Perimenopause or the menopause transition is a time of changes for many. It begins with changes in the menstrual cycle length and flow and people may experience other symptoms such as hot flashes and night sweats. The length of perimenopause is different for everyone but can last for several years. Menopause is the final menstrual period, which is confirmed 12 months after no further periods. You are considered “menopausal” 1 year after your final period. No labs are needed to diagnose menopause.

The range of perimenopause or the menopause transition can be 4-10+ years before menopause. The average age of menopause is 51. This means that many people can experience symptoms in their early to mid-40’s and some even in their late 30’s.

Many people will experience a range of symptoms including hot flashes/night sweats, mood changes, brain fog, sleep issues, and more unpredictable cycles. Even though these symptoms are common during this transition, it doesn’t mean that one must suffer in silence! We recommend discussing symptoms, especially if they affect your daily life with a provider knowledgeable in perimenopausal care.

During the menopause transition, the hormones responsible for ovulation are in flux and are decreasing over time. This means one may skip a period due to not ovulating one month and may ovulate twice in another month.

There are many symptoms associated with the perimenopausal transition and menopause. Hot flashes and night sweats are common, but some people also experience mood changes, brain fog, weight gain, vaginal dryness, and sleep disturbances. Much like adolescence, some people may experience only one or 2 mild symptoms, while others experience many or more significant symptoms.

Weight gain during perimenopause and menopause is so frustrating! Weight gain is often due to decreasing estrogen levels which cause fat distribution changes to the abdomen. This also can lead to reduction in muscle mass. Also as we age, metabolism changes. Lastly, if people are experiencing hot flashes/night sweats, sleep disturbances, etc, they are likely not feeling their best and may not be able to keep up with diet and exercise as well as they otherwise would.

Possibly! We believe that the changes in hormones can affect mood in some people. This, along with the added responsibilities and obligations of daily life, with limited time for self-care, can result in increased anxiety and depression for some people. Everyone is different, and it is important that you talk with your health care provider to optimize your mood.

Many people experience sleep disturbances due to fluctuations in hormones. In addition, hot flashes and night sweats can significantly disrupt sleep. Good sleep hygiene, diet and exercise can improve these symptoms, but talk to your health care provider for more information.

There are estrogen receptors everywhere in the body including the brain. About half of midlife women report difficulty focusing, concentrating, or remembering words or names. These changes are typically mild and will get better after the menopausal transition and are not signs of dementia.

Without estrogen, the vaginal lining becomes thinner and less elastic. There is less blood flow and lubrication. The pH and normal flora change. In addition, patients can experience urinary frequency and urgency. All these changes can negatively affect desire and vaginal estrogen can help.

Hormone therapy is very effective in treating hot flashes and night sweats, as well as vaginal dryness. Hormones may not be for everyone; there are non-hormonal options that can also be discussed with your provider.

Hormone therapy is safe; however, there are certainly circumstances where the risks of therapy outweigh the benefits. This is why it is so important to feel empowered to reach out to your provider to discuss your symptoms and safe, personalized options for you.

Regular exercise, balanced diet, adequate sleep, utilizing stress reduction techniques, and minimizing alcohol intake have been shown to make a difference in symptom management. In fact, a regular yoga practice has been demonstrated to improve perimenopausal and post-menopausal symptoms!

Hot flashes and night sweats can last, on average, for 7 years but may last longer for some patients. Symptoms such as vaginal dryness may be lifelong for some people.

Do not wait it out. Many patients experience symptoms for months to years by the time they seek help. It is common for patients to not recognize perimenopausal symptoms until they are severe. Not everyone presents with typical hot flushes. They might have anxiety, heart palpitations, waves of nausea, or sleep disturbance. For many patients, it can take a long time before they connect with a provider who takes them seriously. Fortunately, the Menopause Society is working to change that. If you are not getting the help you need, consider seeing a Menopause Society Certified Practitioner (MSCP). Like Dr. Amanda Schmehil, MSCPs show their commitment by passing an exam and completing 15 hours a year of medical education on menopause. The MSCPs at Associated Physicians work closely with everyone on the team, so our patients do not need to go anywhere else.