Typically, between 45 – 55, women experience hormonal changes that interfere with the flow of their menstruation, thereby leading to menopause.
Symptoms such as irregular menstruation, hot flashes, sleep disturbances, weight gain, mood changes, urinary incontinence, vaginal discomfort, and so on, may start years before the onset of menopause.
This period is tagged perimenopause and starts when the ovaries reduce the usual amount of estrogen and progesterone produced significantly, limiting the number of times ovulation takes place.
“This is when there is a gradual decline of ovarian function, or as I like to call it, the popping out of the ovaries,” says Mary Jane Minkin, MD, clinical professor in the department of obstetrics, gynecology, and reproductive sciences at the Yale University School of Medicine.
“And while the overall trend is that estrogen, progesterone, and testosterone levels are declining, it’s not a smooth transition—one day your hormones may drop way down, then the next day they spike up again.”
A whole year without periods marks the postmenopause stage. Though menopausal symptoms vary from woman to woman and maybe a difficult period, knowing what to expect during this natural phase fosters managing the symptoms better and having a more pleasant experience.
While menopause can impact each woman differently, some common symptoms tend to happen at one time or another. According to gynecologists, below are nine facts every woman should know…
For many, this will be the first sign something’s starting to change. Periods might come closer together, or you might skip a month, they might be heavier or lighter than usual, they may stretch on for longer, or be super short.
Hot flashes and night sweats
These guys are public enemy #1 for women going through menopause.
“A strong theory is that they are caused by the fluctuations in estrogen, so they are often more severe during perimenopause when your levels are all over the place,” says Dr. Minkin.
That said, they can sometimes last for years after menopause. Some women only get them once or twice a week, while others can get them multiple times an hour.
There’s more than night sweats getting in the way of your slumber. “The sleep center in your brain is right next to the hypothalamus, which is where your hormones are regulated,” says Dr. Minkin.
The belief is that when your hypothalamus constantly revs up to deal with fluctuations in estrogen levels, it upsets your sleep center, and you can’t rest peacefully. On top of that, the lower levels of progesterone make it harder to fall and stay asleep.
Because it’s directly related to total amounts of estrogen, this symptom tends to get worse the longer you’ve been post-menopausal. This lack of moisture often leads to a condition known as dyspareunia, which is a pain in the genitals or pelvis during sex.
“Vaginal dryness can also lead to incontinence or urinary tract infections,” says Dr. Minkin. “When the vagina gets dry, so does the bladder.”
Loss of libido
Not only can sex be painful, you just might not want it as much. “The ovaries have stopped producing estrogen and testosterone, which are both important for sex drive,” says Adeeti Gupta, MD, a gynecologist and founder of Walk In GYN Care in New York. “So you just don’t feel the desire.”
Some women might feel like their mood is suffering—they are quicker to feel irritable. Others may find it harder to focus or remember things. And others may have signs of anxiety or depression. Experts aren’t sure why these changes happen, but they likely have to do with the dropping hormone levels.
Most women already suspect what’s going on, but it gets confirmed after talking over their symptoms with their gynecologists.
“You’ll likely come in and explain your irregular periods or mood changes and hot flashes and your doctor will use those symptoms to diagnose you with perimenopause,” says Dr. Gupta.
“There is some blood work that can measure hormone levels to see if they are dropping, but those fluctuate almost by the minute, so the values during a single test may not help with diagnosis.”
One thing that can help this conversation with your doctor: A symptom log.
“Track your periods and write down what symptoms you are experiencing and when,” says Dr. Minkin. “Also note severity—which ones are driving you crazy? We can fix almost everything, so tell us what you’re going through!”
Your specific treatment plan will depend on your symptoms and your doctor’s advice, but here’s what’s available to you:
Hormone replacement therapy (HRT)
This is a treatment that can help with almost all menopause symptoms. This is when women take supplemental hormones to make up for the fact that their bodies aren’t producing them anymore. There are different options.
Treatment may involve one hormone or a combination—and you may take a pill or go with a skin patch. While there was quite a bit of controversy over HRT in the early 2000s (a study came out showing it raised a woman’s risk for breast cancer), doctors now believe it’s a good option for many women and that using it for an average of five to seven years is safe.
“The products we use now aren’t the same as the ones used 20 years ago,” says Dr. Gupta. “The hormones now are pretty safe as long as you are a good fit, and your doctor is monitoring you closely, ensuring mammograms are up to date and checking your uterine lining, that kind of thing.”
If you have vaginal dryness and pain during sex, you have a few different options. There are moisturizing suppositories you can insert a few times a week as well as lubricants to use during sex that can make it less painful. There are also topical estrogen products (often creams or gels) that can directly deliver the hormone to your vagina, where you need it to feel better.
You might be able to make some relatively simple tweaks to your self-care routine that can make a huge difference in how you feel. For hot flashes, see if something specific like red wine or spicy food is a trigger.
Same with sleep issues: Does alcohol make your sleep worse? Do you sleep better if you lower the temperature in your bedroom?
“Even keeping a spare nightgown next to your bed so that you can quickly change if you have night sweats can help,” says Dr. Minkin. “And layer your clothing! Being able to take off a sweater in the winter and have a shell underneath can be wonderful.”
If you don’t feel like your gynecologist is as well-versed in menopause treatments as you’d like, now might be a good time to change doctors. “Unfortunately, a lot of gynecologists don’t know much about menopause—it’s just not a focus of the medical school,” says Dr. Minkin.
While most of the symptoms will vanish in the years following menopause, the lower levels of hormones are there to stay. And unfortunately, that puts you at risk for heart disease and osteoporosis.
That’s because estrogen is protective—it helps keep blood vessels open, manages the balance of good and bad cholesterol, and stops you from losing bone mass too quickly.
Then there is the potential for weight gain, which many women worry about with menopause. “Most women will gain between five and eight pounds throughout all of the menopause and the weight tends to be focused right around the middle,” says Dr. Minkin. But that extra belly fat isn’t a given.
“I strongly encourage women to strength train,” says Dr. Minkin. “It builds muscle mass, is good for your bones and heart, and will also help with your weight.”
The main takeaway: now it is more important than ever to put yourself—and your health—first. Find a new activity you look forward to doing, fill your plate with wholesome foods, spend time connecting with loved ones, and look forward to everything still ahead of you.