When are menopause symptoms at their worst? Phases and duration

October 21, 2026approx. 15 minutesby mybody®x Editorial & Expert Team

In this article

When are menopause symptoms at their worst?

The answer is supported only for hot flashes, and even then only in terms of likelihood: they are most likely to occur in the first years after the last period (Harlow et al., 2012).

Anyone who wakes up drenched in sweat at night and feels a hot flash in the middle of a conversation during the day wants to know one thing above all: Is the worst still to come, or is it already over? The answer has two parts: timing and duration. Both are tied to one event: the last period.

This final period is called menopause. Women reach it at an average age of 51 (IQWiG, 2023), usually between 45 and 55 (MedlinePlus, 2025). Menopause includes the years before and after this event.

This period is divided into stages that are used in both research and clinical practice: STRAW+10 (Harlow et al., 2012). During the late transition phase, cycles are absent for 60 days or longer (Harlow et al., 2012). According to Harlow et al. (2012), symptoms are likely during this phase, especially hot flashes. This is followed by early postmenopause, the years after the final menstrual period. For its first stage, the working group uses the statement that matters for your question.

Paraphrased from Harlow et al. (2012): Symptoms, especially vasomotor symptoms, are most likely during Stages +1a and +1b. These are the first years after the final menstrual period. The clinical guideline on menopause defines vasomotor symptoms as hot flashes and night sweats (DGGG, 2020).

The word “likely” carries the whole point here. It describes the stage during which hot flashes are most likely to occur in a group of women. It does not follow that they are at their worst for every individual woman during that stage.

One thing does follow, however: the final menstrual period is not the end. Anyone expecting hot flashes to end with it is mistaken according to this classification, because the most likely time begins only afterward (Harlow et al., 2012).

A separate article gives a broader overview of menopause in women. This article focuses only on the question of when symptoms are at their worst and how long this lasts.

During which phase of menopause are symptoms at their worst?

The stages describe when hot flashes are likely, not how severe they are in any individual case. They are most likely during Stages +1a and +1b, which together last about 2 years on average (Harlow et al., 2012).

The STRAW+10 classification assigns numbered stages to the years around the final menstrual period (Harlow et al., 2012). Stage −1 comes before the final menstrual period, and Stages +1a to +1c follow it (Harlow et al., 2012). These stages are sufficient to answer when hot flashes are most likely.

How long does the late menopausal transition phase last?

On average, 1 to 3 years (Harlow et al., 2012).

The late transition phase is Stage −1, characterized by cycles being absent for 60 days or longer (Harlow et al., 2012). The working group estimated its duration from menstrual calendars and hormone patterns (Harlow et al., 2012). According to Harlow et al. (2012), symptoms, especially hot flashes, are likely during this stage, but not yet most likely.

Early postmenopause: How long does this stage of menopause last?

About 5 to 8 years in total, of which stages +1a and +1b together account for an average of about 2 years (Harlow et al., 2012).

The early postmenopause comprises the years after the final menstrual period, divided into stages +1a to +1c (Harlow et al., 2012). Hot flashes are most likely during stages +1a and +1b; their duration was estimated by the research group based on studies of hormonal changes (Harlow et al., 2012). The subsequent stage +1c lasts 3 to 6 years (Harlow et al., 2012).

A separate article about hormone levels during the transition describes how hormones change during this time. When asking which symptoms are worst, the key is the order of the stages, as summarized in the table. Its final row adds duration data from an analysis of the US SWAN study, which included only women with frequent hot flashes (Avis et al., 2015).

Menopause stages and hot flashes

How long do the most severe menopause symptoms last?

In women with frequent hot flashes, they lasted a median of 7.4 years in total and another 4.5 years after the final menstrual period (Avis et al., 2015).

The median is the value in the middle when all measured durations are arranged in order. The figures come from the US observational study SWAN (Study of Women’s Health Across the Nation), which followed 3,302 women at 7 sites (Avis et al., 2015). The analysis included 1,449 women with frequent hot flashes (Avis et al., 2015). The duration after the final menstrual period is based on 881 women whose final menstrual period was observed during the study (Avis et al., 2015).

How long do hot flashes last during menopause when they start early?

Longest duration: Those who started experiencing frequent hot flashes before or early in the transition had them for a median of more than 11.8 years (Avis et al., 2015).

After their last period, they continued for a median of 9.4 years in these women (Avis et al., 2015). The shortest total duration was among women who first began experiencing them after menopause, at a median of 3.4 years (Avis et al., 2015). In this study, the timing of onset therefore offers an indication of how long the symptoms lasted in a group (Avis et al., 2015). It does not predict how long they will last for you.

How long do hot flashes last during menopause, according to IQWiG (2023)?

According to IQWiG (2023): “Hot flashes usually subside on their own after about 4 to 5 years.”

This is consistent with the median duration after the last period of 4.5 years in the SWAN study (Avis et al., 2015). It is not consistent with the median total duration of 7.4 years, because that also includes the years before the last period (Avis et al., 2015). So anyone comparing the two figures needs to pay attention to the starting point. The US health encyclopedia MedlinePlus notes that symptoms can last 5 years or longer (MedlinePlus, 2025).

If hot flashes continue long after menopause, you can find out more in the article about late hot flashes.

What are the most common symptoms of menopause?

According to IQWiG (2023), hot flashes and sweating are the most common symptoms of menopause, and they can also disrupt sleep at night.

The guideline agrees: hot flashes and night sweats are the most common symptoms in women around menopause and afterward (DGGG, 2020). IQWiG (2023) cites falling estrogen levels as the reason, which “cause hot flashes in most women for a while.”

According to IQWiG (2023), these symptoms may also occur:

• trouble falling or staying asleep
• mood swings or depressed mood
• weight gain

The DGGG guideline (2020) leaves partly open whether these symptoms are caused by hormones. It is unclear whether sleep disorders and mood swings are hormonally caused (DGGG, 2020). The same applies to anxiety and sexual problems (DGGG, 2020). According to the DGGG (2020), this is different for hot flashes. The article on sleep disorders during menopause explores the relationship between sleep and menopause in more depth.

Pain is a topic in its own right. In an analysis of the SWAN study involving 2,218 women, one in six reported daily pain (Dugan et al., 2006). Women after menopause reported more pain than women before menopause, even after other influencing factors were accounted for (Dugan et al., 2006). This analysis does not establish a cause. Read more about a specific symptom in the article on back pain during menopause.

The key facts and figures

Source: IQWiG (2023) and DGGG (2020); pain findings according to Dugan et al. (2006)

Why do women experience menopause so differently?

Because the frequency and duration of symptoms vary widely (DGGG, 2020), and the duration of hot flashes was linked to personal circumstances in a large US study, such as greater perceived stress (Avis et al., 2015).

Even the timing varies. Women reach menopause at an average age of 51, with “some much earlier and others later” (IQWiG, 2023). Symptoms also differ from woman to woman (MedlinePlus, 2025).

The guidelines note that the frequency and duration of all menopausal symptoms vary widely (DGGG, 2020). They list the following as possible influences, among others (DGGG, 2020):

• overall health and well-being
• social and economic status
• cultural influences

The SWAN study gives a more detailed picture. The following characteristics were associated with longer-lasting hot flashes (Avis et al., 2015):

• younger age
• lower educational attainment
• greater perceived stress and increased sensitivity to symptoms
• more depressive symptoms and anxiety when hot flashes first appeared

These are associations observed in a group of women. They don’t mean that stress causes hot flashes, and they aren’t a diagnosis. But they help explain why women of the same age can have very different experiences over the years.

Which hormone levels show what stage of menopause you’re in?

According to the guidelines, no hormone test is needed for this purpose after age 45: Menopause is identified based on symptoms, and hormone measurements are usually unnecessary (DGGG, 2020).

It seems reasonable to think that a blood test could simply identify the phase. But for the hormone FSH, whose levels fluctuate during this time, the guidelines recommend testing only in exceptional cases (DGGG, 2020):

• Women between 40 and 45 with menopausal symptoms (DGGG, 2020)
• Women under 40 with suspected premature ovarian insufficiency, in which the ovaries lose function prematurely (DGGG, 2020)

This is consistent with a finding on the late transition phase. FSH levels there are sometimes in the menopausal range and sometimes in the range seen in earlier years, especially when estradiol is high (Harlow et al., 2012). So at this stage, a single test result can fall in either range.

IQWiG also sees hormone levels as no guide: according to IQWiG (2023), the result says nothing about whether treatment is advisable. MedlinePlus (2025), a US health encyclopedia, takes a somewhat different view of blood tests. They can help a doctor assess whether menopause is near, although when periods are still occurring, levels may need to be measured several times (MedlinePlus, 2025).

What does a hormone test show during menopause, and what doesn’t it show?

It shows your hormone levels at the time the sample was taken, not which stage of menopause you are in.

The Menopause Check by mybody®x (MYBODY Lab GmbH) measures eight hormone levels from capillary blood, including estradiol and FSH. You collect the sample yourself at home with a finger prick. It is analyzed at a specialized laboratory in Germany, and you receive the report as a PDF in the customer portal. If you still have a menstrual cycle, note the cycle day—without it, the report is difficult to interpret.

What you get is a snapshot of your levels right now. The test does not determine which stage of menopause you are in, and an abnormal result does not automatically mean you are ill. Its purpose is to help you prepare for your doctor’s appointment, where you can discuss your symptoms alongside specific results. It does not replace medical evaluation.

Limitations: What stages and numbers don’t show about menopause

The figures describe groups of women, not any one woman. They don’t predict how you will experience menopause.

The STRAW+10 stages are a classification for research and clinical practice (Harlow et al., 2012). Their statements describe when hot flashes are likely and most likely (Harlow et al., 2012), not how severe they’ll be for you.

The duration figures come from an observational study in the US involving 3302 women at 7 sites (Avis et al., 2015). Only frequent hot flashes were counted, meaning those occurring on at least 6 days in the preceding 2 weeks (Avis et al., 2015).

The pain finding comes from a cross-sectional analysis, meaning an assessment at a single point in time, involving 2218 women from the same US study (Dugan et al., 2006). It shows a difference between groups, not a cause.

We paraphrase the guideline’s statements based on its published English short version, as of 2020 (DGGG, 2020).

The Menopause Check shows hormone levels at the time the sample was taken. It doesn’t determine which stage of menopause you’re in.

What does “at its worst” mean for you during menopause?

“At its worst” during menopause doesn’t refer to a fixed phase, but to a likelihood, and this has only been established for hot flashes. They’re most likely in the first few years after the last period (Harlow et al., 2012), and how long they lasted was associated with when they began in the SWAN study (Avis et al., 2015). According to the guideline, menopausal status is determined primarily by your symptoms (DGGG, 2020), so it’s worth writing them down before your appointment. The last period isn’t an endpoint; it’s a reference point.

Frequently asked questions

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Sources

1. IQWiG: Menopausal symptoms, gesundheitsinformation.de (as of 2023) – gesundheitsinformation.de; MedlinePlus (U.S. National Library of Medicine): Menopause (as of 2025) – medlineplus.gov
2. Harlow S. D. et al. (STRAW + 10): Executive summary of the Stages of Reproductive Aging Workshop + 10, Journal of Clinical Endocrinology and Metabolism (as of 2012) – europepmc.org
3. Avis N. E. et al. (SWAN): Duration of menopausal vasomotor symptoms over the menopause transition, JAMA Internal Medicine (as of 2015) – europepmc.org; Dugan S. A. et al. (SWAN): Musculoskeletal pain and menopausal status, The Clinical Journal of Pain (as of 2006) – europepmc.org
4. DGGG et al.: S3 Guideline on Peri- and Postmenopause, short version (Ortmann et al.), Archives of Gynecology and Obstetrics (as of 2020) – europepmc.org

Age at menopause and symptom profiles are based on [1] and [4]. The stages and their duration are based on [2]. The duration of hot flashes and pain findings are based on [3], with the interpretation of duration supplemented by [1]. The identification of menopause and the role of FSH are based on [4] and [2]. Information about mybody®x's Menopause Check is current as of October 20, 2026.