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Menopause 101
Menopause 101: Your Definitive Guide to Navigating Life Post-Periods
Andy Dean / Adobe Stock
AnnaMarie Houlis,
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Did you get a hot flush in the middle of your work day? Are you noticing hair loss when you hop out of the shower? Are you experiencing unexpected weight gain? Is anxiety consuming you and affecting your performance at work? You might be going through menopause.

Menopause affects all women differently, but there’s one common denominator for all of them: It changes things. In short, the ovaries no longer make estrogen or progesterone, which are two hormones necessary for fertility. And so your body must adapt.

But what are the signs and symptoms of menopause, and how do you cope with it when it kicks in? This guide should help you navigate your experience and make your menopause transition as smooth as possible.

Menopause Predictions: When to Expect It

A lot of women looking to build families wonder how many years of fertility they have left. There are a number of factors that affect the age that a woman goes into menopause. The most significant factor is genetics — the age your mother experienced natural menopause. 

“Menopause is strongly genetically linked, so you’re very likely to fall within a few years either way of the age your mother was at menopause,” Nanette Santoro, MD, director of the division of reproductive endocrinology and infertility at the University of Colorado-Denver School of Medicine and a member of the board of directors of the American Society for Reproductive Medicine, told WebMD.

Typically, menopause begins at the culmination of a woman’s menstrual cycle, about a year after the last menstrual period. Natural menopause happens with age — usually around 51 years old — but, for some women, it can naturally occur before the age of 40, which would be considered premature menopause. This could be the result of an inherited issue or a one-time genetic mutation. A 2011 review of studies found that in up to 20 percent of cases of early menopause, the woman has a family history of the condition. Likewise, you may have an FMR1 gene, which causes Fragile X Syndrome, the most common form of inherited intellectual impairment. Even without the actual syndrome, you could have a mutation on that same gene that affects your ovaries and leads to fragile X-associated primary ovarian insufficiency. According to a report by the National Institutes of Health, one in 33 women deal with this. Turner Syndrome, in which a woman has only one X chromosome, is yet another associated genetic disorder. Meanwhile, autoimmune disorders and toxins (smokers) that can attack the follicles in your ovaries can also lead to early menopause.

Regardless of why you went into early menopause, you’re not alone if it happens to you — one in 100 women will experience menopausal symptoms by the age of 40. And, beyond premature menopause, it can sometimes be brought on even earlier as a result of surgery or treatment of a disease or an illness, that’s recognized as induced or surgical menopause, or premature ovarian failure, according to WebMD. 

Premature ovarian failure is nothing to be ashamed of. For example, ovarian surgery for anything like endometriosis, for example, could lead to the early onset of menopause. Hysterectomies (removal of the uterus) and oophorectomies (removal of the ovaries) are two other surgeries that could play a role. And treatments like chemotherapy can be at least mildly toxic to the ovaries; women who undergo chemotherapy for breast cancer or other types of cancer might expect to reach menopause earlier than others. 

According to WebMD, your age during your first menstrual period, pregnancy, breastfeeding and the use of hormonal birth control methods that could affect any one hormone level does not actually affect the age you will begin menopause.

The best way to predict when you’ll reach menopause is by tracking your period and keeping an eye on symptoms (more on those later). Your doctor can also check your blood for increased levels of follicle stimulating hormone (FSH level), which jump when your ovaries start to shut down. Your doctor may also check your thyroid-stimulating hormone (TSH level), because an underactive thyroid (hypothyroidism) can cause symptoms similar to those of menopause.

Menopause Stages: How It Happens

There are a few stages of menopause — it doesn’t just happen all at once. It takes some time for your ovaries to get small and stop the production of estrogen and progesterone that control the menstrual cycle. Here’s how it pans out, according to the Women’s Health Research Institute at Northwestern University. 

  1. Perimenopause: This occurs three to five years before menopause when your estrogen and hormone levels start to drop. Typically, you’ll enter perimenopause in your late 40s and might experience irregular periods and symptoms such as hot flashes, sleep disturbances and insomnia, night sweats, an elevated heart rate, mood swings that could lead to anxiety or depression, vaginal dryness or discomfort during sexual intercourse and urinary complications. You can still get pregnant during perimenopause, though it’s not as likely.
  2. Menopause: You’ve officially hit menopause when you’ve missed your period for a period of 12 straight months without other causes such as illness, medication, pregnancy or breastfeeding. The transition to menopause can take about one to three years and symptoms vary widely from woman to woman.
  3. Postmenopause: This stage begins after one year has passed since your last menstrual cycle. You might still experience vasomotor symptoms like hot flashes, night sweats and sleep disturbances like insomnia, as well as an elevated heart rate, mood swings, vaginal dryness and discomfort, and urinary issues.

Menopause Symptoms: What to Expect

While the symptoms vary, there are some not-so-surprising ones that a lot of women get. Each menopause symptom can vary by intensity, too. They can be both physical and emotional. Here’s a general list of the symptoms you might experience during the three stages of menopause: 

  • Irregular periods
  • Loss of libido
  • Mood swings
  • Fatigue
  • Hair loss or thinning
  • Hot flashes
  • Sweating
  • Racing heart
  • Headaches/dizziness
  • Vaginal dryness and soreness
  • Painful sex
  • Sleep disturbances such as insomnia
  • Difficulty concentrating
  • Memory lapses
  • Brain fog
  • Weight gain/bloating
  • Incontinence
  • Brittle nails
  • Changes to body odor
  • Depression/anxiety/irritability/panic disorder
  • Burning tongue
  • Breast pain
  • Joint pain/muscle tension
  • Electric shock sensation/tingling extremities
  • Digestive issues
  • Itchy, crawly skin
  • Gum problems
  • Osteoporosis 

Menopause Treatment: How to Cope with It

Menopause does not require medical treatment. Rather, there are a bunch of ways to relieve the symptoms of menopause that of course depend on what symptoms you experience.

With all things, lifestyle changes such as to your diet and exercise plans are always positive. Kicking unhealthy habits like smoking and drinking, and eating unhealthy foods (or triggering ones such as caffeinated or spicy ones) will also do well for your body and overall health.

On top of making lifestyle changes, women can explore hormone therapy options. Estrogen therapy is the most effective treatment option for relieving menopausal hot flashes, according to the Mayo Clinic. An increased estrogen level also helps prevent against bone loss and osteoporosis that may be a side effect of menopause. If you still have your uterus, your doctor might even prescribe treatment with both estrogen and progesterone. This is called combination hormone therapy (HT) or hormone replacement therapy (HRT). It helps with vasomotor symptoms like hot flashes, a hot flush and night sweats, and it may help prevent osteoporosis.

Hormonal therapy treats more than hot flashes and osteoporosis, too. To relieve vaginal dryness, vaginal estrogen can also be administered directly to the vagina using a cream, tablet or even a ring these days. They each release a small amount to boost your estrogen level, which is absorbed by the vaginal tissues to relieve dryness, discomfort with intercourse and some urinary symptoms. Of course, over-the-counter products such as lubricants and lubricated condoms also help treat vaginal dryness and relieve painful sex.

That said, the hormonal therapy route is not for everyone. There are some cardiovascular and breast cancer risks associated with long-term use of hormone therapy. Anyone who has ever had breast cancer, uterine or "endometrial" cancer, blood clots, liver disease or a stroke are advised not to get hormonal therapy. Anyone who might be pregnant or you have undiagnosed vaginal bleeding are also advised against hormonal therapy. 

For those who don’t want to or cannot get hormonal therapy, some consider low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may also decrease menopausal hot flashes. This has proven useful for women who can’t actually take hormones for health reasons or for women who need an antidepressant to treat a mood disorder, too.

There are also some drugs that are intended for seizures but have also been approved to treat hot flashes and night sweats, including Gabapentin, Neurontin and Gralise. Meanwhile drugs like Clonidine, Catapres, Kapvay and others, which treat high blood pressure, might also provide relief to hot flashes. Black cohosh is another menopause treatment to relieve symptoms, among other over-the-counter products. 

If none of the above are for you, some women believe in all-natural ways to treat menopause. These include acupuncture, meditation and relaxation techniques, which are all totally harmless, non-invasive ways to, at the very least, ease the stress of menopause. Acupuncture is also expected to reduce hot flashes and night sweats without any side effects.

Whatever you choose to do, know that menopause is a natural phenomenon that all women go through at some point in their adult lives. The North American Menopause Society is also a great resource that promotes women’s health at midlife and beyond for anyone seeking more information about menopause and how to make their menopause transition as easy as possible. Through the site, you can find a menopause practitioner, get expert answers to frequently asked questions, find recommendations to books and other scientific texts on menopause, and even find opportunities to participate in menopause studies and helm new research, yourself. The Menopause Society welcomes curious women who haven’t yet undergone menopause, women in the middle of it and postmenopausal women alike. So if you’re anticipating it, experiencing it or a postmenopausal woman yourself, be sure to check out what resources are available to you.

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AnnaMarie Houlis is a multimedia journalist and an adventure aficionado with a keen cultural curiosity and an affinity for solo travel. She's an editor by day and a travel blogger at HerReport.org by night.

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