It is a normal part of life, just like puberty. It is the time of your last period, but symptoms can begin several years before that and last for months or years after that occurs. Some time around 40, you might notice that your period is different—how long it lasts, how much you bleed, or how often it happens may not be the same. Or, without warning, you might find yourself feeling very warm during the day or in the middle of the night. Changing levels of estrogen and progesterone, which are two female hormones made in your ovaries, might lead to these symptoms.

This time of change, called perimenopause by many women and their doctors, often begins several years before your last menstrual period. It lasts for 1 year after your last period, at this point in time known as menopause. A full year without a period is needed before you can say you have been “through menopause.” Postmenopause follows menopause and lasts the rest of your life.

Menopause doesn’t usually happen before you are 40, but it can happen any time from your 30s to your mid 50s or later. The average age is 51. Smoking can lead to early menopause. Some types of surgery can bring on menopause. For example, removing your uterus (hysterectomy) before menopause will make your periods stop, but your ovaries will still make hormones. That means you could still have symptoms of menopause like hot flashes when your ovaries start to make less estrogen. But, when both ovaries are also removed (oophorectomy), menopause symptoms can start right away, no matter what your age is, because your body has lost its main supply of estrogen.


Women may have different signs or symptoms at menopause, because estrogen is used by many parts of your body. So, changes in how much estrogen you have can cause assorted symptoms. But, that doesn’t mean you will have all, or even most, of them. In fact, some of the signs that happen around the time of menopause may really be a result of growing older, not changes in estrogen.

Changes in your period. This might be what you notice first. Your period may no longer be regular. How much you bleed could change. It could be lighter than normal. Or, you could have a heavier flow. Periods may be shorter or last longer. These are all normal results of changes in your reproductive system as you grow older. But, just to make sure there isn’t a problem, see your doctor if:

• Your periods are coming very close together
• You have heavy bleeding
• You have spotting
• Your periods are lasting more than a week

Hot flashes. These are very common around the time of menopause because they are related to changing estrogen levels. They may last a few years after menopause. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Flashes can be as mild as a light blush or severe enough to wake you from a sound sleep (called night sweats). Most hot flashes last between 30 seconds and 10 minutes.

Problems with the vagina and bladder. Changing estrogen levels can cause your genital area to get drier and thinner. This could make sexual intercourse uncomfortable. You could have more vaginal or urinary infections. You might find it hard to hold urine long enough to get to the bathroom. Sometimes your urine might leak during exercise, sneezing, coughing, laughing, or running.

Sex. Around the time of menopause you may find that your feelings about sex have changed. You could be less interested or you could feel freer and sexier after menopause. You can stop worrying about becoming pregnant after one full year without a period. But, remember you can’t ever stop worrying about sexually-transmitted diseases (STDs), such as HIV/AIDS or syphilis. If you think you might be at risk for an STD, make sure your partner uses a condom each time you have sex.

Sleep problems. You might start having trouble getting a good night’s sleep. Maybe you can’t fall asleep easily, or you wake too early. Night sweats might wake you up. You might have trouble falling back to sleep if you wake during the night.

Mood changes. You might find yourself more moody, irritable, or depressed around the time of menopause. It’s not clear why this happens—is there is a connection between changes in estrogen levels and emotions or not? It’s possible that stress, family changes such as growing children or aging parents, or always feeling tired could be causing these mood changes.

Changes in your body. You might think your body is changing: Your waist could get larger, you could lose muscle and gain fat, your skin could get thinner. You might have memory problems, and your joints and muscles could feel stiff and achy. It hasn’t been determined if these are the result of having less estrogen or just related to growing older.


Two common health problems can start to happen at menopause, and you might not even notice.

• Osteoporosis. Day in and day out your body is busy breaking down old bone and replacing it with new healthy bone. Estrogen helps control bone loss. So losing estrogen around the time of menopause causes women to begin to lose more bone than is replaced. In time, bones can become weak and break easily. This condition is called osteoporosis. Talk to your doctor to see if you should have a bone density test to find out if you are at risk for this problem. Your doctor can also suggest ways to prevent or treat osteoporosis.
• Heart disease. After menopause, women are more likely to have heart disease. Changes in estrogen levels may be part of the cause but, so is getting older. As you age, you may develop other problems, like high blood pressure or weight gain, that put you at greater risk for heart disease. Be sure to have your blood pressure and levels of triglycerides, fasting blood glucose, and total cholesterol (LDL and HDL) checked regularly. Talk to your health care provider to find out what you should do to protect your heart.
  

Staying healthy after menopause may mean making some changes in the way you live.

• Don’t smoke. If you do use any type of tobacco, stop—it’s never too late to benefit from quitting smoking
• Eat a healthy diet—one low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals
• Make sure you get enough calcium and vitamin D—in your diet or in vitamin/mineral supplements
• Learn what your healthy weight is, and try to stay there
• Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. Try to be physically active in other ways as well, for your general health

• Take medicine to lower your blood pressure if your doctor prescribes it for you
• Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort
• Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed in size or color
  

Menopause is not a disease that has to be treated. But you might need help with symptoms like hot flashes. Here are some ideas that have helped some women:

• Try to keep track of when hot flashes happen—a diary can help. You might be able to use this information to find out what triggers your flashes and then avoid it.
• When a hot flash starts, go somewhere cool
• If night sweats wake you, try sleeping in a cool room or with a fan on
• Dress in layers that you can take off if you get too warm
• Use sheets and clothing that let your skin “breathe”
• Have a cold drink (water or juice) when a flash is starting

You could also talk to your doctor about whether there are any medicines to manage hot flashes. Gabapentin, megestrol acetate, and certain antidepressants seem to be helpful to some women.


These days you hear a lot about whether you should use hormones to help relieve some menopause symptoms. It’s hard to know what to do.

During perimenopause, some doctors suggest birth control pills to help with very heavy, frequent, or unpredictable menstrual periods. These pills might also help with symptoms like hot flashes, as well as prevent pregnancy.

As you get closer to menopause, you might be bothered more by symptoms like hot flashes, night sweats, or vaginal dryness. Your doctor might then suggest taking estrogen (as well as progesterone, if you still have a uterus). This is known as menopausal hormone therapy (MHT). Some people still call it hormone replacement therapy or HRT. Taking these hormones will probably help with menopause symptoms and prevent the bone loss that can happen at menopause. However, there is a chance your symptoms will come back when you stop MHT.

Also, menopausal hormone therapy has risks, that is why the U.S. Food and Drug Administration suggests that women who want to try MHT to manage their hot flashes or vaginal dryness use the lowest dose that works for the shortest time it’s needed.


Phytoestrogens are estrogen-like substances found in some cereals, vegetables, legumes (beans), and herbs. They might work in the body like a weak form of estrogen. They might relieve some symptoms of menopause, but they could also carry risks like estrogen. It is nor certain yet. Be sure to tell your doctor if you decide to try eating a lot more foods that contain phytoestrogens or to try using an herbal supplement. Any food or over-the-counter product that you use for its drug-like effects could change how other prescribed drugs work or cause an overdose.


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