On Menopause: When to Expect It and How To Deal With Symptoms

Menopause is what your mother probably called “The Change.” Today, modern women understand the concept of healthy aging; still, they are apprehensive about dealing with menopause.

There is a lot of misinformation out there about menopause. You hear stories about women with uncontrollable hot flashes and unwanted pounds that never go away. Menopause represents being old and losing beauty — but is that true?

Women should see menopause for what it is, the end of something, yes, but the beginning of something else — a life free from the burden of periods. As menopause approaches, changes do occur. Learn more about menopause and how to cope with these changes in a positive way.

What is Menopause?

Menopause is more complex than you might realize. It is a process that takes years and happens in stages. When does menopause start is a common question and the answer is earlier than you might think.

Perimenopause, the first stage, refers to a time when your body starts to transition into menopause. Like menopause itself, it begins at different ages for different women, and many factors, including genetics and environment, influence it. A majority of women will experience perimenopause in the ’40s; for some, it starts earlier.

During this time, levels of estrogen, a hormone associated with menstruation, go up and down. It is in these years that women start experiencing signs of menopause, such as:

• Irregular periods

• Vaginal dryness

• Hot flashes

• Sweating at night

• Chills

• Mood swings

• Sleep issues

• Weight gain

• Slow metabolism

• Thinning hair

• Dry skin

• Loss of fullness in the breasts

The other two stages are menopause and post-menopause. Menopause represents the full cessation of menstrual cycles for at least 12 consecutive months. Postmenopause starts with menopause and lasts for the rest of your life.

How To Tell If You’re Menopausal

You officially transition from perimenopause to menopause when you have gone a full 12 months without a period. The average age for menopause is around 51 or 52, but some women experience it earlier or later in life.

Once you make it that full year without a period, you become a postmenopausal woman. You may have some of the same symptoms, though, such as hot flashes and night sweats.

What About Premature Menopause?

Premature menopause can happen for a number of reasons. The hormones that control your menstruation come from your ovaries. If you have your ovaries removed surgically, called an oophorectomy, because of cancer risk or some other disease process, you are thrown automatically into menopause no matter what your age.

The same isn’t true for women that have a hysterectomy to remove the uterus. The surgeons will not remove the ovaries during a hysterectomy unless it is medically necessary. You will no longer have periods because you don’t have a uterus, but you will go through menopause normally at the appropriate age.

Cancer therapies can also cause a woman to go through premature menopause. If you have chemotherapy or radiation treatments, talk to your doctor about what to expect.

Finally, some women have a medical condition called primary ovarian insufficiency. It affects about one percent of the female population. Primary ovarian insufficiency means the ovaries do not produce the right amount of estrogen, so you experience premature menopause. The exact cause isn’t always known. It might be a hereditary factor or related to an autoimmune disease. For some women, it just happens, and there is not an explanation.

How The Body Changes in Menopause

By the time you become postmenopausal, your ovaries stop releasing eggs, which is why you no longer have periods. The changes in hormone levels can increase your risk of chronic medical conditions, as well, such as:

• Cardiovascular disease – Heart disease is the leading cause of death in women.

• Osteoporosis – Bone is tissue that breaks down and regenerates consistently. As women become postmenopausal, that process changes. The tissue breaks down faster than it regenerates, so bones can become brittle and weak. Twenty-four percent of women over the age of 65 develop this weakening in the thigh bones and the spine.

• Urinary incontinence – The muscles that control the urethra lose their elasticity, so you may pee a little when you are not expecting it, especially when you sneeze or cough.

• Vaginal dryness – This may make sex uncomfortable. You may even notice some bleeding after intercourse.

• Weight gain – As the metabolism slows down, the pounds can start adding up, making it hard to maintain your current weight.

• Mood changes and depression – Some women do experience depression with menopause, in part, because of the hormone changes. They also may be reacting to the idea of growing older and losing the ability to bear a child.

• Reduced sex drive – For some women, this lack of sex drive relates to the hormone changes. It may also have to do with sex becoming uncomfortable.

Introduction To Menopause Medicine

Menopause medicine refers to ways you can approach managing some of the symptoms that come with this major change in your life. It will include a combination of medical treatments like hormone therapy, complementary health practices, and lifestyle changes designed to provide menopause relief.

What Is Hormone Replacement Therapy (HRT) For Menopause?

During menopause, estrogen levels drop, causing those uncomfortable symptoms. Hormone therapy replaces it to relieve those symptoms.

HRT combines in three formats: estrogen-only, a combination of estrogen and progestin (synthetic progesterone), or estrogen and natural progesterone.

Estrogen Only Therapies

For estrogen-only hormone replacement, you have four options:

• Estrogen pill – The most common treatment for menopausal women.

• Estrogen patch – The patch goes on the belly and may need replacement every few days. The body absorbs the hormone through the skin.

• Topical estrogen – These come as creams, gels, or sprays. As with the patch, the body absorbs the hormone through the skin. You should follow the directions very carefully when it comes to the placement of topical estrogen.

• Vaginal estrogen – As the name suggests, the body absorbs this estrogen through the vagina, either as a cream, ring, or tablet. This treatment is especially helpful for women experiencing vaginal dryness.

Combination Hormone Therapy

Combination hormone therapies involve either estrogen and progestin or estrogen and progesterone. The purpose is the same as the estrogen-only treatment, to increase the levels of estrogen, but the added progesterone, synthetic or natural, can lower the risk of cancer in the endometrium, the lining of the uterus. This treatment is very similar to taking an oral birth control pill.

The Risks of HRT

Hormone replacement therapy does come with some risks. There is evidence that HRT can increase a woman’s chances of:

• Heart attack

• Stroke

• Breast cancer

• Blood clots in the lungs

It is not recommended for women with a history of blood clots, cancer, heart or liver disease, or stroke. Women should not start hormone replacement therapy if they might be pregnant.

How to Deal With Menopause Without Hormone Therapy

There are alternative treatments for the symptoms of menopause for women who want to avoid hormone replacement therapy. Natural supplements, for example, can help. Some examples of supplements that might work for you include:

• Black cohost – Might be effective in treating hot flashes. You can use either fresh roots and stems or buy dried black cohost to use as a tea.

• Phytoestrogens. – Several foods contain chemicals that can mimic estrogens, such as red clover and soy. Keep in mind, though, if the doctor doesn’t want you to have HRT therapy, that applies to phytoestrogens, too. They may represent the same risk of stroke or heart disease as hormone replacements.

• Relaxing practices – Like yoga, meditation, mindfulness exercises, and acupuncture, can reduce menopause symptoms without HRT.

Hot Flash Cooldown

Hot flashes occur when blood rushes to the vessels near your skin, raising its temperature suddenly by as much as seven degrees. Your skin will flush in response, and you may start to sweat. During menopause, these flashes are the result of fluctuations in estrogen levels.

The key is to figure out what triggers them for you. It might be something in your diet, like caffeine or spicy foods. It could be how you dress. Ideally, you should dress in layers, so when you start to heat up, you can take something off to cool down. Choose clothing that is breathable, too, such as cotton, linen, or rayon.

You also want to keep the temperature of the room on the low side. If that’s not possible, find ways to fan yourself. You might carry a hand fan in your purse or keep a small fan on your desk or near your favorite chair.

Finally, find ways to control your stress, which will almost always be a trigger. That might mean leaving a little earlier if you have an appointment or trying relaxation techniques like deep breathing experiences.

When a hot flash hits, put an ice pack on your neck or feet for instant cooling relief.

Head Off Headaches

Headaches are not a typical symptom of menopause. Some women, however, experience migraine headaches their whole lives, often associated with hormone changes. For them, the news is good and bad. You may notice fewer and weaker headaches during perimenopause. They may disappear completely once you are postmenopausal.

The problem is for some women, hormone fluctuations in perimenopause can make the headache worse and more frequent. Estrogen withdrawal can trigger migraines, so when the estrogen levels surge and then start to drop, you can develop a headache.

There are a number of ways to approach managing these headaches. If they are debilitating, talk to your doctor. Starting hormone replacement therapy may help control them.

Women who live with migraines know that hormones are not the only trigger. It’s important to be aware of what else might trigger a migraine, such as certain foods like red wine or Parmesan cheese.

If you are not sure, start keeping a notebook. When you feel a headache coming on, write down what you ate prior to it and any other activities. Some people develop migraines after extreme exercise, for example. Pinpoint all your triggers and avoid them.

As you feel a headache approaching, do what you can to push it back. That will mean different things for different women. For example, take over the counter pain medication at the first sign of a headache. For some woman, exercising help lower their risk of a migraine. Do what works for you.

Mood Highs and Oh-So Lows

Not all women have mood swings during menopause. There are risks factors for them, such as:

• History of depression

• Women under stress

• Women in poor physical health

Any woman who experiences extreme anxiety or depression should talk to her doctor, especially if it comes with feelings of hopelessness or thoughts of suicide.

There are things you can do at home to help manage mood swings as well, such as:

• Cardio exercise – Exercise is nature’s antidepressant. When you workout, your body releases endorphins that make you feel good as a reward.

• Following a healthy diet – The temptation when you are feeling down might be to reach for ice cream or chocolate but, instead, focus on ensuring you eat plenty of lean protein, fruits, and vegetables. When your body feels good, your mind will, too.

• Practice good sleep hygiene – Go to bed and get up at the same time each day. Make sure your bedroom stays nice and cool, and turn off any ambient light that might keep you up like from your phone.

You might toss in some daily meditation or stress-relieving exercise programs, too, like yoga or tai chi.

How Symptoms Change During Menopause

For most women, the symptoms of menopause start one to three years before they stop having periods. They continue until menopause — 12 consecutive months without a period — and they usually start to ease up during postmenopause.

There is no one size fits all formula for menopause, though. Each woman experiences it differently.

There are usually similar patterns in families. Talking to your mother, maternal aunt, or an older sister can provide you with insight on what to expect.

How Long Does Menopause Last?

It varies from woman to woman. It starts with perimenopause in your 30s or 40s. Perimenopause can last from one to three years or longer. Menopause is simply a way of identifying when you go 12 months without a menstrual cycle. As soon as you hit menopause, you are in postmenopause.

The symptoms should start to ease, but there is no way to say how long it will take. For some women, they will end sooner. Others may continue to have them throughout life. On average, symptoms will last 4.5 years after you have your last period and 7.4 years total.

The Importance Of The Quality Of Life

Although menopause is a sign of growing older, it doesn’t have to be the same as getting old. Things will change, but that doesn’t mean this time in your life has to be any less rewarding. You could argue that the best is yet to come. It will matter a lot on how you choose to live.

Here are some natural remedies for menopause:

• Focus on whole foods. Now is the time to make your diet work for you. Healthy eating should include avoiding fatty meats, butter, salt, and processed foods and can help you live better and longer. It will also reduce your risk of age-related illnesses like dementia. Our Mighty Health app can show you how it’s done with customized nutrition plans.

• Get into walking. There is a reason all those trackers count steps — how much you walk matters. Even if you have a regular exercise program, try to walk at least 30 minutes a day.

• Keep connected with family and friends. Being alone all the time increases your risk of depression and dementia. Social media is great, but try calling a friend or family member. Take a class, join a group, say hi to your neighbors, whatever it takes to add some socializing to your life. Take a healthy cooking class with a friend or partner for some fun.

• Be optimistic because positive thinking is powerful. Do things to encourage yourself to think positively, like meditating in the morning or reading a few inspirational paragraphs each day.

It is safe to say that the better you live, the better you will live. Menopause doesn’t have to be an earth-shattering experience if you maintain a balanced lifestyle. It is, however, something every woman will go through. There is no getting around it. It’s is better to accept it as just another one of life’s experiences and move on from there.