Menopause 101 for Men

Menopause represents a profound transition not only for women but also for their spouses and partners. As a man, it is important to educate yourself about menopause as understanding what menopause is and how it may affect you and your wife; you are better positioned to provide support, communicate openly and honestly, and share your own needs. This page includes the definition, causes, duration, stages, symptoms, impacts, treatment, and management of menopause. It also includes strategies to help navigate this transition, including relationship and sexual challenges, and enhance your overall experience as a couple.

Menopause (also known as climacteric) is a natural biological process experienced by women typically between the ages of 45 and 55, were following a decrease in the production of hormones estrogen and progesterone, and the loss of ovarian follicular function, a woman stops menstruating or having their periods, and can no longer naturally reproduce or fall pregnant. It is a universal phenomenon affecting every woman (excluding females who have had both ovaries surgically removed before puberty) who reaches a certain age.

Menopause can be naturally occurring, occur due to premature ovarian insufficiency (POI), which can lead to premature menopause, or be induced by surgical and medical interventions. Menopause involves three stages: perimenopause, menopause, and postmenopause.

Symptoms like irregular periods, weight gain, mood changes, hot flashes, night sweats, disrupted sleep, vaginal dryness, reduced sexual desire (libido), and several health consequences and risks can occur because of the hormonal changes beginning in perimenopause and beyond.

While menopause itself cannot be prevented or cured, there are many options available for women to help prevent, treat, and manage symptoms and impacts, and improve their quality of life. Additionally, support from husbands and partners can help reduce some of the challenges associated with menopause.

Unlike women, men do not universally experience a direct equivalent to menopause. While testosterone levels typically fall as men age, the decline is steady from around age 30, and generally does not cause symptoms or problems. This is often termed Androgen Decline in the Aging Male (ADAM). Unlike menopause, which ends fertility following a sudden decline in hormones estrogen and progesterone, and the loss of ovarian follicular function, decline in testosterone does not end male fertility.

Testosterone deficiency can develop later in a man’s life, known as Late-Onset Hypogonadism (LOH) or Testosterone Deficiency Syndrome (TDS). This is colloquially called andropause, or male menopause. TDS is characterized by deficient testicular production of testosterone. Symptoms can include fatigue, depression, reduced libido, erectile dysfunction (ED), changes in mood, low energy, and concentration difficulties. These symptoms can also be attributed to general aging and other underlying health conditions, including prostate disease, namely, prostate inflammation (prostatitis), enlarged prostate (benign prostatic hyperplasia (BPH)), and prostate cancer.

Additionally, men may experience androgen deficiency, meaning the body has low levels of male sex hormones, including testosterone. Androgen deficiency can be caused from the testicles not functioning properly (primary hypogonadism), or from the hormones that control the testicles’ function not working properly (secondary hypogonadism). With TDS and androgen deficiency, men may consider Testosterone Replacement Therapy (TRT).

The primary cause of menopause is naturally occurring menopause, which typically occurs between 45 and 55 years. Other causes include Primary Ovarian Insufficiency (POI) (also called Premature Ovarian Insufficiency and Premature Ovarian Failure), which can lead to premature menopause, and induced menopause, which can result from surgical or medical intervention.

Naturally occurring menopause is initiated when a woman’s ovaries stop producing eggs. An egg can develop into an embryo and then a baby. When a woman stops producing eggs, this results in lower levels of estrogen and progesterone, the hormones that regulate menstruation. Early menopause occurs between 40 and 45 years, and can occur naturally or be induced. Late menopause occurs after 55 years, and can also occur naturally, or related to medical conditions or treatments affecting hormonal balance.

Menopause can occur prematurely in some women because of POI. In POI, a woman’s ovaries fail to produce normal levels of reproductive hormones, leading to premature menopause before 40 years. This condition, while uncommon, can be spontaneous or associated with health conditions like autoimmune disorders or chromosomal defects. Premature menopause can also be induced.

Induced menopause can occur following surgical removal of both ovaries like bilateral oophorectomy or a radical hysterectomy. It can also occur following certain chemotherapies and radiation therapies, including pelvic radiation. When menopause is induced, women experience abrupt and often severe symptoms as their reproductive organs have been damaged or removed, and there is a sudden halt in hormone production.

To learn more about causes from a woman’s perspective, visit the Causes of Menopause page.

Menopause typically starts between 45 and 55 years, with the average age for naturally occurring menopause at 51 in the United States.

The timing of menopause varies widely among women. Some women may begin experiencing perimenopausal symptoms as early as in their late 30s or early 40s. For other women, menopause may not begin until their late 50s.

Menopause is different for everyone. The starting age, and progression and type of symptoms varies among women. For example, menopause can occur earlier for women who smoke, live at high altitudes, are malnourished, have autoimmune diseases, or are of Hispanic or Black race.

Perimenopause, the transitional and gradual phase before menopause, can last between two to eight years, averaging around four years, and it can be over ten years for some women.

Menopause is confirmed after a woman has gone 12 consecutive months without a menstrual period. A woman is then in postmenopause, which lasts for the rest of her life.

Duration can depend on many factors, including the starting age of menopause, lifestyle factors such as smoking, and race as Hispanic and Black women may experience symptoms longer than Chinese, Japanese, and White women.

These are the three stages of menopause: perimenopause, menopause, and postmenopause.

Perimenopause (also called menopause transition or menopausal transition). This stage typically begins between 45 and 55 years, and can last from two to eight years, averaging around four years. Women will likely experience hormonal fluctuations, irregular menstrual cycles, and menopause symptoms like mood swings, hot flashes, and disrupted sleep.

Menopause is confirmed after a woman has gone 12 consecutive months without a menstrual period (also called amenorrhea), including spotting, which is when a woman bleeds outside of her monthly period. This stage marks the end of natural fertility, meaning a woman can no longer fall pregnant naturally. Symptoms can intensify and hormonal changes typically lead to physical, cognitive, and emotional changes.

Postmenopause follows menopause, and a woman is postmenopausal for the remainder of their life. During this stage, a woman’s ovaries produce significantly less estrogen, and symptoms gradually decrease. There is a shift from treating and managing symptoms to preventing health risks associated with reduced estrogen, like osteoporosis. With symptoms decreasing during this stage, many women experience postmenopause as a liberating and fulfilling time of their life, without the concerns of menstruation and conception.

To learn more about stages from a woman’s perspective, visit the Stages of Menopause page.

During menopause, a woman’s ovaries stop producing high levels of estrogen and progesterone, hormones that control menstruation, prepare a woman’s body for pregnancy, and maintain bone health. Estrogen plays a protective role in safeguarding the cardiovascular system, bones, brain, vaginal and bladder tissues, and many other functions. As estrogen levels decline, a woman’s body’s ability to regulate calcium and cholesterol is affected, leading to increased risks of health conditions such as osteoporosis and cardiovascular disease.

In naturally occurring menopause, the hormonal changes are gradual, often over several years. Due to the hormonal changes, a woman’s brain compensates by increasing the production of Follicle-Stimulating Hormone (FSH) to stimulate the ovaries, resulting in a range of physical, cognitive, mood, and emotional symptoms. These symptoms decrease during postmenopause as a woman’s body gets used to the hormonal changes. In the meantime, you might hear your wife say “It’s not you, it’s my hormones”, and that is because hormones, particularly estrogen, impacts brain chemicals like dopamine, serotonin, and norepinephrine, which are known as happy hormones, and can result in your wife not feeling like herself.

When women are transitioning into menopause in the perimenopause stage, they will most likely notice changes in their menstrual patterns. These changes may include irregular periods, a heavier or lighter flow, shorter or longer periods, and worsening Premenstrual Syndrome (PMS), which is a group of physical and emotional symptoms like tender breasts, irritability, bloating, and fatigue, that start one to two weeks before a woman’s period.

Besides menstrual changes, other signs, and symptoms may include vasomotor symptoms such as hot flashes and night sweats, vaginal dryness, urinary issues, mood changes, sleep disruption, and memory problems.

If you notice your wife or partner is experiencing different signs or symptoms or more intense signs or symptoms like mood swings, mention this to her. Some women can find it challenging to identify that perimenopause may be causing their symptoms, as they can be similar to symptoms they have experienced before. It is also beneficial to try and anticipate your wife’s moods and potential triggers to minimize any hostile interactions.

Your wife may need to consult a healthcare professional where she has abnormal periods, or symptoms that are potentially related to other related conditions such as thyroid disorders.

Due to the significant hormonal changes during menopause, most women will experience symptoms related to one or more of these categories: Physical and Physiological; Genitourinary Syndrome of Menopause (GSM); Cognitive and Thinking; and Mood and Psychological.

Physical and Physiological symptoms include vasomotor symptoms such as hot flashes and night sweats, disrupted sleep, changes in menstrual patterns, weight gain, joint pain, and headaches. Women can also experience changes to areas on their body such as breasts, skin, and hair, as well as changes to bodily functions such as digestion, heart rate, and breathing.

GSM is a term that includes sexual, urinary, and vaginal symptoms. Some symptoms include low sex drive (libido), painful intercourse, urinary infections, urinary incontinence, and a dry, inflamed and painful vagina and vulva. These symptoms can affect your wife’s, and your, experience in the bedroom. Often, it is not that she has lost interest in you, or sex in general, it is that sex is not like it used to be in terms of sensitivity and response, and can be uncomfortable and even painful. Sexual experience will be expanded on in the
How does Menopause Impact Sexual Experiences? section below.

Cognitive and Thinking symptoms relate to attention, focus, and memory, including concentration difficulty, inattentiveness, postmenopausal confusion, or brain fog, memory impairment, and recall impairment.

Mood and Psychological symptoms include mood, thought and behavior changes, like anxiety, depression, malaise, mood swings, low self-esteem, irritability, and low energy or lethargy. Additionally, anger or rage may be directed at spouses and partners, which can be intense, unpredictable, and disproportionate to the situation.

Menopause symptoms can range from mild to severe and can last for a couple to many years. Every woman’s experience is unique. Many symptoms that women experience during perimenopause become less frequent and intense following menopause. Some symptoms may be related to aging; however, hormonal fluctuations can worsen them. Additionally, some men are more negatively affected by menopause symptoms than their wives, because of a lack of knowledge and understanding around menopause, and inadequate communication with their spouses.

To learn more about symptoms from a woman’s perspective, visit the Symptoms of Menopause page.

Healthcare professionals typically diagnose menopause based on a woman’s self-reported symptoms and changes in her menstrual cycle. Some women record and keep track of these changes as they start to experience them. Healthcare professionals confirm a menopause diagnosis once a woman has missed their periods for 12 consecutive months, with no other suspected causes.

Asking your wife if she would like you to attend medical appointments with her may offer her moral support, help with transportation, and help with remembering information discussed during appointments.

During a medical appointment to potentially diagnose menopause, a healthcare professional may use Quality-Of-Life (QOL) scales to assess symptom severity and quality-of-life impact, or complete further tests like blood tests if other health conditions are suspected. Other conditions, such as thyroid disease or vitamin deficiencies, can mimic menopause symptoms, so may need to be ruled out.

To learn more about diagnosis from a woman’s perspective, visit the Diagnosis of Menopause page.

The rapid decline in estrogen during menopause negatively affects the reproductive tract, urinary tract, skin, bones, brain, cardiovascular system, and cholesterol levels, which can lead to a range of health impacts, namely consequences and risks.

Consequences include bone density loss, increased central abdominal fat, declining muscle mass, alterations in cholesterol profile, changes in vascular function, bladder, and bowel dysfunction, oral health problems, and cognitive decline. These consequences can result in various health issues and increased risks for certain health conditions. These include osteopenia, osteoporosis, diabetes, insulin resistance, metabolic syndrome, cardiovascular disease, high blood pressure, urinary incontinence, prolapse, gum disease, and dementia.

While a woman may be at an increased risk of developing certain conditions because of hormonal changes during menopause, the risk for any condition depends on many factors, including family history, overall health before menopause, and lifestyle factors.

With these impacts, it is important for your wife or partner to maintain regular health check-ups, undergo appropriate screening and testing, adopt nutritional and lifestyle changes, and seek aligned treatment and management options as proactive and reactive measures to manage symptoms and safeguard overall health.

It is also important for you to maintain regular health check-ups and undergo appropriate screening and testing, and it can be encouraging for both of you to adopt nutritional and lifestyle changes, such as eating a similar diet and exercising together.

To learn more about impacts from a woman’s perspective, visit the Impacts of Menopause page.

The physical, GSM, cognitive, and psychological changes associated with menopause can challenge and strain relationships, particularly with spouses and partners. These changes, coupled with aging, life stressors such as employment pressures and caregiving responsibilities, changes in priorities, and previous unresolved relationship issues, can also contribute.

As a result of relationship challenges, yourself and your wife, or partner, may feel isolated and rejected, and may begin to withdraw from one another. Often, you can bear the brunt of these emotions, as you are the one your wife spends the most time with and feels the most comfortable around.

Education, preparation, adaptability, and open, honest and early communication are key in managing these challenges, including any previous unresolved issues, and can help mitigate strain, foster understanding, and enhance overall relationship experiences. Where possible, try to anticipate your wife’s moods and potential triggers to minimize any hostile interactions.

Additionally, patience and flexibility will go a long way during this transition, as well as listening without trying to offer solutions, accepting silence and instability, asking what your wife needs and telling her what you need, maintaining both of your individuality, and working as a team. Where additional help is needed, counseling, couple therapy, or sex therapy may assist in improving communication, trying different strategies, and overcoming challenges.

Like relationships, the physical, GSM, cognitive, and psychological changes associated with menopause can challenge and strain sexual experiences. In particular, GSM symptoms on sexual (low sex drive (low libido), orgasm and sexual arousal difficulty, and painful sexual intercourse (dyspareunia)), urinary (urinary tract infection (UTI), kidney infection (pyelonephritis), and urinary incontinence), and vaginal (dry vagina, vaginal tear, and pelvic organ prolapse (POP)) dimensions largely contribute.

Additionally, menopausal symptoms, such as mood swings, sleep disturbances, and fatigue, can indirectly affect libido. As can other factors like emotional health, changes in a woman’s body image, stress, relationship quality, aging, and overall health. Factors affecting your own sexual ability such as such as TDS, ED, prostate disease, low libido, and premature, delayed or retrograde ejaculation, also play a role.

Ironically, while a woman may not be in the mood, sexual activity releases oxytocin and endorphins, hormones that help to decrease feelings of pain, reduce stress, boost mood, and promote feelings of wellbeing, so can help a woman feel better after any sexual activity.

As such, a number of strategies can encourage fulfilling sexual experiences. First, treating and managing symptoms and health conditions indirectly and directly affecting sexual experiences, including your own. Second, prioritizing affection and intimacy outside of the bedroom by kissing, hugging, touching, holding hands, maintaining eye contact, spending time together, and participating in activities you both enjoy. Third, creating an ambience for sexual experiences, including playing music, having dimmed lighting, using candles, diffusing essential oils, and removing any visible distractions. Fourth, sexual experiences can be enjoyable with or without intercourse, for example, masturbation (autoeroticism or autosexuality), foreplay, and massage. Last, practicing patience, exploring different sexual paces and positions, sharing likes and dislikes, role playing, using products and devices like lubricants, creams, arousal oils, vibrators, sex toys, and vaginal dilators can significantly enhance sexual experiences.

Again, where additional help is needed, counseling, couple therapy, or sex therapy may help in improving communication around sexual experiences, trying different strategies, and overcoming challenges.

Menopause and aging do not signify the end of satisfying, diverse, and healthy sexual experiences. Many couples have better sex lives than they did before menopause as women become more confident in themselves, develop different perspectives, and have different life responsibilities.

While menopause itself cannot be prevented or avoided, many treatment options exist for women to manage menopause symptoms, ranging from Hormone Replacement Therapy (HRT) and prescription medications to conventional and alternative therapies and dietary supplements.

HRT (also called Hormone Therapy (HT), Menopause Hormone Therapy (MHT), Estrogen Replacement Therapy (ERT), and Postmenopausal Hormone Therapy (PHT)) is a prescription medication treatment used to relieve symptoms of menopause by replacing hormones, primarily estrogen and progesterone or progestin, that the body produces less of following menopause. The treatment of HRT may help ease vasomotor symptoms, such as hot flashes and night sweats, mood changes, and bone loss. HRT may interfere with existing medications and increase the risk of breast cancer, blood clots, heart attacks, and strokes.

Prescription medications such as antidepressants, blood pressure, and certain anti-seizure medications may help manage vasomotor symptoms. Over-the-counter medications include vaginal moisturizers with low-dose estrogen targeting vaginal dryness and discomfort.

Procedures include vaginal laser therapy to treat vaginal atrophy, nerve block procedures to target specific nerve pathways responsible for symptoms like hot flashes, and radiofrequency treatments to stimulate collagen production in tissues for urinary incontinence. Additional procedures, such as uterine artery embolization, endometrial ablation, and a total hysterectomy, may be performed during the perimenopausal stage to treat heavy menstrual bleeding and discomfort.

Conventional and traditional therapies like cognitive-behavioral therapy (CBT) can help address mood changes, as can psychotherapy, hypnotherapy, and counseling. Complementary and alternative therapies like acupuncture (part of Traditional Chinese Medicine (TCM)), Ayurveda, homeopathy, and naturopathy can help treat a host of symptoms.

Dietary supplements containing plant estrogens (phytoestrogens) such as soy, red clover (Trifolium pratense) and flaxseed (Linum usitatissimum), adaptogens like ashwagandha (Withania somnifera), black cohosh (Actaea racemosa), Panax ginseng (red ginseng or Korean ginseng), and St. John’s wort (Hypericum perforatum), and those offering hormonal support like dong quai (Angelica sinensis), pumpkin seed extract (Cucurbita pepo), saw palmetto extract (Serenoa repens), and beta-sitosterol (β-sitosterol), may also provide relief for women. Products include vaginal moisturizers without estrogen, lubricants, vaginal dilators, pelvic weights, and pelvic wands.

To learn more about treatment from a woman’s perspective, visit the Menopause Treatment page.

The management of menopause goes beyond medical treatments to include factors like mindset and environment, diet and lifestyle, exercise and activity, sleep and recovery, employment and social interaction, and relationships and sexual health.

Women who adopt a realistic mindset toward menopause can address any stress, and anxiety associated with this natural transition. You can also adopt a realistic mindset and celebrate milestones and positive changes with your wife. Being in a comfortable and supportive environment at home and work can significantly enhance their emotional well-being.

Diet and lifestyle changes play a pivotal role in managing menopause symptoms. Reducing carbohydrate intake, including sugar, increasing protein and fat intake, and practicing intermittent fasting, can address the metabolism and fat distribution changes associated with menopause. Lifestyle changes such as reducing alcohol, caffeine, and smoking can support hormonal and overall health.

Regular exercise and activity, including weight training, may boost a women’s mood, promote sleep, strengthen bones, manage weight gain, increase muscle mass, and improve cardiovascular health. Embracing a shared, active, healthy lifestyle with your wife or partner can be beneficial for your relationship, sexual health, and overall health and wellbeing.

Adequate sleep is vital for overall health and recovery. Deep and restorative sleep will help to keep a woman’s fatigue and mood swings at bay. Maintaining a regular sleep schedule can significantly improve sleep quality. You can also contribute by helping to create a conducive sleep environment and practicing good sleep hygiene before, during, and after sleep.

Supporting your wife in maintaining social connections and engaging in activities that promote mental stimulation and enjoyment can help her manage stress, menopause symptoms, and improve overall well-being. As can a supportive work environment including physical and psychosocial elements such as temperature control, and working hours.

Last, the physical, cognitive, GSM, and psychological changes associated with menopause can challenge and strain relationships, particularly with spouses and partners. Open communication, having an active and satisfying sexual life, can improve physical and emotional health.

To learn more about management from a woman’s perspective, visit the Menopause Management page.

Navigating menopause extends beyond understanding and managing symptoms; it provides an opportunity for couples to strengthen their relationship and adapt to a new phase of life together. As men, educating ourselves about menopause and its many symptoms–from hot flashes and mood swings to low libido and vaginal dryness–enables us to support our partners, communicate openly and honestly, and share our own needs. This journey, while often challenging, brings opportunities for growth, renewed connection, and new ways to relate and experience intimacy, free from the concerns of menstruation and conception.