This piece was originally published on Elektra Health.
For a good portion of our life, menopause is one of those “out of sight, out of mind” concepts.
Of course, we all know it’ll happen eventually, but it just seems so far off until it isn’t.
It’s common for menopause to catch you by surprise and while we don’t talk menopause prep enough, knowing what you can expect is very helpful. Let’s break down all the need-to-knows when it comes to causes, timing, and symptom management.
When, how, and why
During the menopausal transition, the body’s production of two key female hormones, estrogen and progesterone, begins to progressively decline. This happens until you hit menopause. You’ve officially reached menopause when you’ve gone 12 consecutive months without a period.
As you can see here, progesterone starts to decline first, and the decline is steep. Estrogen follows the same course but fluctuates a lot as it decreases. Testosterone also declines on a gradual slope.
In Western societies, the average person hit menopause 51, but many start experiencing symptoms — like irregular periods and hot flashes — upwards of 8-10 years beforehand. This stage is known as perimenopause (aka “around menopause”). Once you’ve hit menopause, ovaries stop releasing eggs and stop producing estrogen.
Many of us assume menopause means we’re destined to feel tired, deflated, and, well, “meh” for years on end, which is simply not the case. As Oprah Winfrey once said, “So many women I’ve talked to see menopause as an ending. But I’ve discovered this is your moment to reinvent yourself after years of focusing on the needs of everyone else. It’s your opportunity to get clear about what matters to you and then to pursue that with all of your energy, time, and talent.”
Perimenopause and menopause symptoms: what to expect
In an ideal world, we’d be able to package the symptoms of perimenopause, menopause, and postmenopause into neat, well-organized boxes and unpack them one at a time. Unfortunately, menopause isn’t one-size-fits-all, and every woman experiences the transition differently.
“The experience can vary from individual to individual as well as across ethnic and cultural groups and different countries and regions of the world,” says Dr. Barbieri.
That said, research does point toward certain patterns and trends. For example, we know that the symptoms typically associated with menopause (there are roughly 34) are actually experienced by most women during late perimenopause, peaking during the last two years due to an accelerated drop in estrogen levels. Below are the most common:
- Hot flashes/night sweats
- Irregular periods
- Vaginal dryness and discomfort during sex
- Urinary urgency and incontinence
- Difficulty sleeping
- Emotional changes (e.g., irritability, mood changes, anxiety/depression)
- Dry skin, eyes, or mouth
After you hit the menopause mark (12 months without a period), you officially enter post-menopause. Many women will go 8-9-10 months and think they are in the clear and then they get a period, at which point the clock starts over.
Once you are post-menopausal, many symptoms tend to subside and some may persist, like vaginal and urinary symptoms. And, unfortunately, there are some longer-term health implications that come with being post-menopausal. Post-menopausal women have a higher risk of developing heart disease, diabetes, and osteoporosis.
The menopause transition is therefore the time to take action to help prevent those conditions by establishing healthy habits, caring for yourself, and being proactive about getting the healthcare you deserve.
Unless we go through “sudden” or premature menopause for medical reasons, we’ll spend a third or more of our lives in postmenopause. This is a long time, so it’s important to understand what treatments are out there. Sure, some symptoms may be unavoidable, but there are still ways to have agency and manage the impact they have on your life. It’s all about optimizing your health for the long term.
Lifestyle changes for menopause
Lifestyle changes are paramount to temper the symptoms of menopause and postmenopause, whether or not you’re considering additional treatments, like hormone replacement therapy. Fortunately, research shows they can be as effective as medication, sometimes even eliminating the need for it. And the good news is that it doesn’t matter if you’re just starting perimenopause, beginning full-fledged menopause, or enjoying what many regard as the period-free liberation of postmenopause.
Leaning into healthy lifestyle changes at any age can greatly improve your symptoms, energy levels, and overall health. In other news, it’s never too early and it’s never too late.
“Hormones are very much affected by your mood, stress levels, sleep, exercise, and nutrition,” says Dr. Eva Selhub, MD, a physician, author, and resiliency expert — so much so, in fact, that studies have shown that a diet high in whole foods, especially vegetables is inversely correlated with menopause symptoms.
Tapping into your community
We also recommend building a “menopause support team.” Start by reviewing the list of symptoms, recording your experience with each on a scale of 1-10 (least disruptive to most disruptive), and prioritizing which to tackle first. You can track all of this information in your Ovia app. Bring the list to your next doctor’s appointment to discuss
It’s essential that you have provider who listens to you and is informed about the menopause journey. And it’s very possible that a provider you have loved isn’t the right fit for this new stage. Evaluate how comfortable you feel asking questions about your symptoms, how confident you feel in the answers, and how you feel leaving appointments.
Do you leave feeling informed and confident about your next steps? If not, or if you don’t feel like your provider is listening to you, then find a new one! Having a provider on your team with deep menopause training and understanding is key to thriving during this period of life.
Reach out to family and friends for support — the more conversations you have, the more you’re helping to break down the stigma around menopause that prevents so many people from sharing their experiences.
At any given moment, 50 million or more women in the U.S. are experiencing menopause, and a whopping 16% never discuss it with anyone at all. That needs to change!
In addition to building a “menopause support team,” consider meditation and mindfulness for stress management and other psychological symptoms associated with menopause. “These techniques,” explains Dr. Selhub, “…allow one to manage them better without distress.”
Alongside nutrition, physical activity, sleep, and mind-body interventions, there are a number of botanical and supplement solutions that can help, including soy isoflavones, black cohosh, and vitamin B6. Like hormone replacement therapy, however, some come with risks, side effects, and medication interactions, so it’s important to carefully evaluate your options and consult your healthcare provider first.
One of the most effective therapies for menopause is hormone replacement therapy (HRT), which involves taking a supplemental form of either estrogen — or estrogen and progesterone — to balance out the two and replace what the body is no longer naturally producing.
As with all medications, there are benefits and risks. For HRT, the benefits can include improving hot flashes, night sweats, sleep, mood, sex drive, and bone density, among others.
Despite the fact that today, the North American Menopause Society (NAMS) considers HRT to be safe and effective for most women in menopause (especially when started prior to age 60 or within 10 years of menopause), it is still a hotly debated and often misunderstood topic. When factors such as health history and medical conditions, as well as the type, dose, and duration of therapy are considered, benefits of HRT can outweigh the risks. Speak with your provider to find the right option for you.
Remember that there are also non-hormonal prescription options, including certain antidepressants, that can be used for severe symptoms, especially for women who cannot or do not wish to try hormonal therapies.
The bottom line? Yes, menopause comes with symptoms. No, you’re not alone in what you’re experiencing. Medications and supplements can play an important role, but don’t underestimate the power of nutrition, exercise, quality sleep, and stress management.
Reframing how you think about menopause is also incredibly powerful. For example, you can turn this time into an opportunity to step back, renew your identity, and set future goals.
Many of us will be retired and/or empty nesters with more time on our hands — perfect for considering what pursuits we used to love that we’ve not had time for lately Or, what new interests do you want to dive into? Not only will challenging ourselves in new ways keep our brain healthy, but it’ll also help us combat stress, stay present, and pursue long-overdue passions.
No matter how you’re feeling about this transition, the first step is finding a knowledgeable who can help you navigate the journey ahead.