By Azadeh Nasseh, MD
Department of Internal Medicine

Menopause is a natural part of aging and signals the end of a woman’s reproductive years. While it is something that all women go through, dealing with the sometimes unpleasant symptoms can be challenging. However, knowing more about menopause and what to expect may make things a little easier and less stressful.

Menopause can start as early as age 40, but usually begins when a woman is in her late forties to mid-fifties. On average, menopause happens at age 51. Menopause is the time of life when you stop having menstrual cycles and is divided into three stages – perimenopause, menopause and postmenopause.

Perimenopause is the time leading up to menopause when your hormones start changing and your body starts preparing for the transition to menopause. It occurs in most women in their forties. The average length of perimenopause is variable. One of the first symptoms of perimenopause is changes in your menstrual cycle. Periods often start coming closer together, which means your cycle is shortening. So instead of 28 days, a cycle might be 26 days. The amount of bleeding could also change and be heavier or lighter and last for more or fewer days than previously. Perimenopause is also when symptoms start due to fluctuating hormone levels. Symptoms can include:

• Hot flashes, chills and night sweats
• Sleep disturbances (such as waking and not being able to get back to sleep)
• Fatigue
• Mood swings, including irritability, anger and rage
• Weight gain
• Brain fog
• Decrease in sex drive
• Vaginal dryness
• Heart palpitations
• Depression
• Joint Pain
• Headaches
• Dry skin
• Urinary incontinence

When perimenopause begins you should keep track of your symptoms and the timing of each period so you can accurately inform your healthcare provider. Be sure to track the symptoms you are experiencing, symptom severity, and when it happens and how often they occur. It’s important for your healthcare provider to know since some of these symptoms may be caused by health problems other than menopause as well.

Menopause is the time when your menstrual cycle and ovulation stop. This is also when your body’s hormones change dramatically and you experience the most symptoms, such as hot flashes, mood swings, and night sweats due to lower levels of estrogen and other hormones. Some surgeries and medical treatments can also induce menopause in women.

Postmenopause is the time after menopause and begins after you have gone 12 consecutive months without your period. This lasts throughout the rest of your life. The good news is that in most women the majority of symptoms experienced during menopause will subside over time as the body is no longer dealing with fluctuating hormone levels.

Menopause is a normal life transition, however, there are some medical options to help manage your symptoms and improve your quality of life, and you can discuss these with your primary care or OB-Gyn provider. These include some lifestyle changes (such as routine exercise, stopping smoking, limiting alcohol use, wearing clothes in layers), non-hormonal pharmacological treatments and hormone replacement therapy. Keep in mind that hormone therapy can benefit some women, but long-term use may have some cardiovascular and breast cancer risk. Your medical provider can provide you with more information on medications that can help with your symptoms, and which are safe for you. This would also be an opportunity to discuss bone health with your provider.

Menopause is a significant transition in a woman’s life, and everyone goes through it a little differently. Some women will go through menopause with few or almost no symptoms. Other women may notice significant hormone-related physical and mental changes that can negatively impact their day-to-day life. Be sure to talk to your primary care or OBGYN provider with any questions or concerns you may have!