment shifts.
Estrogens don't only act on the reproductive system. They have receptors in the brain, bones, heart, skin, mucous membranes, and muscles. That's why menopausal symptoms are so varied and, at times, so difficult to relate to each other.
Most common menopausal symptoms
Vasomotor symptoms
- Hot flashes: sudden sensation of heat affecting the face, neck, and chest. They can last from seconds to several minutes.
- Night sweats: hot flashes that appear while you sleep and disrupt rest.
- Palpitations: a sensation of a momentarily accelerated or irregular heartbeat.
Sleep disturbances
- Difficulty falling asleep
- Frequent awakenings, especially between 3 and 5 in the morning
- More superficial or non-restorative sleep
- Insomnia associated with night sweats
Emotional and cognitive symptoms
- Mood swings and increased irritability
- Anxiety or feeling "on edge"
- Sadness, apathy, or low motivation
- "Brain fog": difficulty concentrating, memory lapses, words not coming out
- Increased sensitivity to stress
Physical and bodily changes
- Increased abdominal fat and changes in body composition
- Loss of muscle mass (sarcopenia)
- Increased fatigue or feeling of less energy
- Changes in hair (thinner, hair loss) and skin (drier)
- Joint and muscle pain
- More frequent migraines or headaches
Genitourinary health
- Vaginal dryness
- Decreased libido
- Discomfort during sexual intercourse
- Increased frequency of urinary tract infections
- Urinary urgency or small leaks
Changes in the menstrual cycle (in perimenopause)
- Shorter or longer cycles
- Heavier or lighter bleeding
- Occasional missed periods
- More intense PMS than in previous years
You don't have to have all of them to be in menopause. Each woman experiences a different combination.
How to know if I am in perimenopause or menopause
Diagnosis is clinical, not analytical. If you are over 45 and begin to notice changes in your cycle or symptoms as described, it is very likely that you are in perimenopause. Hormonal tests (FSH, estradiol) can provide guidance, but as hormones fluctuate so much in this phase, a specific test does not always reflect what is happening.
There are some exceptions:
- Early menopause: before 40. A medical study is always advisable.
- Premature menopause: between 40 and 45.
- Surgical menopause: after removal of the ovaries. Symptoms tend to be more abrupt.
- Treatment-induced menopause: chemotherapy, radiotherapy, certain medications.
How long do symptoms last?
It depends greatly on the individual. The average duration of hot flashes in recent studies is around 7-10 years, although some women experience them for only a few months, and others for more than a decade. Sleep and emotional symptoms usually improve after the first few years of postmenopause. Bone, cardiovascular, and genitourinary health require continuous attention throughout postmenopause.
How to support this stage: evidence-based keys
1. Sleep first
It is the most undervalued factor. Poor sleep in perimenopause amplifies almost all other symptoms: irritability, brain fog, fatigue, and pain. Prioritize sleep routines: stable schedules, a cool bedroom (important for hot flashes), no screens at least 1 hour before, and breathable clothing.
2. Strength, strength, strength
Strength training 2-3 times a week is the non-pharmacological intervention with the most evidence in menopause. It prevents muscle mass loss, protects bones, improves body composition, and reduces vasomotor symptoms. There is no substitute.
3. Pay attention to protein intake
From age 40, protein needs increase: around 1.2-1.6 g per kilogram of body weight per day. Without sufficient protein, strength exercise loses much of its effect.
4. Vitamin D and calcium
The drop in estrogen accelerates bone loss. Ensuring sufficient vitamin D (with a blood test if in doubt) and adequate calcium through diet or supplementation is essential. Vitamin D3 with K2 and magnesium offers a more comprehensive approach: D3 facilitates calcium absorption, K2 helps direct that calcium to the bones and not the arteries, and magnesium activates D3 to make it effective.
5. Manage stress
Sustained high cortisol levels worsen symptoms. It's not about "relaxing": it's about incorporating real routines (walking, conscious breathing, reducing nocturnal stimulation, saying no more often).
6. Take care of your digestive system
The gut microbiota participates in estrogen metabolism through the estrobolome. A well-maintained microbiota (fiber, fermented foods, variety of plant-based foods) helps to better navigate the transition.
7. Reduce alcohol and caffeine
Both worsen hot flashes, night sweats, and sleep quality in many women. It's not necessary to eliminate them, but reducing them during the phase with the most symptoms is advisable.
Supplements with evidence in perimenopause and menopause
Not all menopause supplements are created equal. These are the active ingredients with the most scientific backing:
- Cimicifuga racemosa: with evidence in reducing hot flashes and night sweats, without direct hormonal action.
- Soy isoflavones: phytoestrogens that help to mildly compensate for the drop in estrogen.
- Sage: traditionally used and with studies to reduce sweating.
- Saffron: growing evidence on mood and emotional well-being in menopause.
- Passionflower: support for the nervous system and rest.
- Resveratrol and Pinus pinaster: antioxidants with an effect on oxidative stress and overall well-being.
- Magnesium and vitamin B6: help with sleep, muscle function, and reduction of fatigue.
- Vitamin D3 + K2: essential for bone and muscle health.
Our formula MenoHarmony combines cimicifuga, soy isoflavones, sage, passionflower, saffron, pinus pinaster, and trans-resveratrol. It is designed to support perimenopause and menopause from various fronts, without abruptly interfering with the endocrine system.
When to consult a professional
It is advisable to see your doctor or gynecologist if:
- Symptoms clearly affect your quality of life.
- You are under 40 and have marked symptoms or cycle changes.
- Bleeding occurs after 12 months without a period.
- You notice urinary or genital symptoms that bother or limit you.
- You have a family history of osteoporosis or cardiovascular disease and want to assess your risk.
- You are considering hormone replacement therapy and want an informed decision.
At tres60, we offer free medical consultation to guide you if you have doubts about your situation.
Menopause and hormone therapy: an important note
Hormone Replacement Therapy (HRT) remains the most effective treatment for vasomotor symptoms in eligible women. Current recommendations (NAMS 2022, IMS 2022) have nuanced the alarms raised by the 2002 WHI study and acknowledge that, in suitable women and initiated within the first 10 years of menopause, the benefits may outweigh the risks.
This should always be assessed individually with a professional. Natural supplements do not replace HRT when it is indicated, but they can be an option for women who are not candidates, prefer a non-hormonal approach, or seek to accompany the transition naturally.
Conclusion
Menopause is not a disease. It is a long and diverse stage that can be managed with knowledge, habits, and, when necessary, well-chosen formulas or treatments.
The most useful thing is to understand what stage you are in, what changes you are experiencing, and what decisions are evidence-based. And, above all, stop normalizing suffering.
If you want a complete formula to accompany this stage, discover MenoHarmony, formulated by doctors.
If you have questions or want personalized guidance, schedule your free medical consultation or write to us on WhatsApp.
Frequently asked questions about menopause
At what age does menopause begin?
The average age in Spain is around 51, but the first changes (perimenopause) can start between 40 and 47.
What are the first symptoms of menopause?
Changes in the menstrual cycle, occasional hot flashes, poorer sleep, increased emotional sensitivity, brain fog, and more intense PMS than in previous years.
How long do hot flashes last?
On average, between 7 and 10 years, although there is much variability: from a few months to more than a decade.
Does menopause cause weight gain?
Menopause promotes changes in body composition (more abdominal fat, less muscle mass). Weight may not change significantly, but body shape and metabolism do.
Is it safe to take supplements during menopause?
Supplements with evidence and quality formulation are safe for most women. If you are taking medication or have relevant medical history, consult your healthcare professional first.
Does menopause affect libido?
Yes, for many women, libido decreases during this stage due to hormonal drop and vaginal dryness. It is a symptom that has solutions and should be addressed if it affects you.
Can I get pregnant during perimenopause?
Yes, as long as you have periods (even if irregular), there is a possibility of pregnancy. Contraception is still recommended until menopause is confirmed.
Are soy isoflavones safe?
In appropriate doses and formulations, they are considered safe by the EFSA for healthy women. For women with a history of hormone-dependent cancers, it is advisable to consult their doctor before taking them.
References
- Davis SR, Lambrinoudaki I, Lumsden M, et al. Menopause. Nat Rev Dis Primers. 2015;1:15004.
- The NAMS 2022 Hormone Therapy Position Statement. Menopause. 2022;29(7):767-794.
- El Khoudary SR, Aggarwal B, Beckie TM, et al. Menopause Transition and Cardiovascular Disease Risk: AHA Scientific Statement. Circulation. 2020;142(25):e506-e532.
- Castelo-Branco C, Gambacciani M, Cano A, et al. Review & meta-analysis: isoflavones in menopausal symptoms. Maturitas. 2021;145:23-35.
- Mehrpooya M, Rabiee S, Larki-Harchegani A, et al. A comparative study on the effect of black cohosh and evening primrose oil on menopausal hot flashes. J Educ Health Promot. 2018;7:36.
- Lopresti AL, Smith SJ. The Effects of a Saffron Extract on Menopausal Symptoms. J Menopausal Med. 2021;27(2):66-78.
- Kanadys W, Barańska A, Błaszczuk A, et al. Effects of Soy Isoflavones on Biochemical Markers of Bone Metabolism. Nutrients. 2021;13(8):2526.
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