Menopause is a big transition not just for your body but your mind. It’s your body’s way of you reminding you that you’ve had quite a journey in this life and you are getting ready for a new chapter.
Menopause can be hard to understand because it is different for every woman and generally there’s a lack of information out there because we don’t talk about it enough.
In a culture that does not celebrate menopausal women nearly as much as it should, it’s easy to feel ashamed, confused, and quite frankly, old as you go through menopause.
These feelings are totally natural but we can do something to change the way we view menopause. This change starts with information and conversation.
The more women know about their bodies as they go through menopause and the more we talk about it, the better our understanding and attitudes towards menopause can be.
Consider this article a one-stop-shop for all you need to know about menopause. From perimenopause to post menopause and everything in between, we’ll do more than just cover the basics.
We hope this knowledge will empower you as you go through the menopausal transition so you can embrace this change knowing your body is capable of amazing things and you are not alone.
Let’s dive in and get down to it.
What is Menopause?
Menopause is the permanent end of the menstrual cycle. It is marked by a missed period for 12 consecutive months, not caused by medication.
That’s right, you’ve got to wait a whole year before you can confirm you’ve reached menopause (ugh).
Menopause indicates the end of fertility and childbearing years in a woman. Natural menopause is brought on by the decreased production of sex hormones progesterone and estrogen in the ovaries, as well as the depletion of ovarian oocytes (eggs), due to aging.
Reduced hormone levels and egg counts mean there is no longer a need for menstruation, so periods stop.
Some people may refer to menopause as the period leading up to this point however, menopause is not reached until 12 consecutive months of missed periods.
Prior to this point a women is in what is called perimenopause, and after this point a women is in post menopause. We will talk more about these stages later on.
What is Induced Menopause?
For many women, menopause is brought on by surgery. This is known as induced menopause and occurs when women have a procedure known as a bilateral oophorectomy, or the removal of both ovaries.
Women with certain cancers, such as ovarian cancer, may also experience induced menopause due to damaged ovaries by radiation therapy or drugs. Just like natural menopause the ovaries stop producing hormones and periods cease.
Whether menopause is brought on naturally or induced, many women are happy to no longer have a period.
Whether you had cramps and bloating or simply had to deal with the inconvenience of vaginal bleeding on a monthly basis, saying goodbye to your period can be exciting.
Of course, along with the good, comes the bad. Menopause can also bring on some less than desirable changes. So, you probably want to know, when does menopause start?
Menopause Age
The average age that women reach menopause (miss their twelfth consecutive period) is 51.
But the typical age range to reach menopause is 40 to 58 years of age.
As you can see there is a very wide age range, which can make it hard to know where you stand in your menopausal transition.
To make it even more confusing some women are outliers and don’t reach menopause till their 60s, and there is such a thing as early menopause that can affect women in their 20s and 30s.
There is evidence linking the age of menopause between mother and daughter implying there is a hereditary factor (you may reach menopause around the same age your mother did) but more research is needed.
What we do know for sure is that the age a woman gets her period or whether or not she has used contraceptives, or had children does not play a role in menopause age or symptom severity.
Studies also show that race and socioeconomic status are also not contributing factors to when and how a women experiences menopause.
The wide age range women reach menopause can make it hard to know if you’re approaching menopause, simply missed your period, or are experiencing symptoms of another condition, such as a thyroid disorder.
In order to clear this up, lets go through some of the signs and symptoms of menopause so you know what to look for and can better understand what’s going on with your body and whether or not to seek medical attention.
Signs and Symptoms of Menopause
Before we dive into the signs and symptoms of menopause its important we clarify our terminology.
As mentioned above, “menopause” simply marks the absence of a period for 1 year, not caused by medication. So really this is the only symptom of “menopause”.
That said, the phases leading into and out of menopause may bring some physical and emotional changes.
Perimenopause
Perimenopause is the phase prior to menopause when a woman may still have her period but begins to show signs of approaching menopause, such as irregular periods, mood shifts, and hot flashes, to name a few.
Perimenopause typically starts 4 years before menopause is reached. But for some women it can last just months and for others it can be 10 years before their period stops. So answering the question: how long does menopause last? is nearly impossible.
If you’re sensing a trend here, you’re right: the menopause transition varies widely from woman to woman and it’s essentially impossible to generalize when you will begin and end this journey, something that can be very frustrating.
But we’ll do our best to answer your questions and address some of these mysteries. Let’s get back to it...
Perimenopause indicates the ovaries are producing less estrogen. Drops in estrogen levels can cause changes in your body.
It is important to note that during perimenopause you can still get pregnant and should act accordingly.
If you are experiencing some of the following symptoms, you may be perimenopausal.
Perimenopause symptoms:
Hot flashes
Breast tenderness
Worse premenstrual syndrome
Lower sex drive
Fatigue
Irregular periods
Vaginal dryness; discomfort during sex
Urine leakage when coughing or sneezing
Urinary urgency (an urgent need to urinate more frequently)
Mood swings
Trouble sleeping
Some women might also experience:
Racing heart
Headaches
Joint and muscle aches and pains
Difficulty concentrating, memory lapses (often temporary)
Weight gain
Hair loss or thinning
Symptoms of perimenopause tend to increase the closer a woman is to menopause.
So if you have been experiencing some of these symptoms for a while and notice they are getting more severe or frequent, you may be nearing menopause.
Not all women will experience these symptoms and the degree to which they are felt also varies drastically from woman to woman.
Some lucky women barely experience any symptoms at all besides decreasing periods, while other women have sever hot flashes, vaginal dryness, and mood swings.
Some symptoms of perimenopause may actually be linked to another condition and therefore medical attention may be needed.
A doctor will be able to tell you if your symptoms are a normal part of your menopausal transition or if something else is causing them.
For this reason it’s important you monitor your body and your symptoms closely so you know when something is out of the ordinary and when you should contact your doctor.
If you experience the following symptoms seek medical attention:
Your periods are changing to become very heavy, or accompanied by blood clots
Your periods last several days longer than usual
You spot or bleed after your period
You experience spotting after sex
Your periods occur closer together
Emotional Changes of Perimenopause
Perimenopause is a transitional period where your body is prepping for menopause and winding down your reproductive abilities.
For many women this change comes not just with physical symptoms but mental challenges as well.
Some of these feelings are due to hormone imbalances, others to lack of sleep due to hot flashes and night sweats, and some just because change is hard and even the strongest of women aren’t immune to that.
Let’s take a look at some of the emotional symptoms of perimenopause:
Irritability
Feelings of sadness
Lack of motivation
Aggressiveness
Difficulty concentrating
Fatigue
Mood changes
Tension
First things first, these feelings are totally normal and you’re not alone. That said, it’s still hard to go through and some days will be worse than others.
Expressing your feelings to your loved ones and other women who are going through what you are can help you cope with the emotional challenges of perimenopause.
It’s also important to take steps to manage stress and ensure you are taking care of yourself so this transition isn’t harder than it needs to be.
Of course this is easier said than done. For many women menopause coincides with other life transitions such as sending kids off to college, prepping for retirement, or dealing with the loss of a parent.
These outside factors quickly become muddled with your menopause transition and can make it difficult to process these life changes and the intense emotions that come with them.
At PlushCare we want to do everything we can to help. Our doctors are available to provide both medical advice and mental health support.
We want you to know that no matter how fed up you are, you will make it through this and it will eventually get better. Which leads us to our next step, post menopause.
Post Menopause
Post Menopause is the time after you have reached menopause and not had a period for 1 year.
You have now completed perimenopause and are on the other side, congratulations!
As we’ve already discussed menopause is a process and it’s different for every woman, so don’t expect that on the 365th day without your period all your perimenopause struggles will disappear.
But you can bet over time you will start to settle into your new normal—one that is period free, we might add!
Post menopause comes with it’s own benefits and challenges.
You are now officially infertile which many women have mixed feelings about. You will also still continue to experience the symptoms you felt during perimenopause but they will gradually begin to decline.
Let’s talk about what this may look like.
Post Menopause Symptoms
Post menopause symptoms are typically the same as those that you felt during perimenopause. That said, over the next few years these symptoms tend to decline in severity and most of them will ultimately subside.
For some women this may only take 1 to 2 years, for others symptoms can linger for as long as 7 years. Most women experience post menopause symptoms for about 4 years.
We’re not here to sugar coat, this may feel like a long time... and while we’re on the subject of not sugar coating, we should mention some conditions that post menopausal women are at risk of due to decreased levels of estrogen.
Post Menopausal Health Risks
Osteoporosis, stroke, and heart disease are the three main risks that post menopausal women face.
Let’s break each one down and talk about why you’re more at risk for these after menopause and what you can do prepare yourself and stay healthy.
Post Menopause Osteoporosis
Osteoporosis is a bone disease. It occurs when bone density is low and bones become weaker and break more easily. In some cases the bones of the lower spine may even begin to fuse together.
Post menopausal women are more prone to osteoporosis because as we age our bones become more brittle and prone to breakage.
Around 35 years of age is when your bones start losing bone mass as opposed to creating it. Aging combined with the drop in estrogen levels postmenopausal women experience leaves them at risk.
Here’s what you can do about it: get a bone mineral density scan to check on the density of your bones.
Many women do not know they have osteoporosis until they fall and break a bone that should have been fine. Knowing the state of your bones will help you prevent breaks and stay healthy.
Talk to a doctor about certain preventative medications if you’re at risk. Vitamin D is known to strengthen bones, ask your doctor if it’s something you should take.
Post Menopausal Stroke
Women who are post menopausal are more likely to have a stroke because of two main factors. The first is a decrease in estrogen by nearly 60%, which leads us to our second factor, a surplus of androgens.
Androgens are known as “male hormones” (which is inaccurate as both women and men have them) but men do have more, so we’ll let it slide.
The most common androgen you’ve probably heard of is testosterone. There has been some research that links the increase of strokes in post menopausal women to higher levels of androgen hormones.
And since we promised not to sugar coat anything, we should mention that your risk of stroke doubles after menopause. That said, menopause cannot take all the credit for this spike as aging in general for both men and women also increases the risk.
To prevent strokes it is advised to eat healthy, exercise, don’t smoke, only drink in moderation and generally speaking, make healthy decisions when and where you can.
Post Menopausal Heart Disease Risk
While there’s still a lot of research to be done about why the risk for heart disease increases in post menopausal women, one key factor is reduced estrogen levels.
Estrogen has been proven to help the inner artery walls remain flexible and adjust with changes in blood flow.
The best way to avoid heart disease at any point in your life, but especially post menopause, is to eat healthy, exercise and avoid harmful activities like smoking and excessive drinking.
Now that you are aware of the health risks you may be facing and you know what to do to prevent them, let's cover what you can do to prevent and treat the symptoms of menopause we mentioned earlier.
Menopause Treatment
At PlushCare we don’t love the term “menopause treatment” because it implies something is wrong with you and needs to be treated. It also isn’t technically correct because at this point menopause is inevitable; there is no treatment or cure that can stop it.
Menopause is not an illness to be rid of but rather a gradual process to be embraced, lived through and at times, managed.
We realize menopause has its highs and lows. And for some women the lows are hot, sweaty, and irritable and you may want to treat these symptoms.
We’ve got your back. Here are some tips and tricks that can help reduce and manage the symptoms of menopause you’d rather live without.
Hormone therapy
If you suffer from hot flashes, like a lot of hot flashes, the kind that wake you up at night in a sweaty puddle, you may want to ask your doctor about hormone therapy.
Hormone therapy is a way to raise estrogen and progestin levels in your body. For some women this helps reduce hot flashes and stabilize moods.
Estrogen has a lot of benefits, like improving bone strength and helping regulate body temperature.
When you go through menopause your estrogen levels decrease which can cause a lot of the negative symptoms women experience.
Hormone therapy is not a good option for everyone and in some cases has been linked to increased risk of cardiovascular issues and breast cancer. If you’re interested in whether or not hormone therapy will benefit you, ask a doctor about it.
Vaginal estrogen
If you’re experiencing vaginal dryness and lubes aren’t cutting it, talk to your doctor about vaginal estrogen.
Estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring. This treatment releases just a small amount of estrogen, which is absorbed directly by the vaginal tissues. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
Low-dose antidepressants
If you’re suffering from hot flashes and/or feeling depressed this may be a great option for you (especially if hormone therapy isn’t an option).
You may have heard of selective serotonin reuptake inhibitors (SSRIs), they are commonly used to treat depression but also have been shown to decrease menopausal hot flashes.
A low-dose antidepressant for management of hot flashes and mood may be useful for some women. Talk to your doctor to see if antidepressants are a good treatment option for your menopause symptoms. Additionally, you can explore the possibility of obtaining antidepressants online as part of the discussion with your healthcare provider.
Gabapentin (Neurontin, Gralise, others)
Gabapentin is FDA approved to treat seizures, but it has also been shown to help reduce hot flashes.
This drug is useful in women who can't use estrogen therapy and in those who also have nighttime hot flashes. If you’re interested in taking a medication that’s not an antidepressant these can be a great option. Ask your doctor for more information.
Clonidine (Catapres, Kapvay, others)
Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes.
Again, this can be a great way to manage menopause symptoms but it’s not for everyone so be sure to talk to your doctor before setting your mind on using these medications.
Medications to prevent or treat osteoporosis
As we mentioned before, osteoporosis is a real risk for postmenopausal women. Depending on the individual, your doctor may recommend medication to prevent or treat osteoporosis.
There are many medications available that help reduce bone loss and risk of fractures. Vitamin D is also a great way to help strengthen bones and may be recommended by your doctor.
It’s a good idea to ask your doctor about osteoporosis prevention and treatment before you have a bad fracture.
The options above are some of the most common and effective treatment methods but are by no means your only choices.
Talk with your doctor about what’s available to you and the risks and benefits involved with each.
It’s important that you also revisit your approach to treatment at least once a year to ensure that it is still the best treatment option for you.
New treatments may become available, or your symptoms and response to treatment may change. It’s good practice to bring up your menopause symptoms and treatment options every time you see your doctor so you stay up to date.
Menopause Treatment Online
Whether you’re in perimenopause, postmenopause, or still unsure where you stand, we are here to connect you with knowledge and medical doctors who can help with symptoms management.
PlushCare connects you with board certified online doctors who can help you manage your menopause symptoms from the comfort of your home.
Our top doctors can prescribe medication and give medical advice that will help you get through this transition with ease. Our clinicians offer ongoing primary care and are here to help you at any stage of your journey. We also offer mental health support.
Book an appointment with a PlushCare doctor and see what a difference digital healthcare can make in you menopause transition.
Read More About Menopause
Sources
Medline.gov. Menopause. Accessed March 27, 2020 at https://medlineplus.gov/menopause.html
Mayoclinic. Menopause Symptoms and Treatment. Accessed March 27, 2020 at https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
Sciencedirect.com. The Normal Menopause Transition. Accessed March 27, 2020 at https://www.sciencedirect.com/science/article/abs/pii/037851229290003M
