Navigating Menopause: Signs, Stages, and Symptom Relief

Ah, menopause. Anyone who has or ever had a uterus or a period is familiar with the term. And for many, the notion of a pause from periods sounds a-okay. But, despite what the term “pause” suggests, there’s a lot more menopause than just a break from the menstrual cycle.

According to Vanessa Ross, CNM and Menopause Society Certified Provider at Baystate Midwifery and Women’s Health, menopause is a full-body experience that can span years, or even more than a decade.

She explains, “Much like puberty, menopause is a time of normal and natural transition. The difference is that puberty marks the start of fertility while menopause marks the end of it. Despite the fact we live 40% of our lives after menopause, it doesn’t get the attention that puberty gets. Which is unfortunate as it comes a host of physical, hormonal, and psychological changes that 85% of people in menopause experience and contend with in some way.”

The Stages and Symptoms of Menopause

Menopause itself is defined after the fact, when someone has gone 12 months in a row with no menstrual cycle. Menopause can also be caused by medical treatment or surgery. While the average age of natural menopause is age 51 or 52, the process of shutting the cycle down begins years earlier in what’s called perimenopause. Perimenopause ends at one year after the final menstrual period, and postmenopause is the rest of one’s life.

Ross says, “Perimenopause can start in your mid-30s or as late as your early 50s.The biggest indication that it’s happening is an irregular menstrual cycle. Periods may start earlier or later, be heavier or lighter than normal, you may skip a cycle entirely, or you may end up with two periods in one cycle. The reason behind the change is that your ovaries are beginning to run out of follicles and to produce less estrogen. During this phase, estrogen levels don’t just steadily decline – they are up and down which leads to unpredictable changes in the menstrual cycle. Perimenopause is a slow road, often lasting years to the moment of menopause when you stop ovulating entirely.”

Ross notes that there are estrogen receptors in every part of the body. So, it makes sense that the erratic and decreasing levels of estrogen impact the entire body, including the brain. In addition to changes to the menstrual cycle, people in perimenopause or postmenopause may experience various symptoms, including:

• Hot flashes
• Night sweats
• Vaginal dryness
• Insomnia
• Changes in mood including anxiety, irritability, mood swings, & depression
• Brain fog
• Vertigo
• Changes in sense of smell
• Tinnitus
• Cold flashes or chills
• Hair loss
• Joint pain
• Weight gain, especially in the abdomen
• Bloating and constipation
• Decreased libido
• Urinary issues including UTIs and leakage

Most Common Menopause Symptoms

Of all the potential symptoms & changes of menopause, three are experienced the most often: hot flashes, bone loss, and urinary and genital changes. Here’s a deeper dive into the impact of these common menopause experiences.

Hot Flashes and Night Sweats

Medically referred to as vasomotor symptoms (VMS), hot flashes are one of the most common symptoms of menopause. In fact, 41-80% of people experience them during perimenopause while 60-80% of people experience them during or after menopause. Unfortunately for those early-experiencers, they’re also likely to experience them for longer than those who have late-onset VMS. The average duration of hot flashes is 7-10 years.

In addition to causing a flush of heat or even sweating, VMS can trigger other issues in your body including:

• Spike in blood pressure
• Heart palpitations
• A boost to bad cholesterol (LDL)
• Weight gain
• Interrupted sleep that leads to mood swings, brain fog, and inflammation

And, the longer you experience VMS, the greater your risk for developing:

• Cardiovascular disease
• Diabetes
• Osteoporosis and fractures
• Dementia
• Poor quality of life

Bone Loss

During menopause, the loss of estrogen significantly speeds bone loss and increases the risk of osteoporosis, a gradual but progressive deterioration of bone. In fact, studies have shown that in the first five to six years of menopause, half of people lose up to 10-20% of their bone mass. Further, 50-60% of postmenopausal people will fracture a bone in their body making osteoporotic fractures more common than breast cancer, heart attacks and strokes combined.

Vaginal Dryness, UTIs, and Other Genitourinary Changes

Because the vagina is filled with estrogen receptors that regulate moisture, blood flow, and the presence of bacteria, it makes sense that the lack of estrogen would lead to significant changes and potential problems for many people during perimenopause and menopause.

Common issues during peri- and postmenopause include:

• Vaginal dryness, burning, and irritation
• Decreased lubrication, which leads to pain or burning during sex and even bleeding
• Recurring urinary tract infections (UTIs)
• Sudden and urgent need to pee, sometimes with leakage
• Pelvic organ prolapse
• Constipation
• Inability to climax during sex

Treatment Options for Perimenopause and Menopause

Without question, the gold standard for treating symptoms of perimenopause and menopause is hormone therapy.

That said, not everyone going through menopause will require or even want medical intervention to help with symptoms. The decision whether and how to treat is yours and should be discussed thoroughly with your health care provider.

In 2002 the Women’s Health Initiative (WHI) study raised concerns about hormone therapy causing an increased risk of breast cancer, stroke and heart disease. However, further study of the data from the WHI and over 20 years of research since then has shown us that the risk of breast cancer is much lower than initially thought, and that the timing of starting hormone therapy is key to using it safely and avoiding risk of stroke and heart disease.

Women who are within 10 years of menopause and/or under age 60, who have no medical contraindications to hormone therapy, generally have more benefits than risks with hormone therapy use.

Hormone therapy is FDA-approved for treating:

• Hot flashes and night sweats
• Prevention of osteoporosis
• Premature loss of estrogen
• Genitourinary symptoms of menopause including painful sex

Other benefits of hormone therapy include:

• Improved sleep and mood
• Reduced risk of diabetes and heart disease
• Improved quality of life
• Possible reduced risk of Alzheimer’s

While hormone therapy is deemed safe, there are certain conditions that might rule it out as an option for treating hot flashes. These include:

• Unexplained vaginal bleeding
• Liver disease
• History of heart disease, stroke, heart attack, or a blood clot in a vein
• Personal history of inherited high risk of thromboembolic disease
• Prior estrogen-sensitive cancer

Hormone Therapy Options

Systemic hormone therapy that raises blood levels of estrogen to reduce hot flashes and prevent bone loss is available in different formulas and forms. If someone has had a hysterectomy, they can use estrogen alone for their symptoms.

Estrogen-only hormone therapy comes in a variety of forms including:

• Pills
• Patches
• Vaginal ring
• Gel or spray

Everyone who still has their uterus needs both estrogen and progesterone therapy. Estrogen alone can increase the risk of endometrial or uterine cancer, but adding progesterone eliminates that risk by protecting the uterine lining. Estrogen and progesterone can be prescribed separately and used simultaneously, or combined estrogen-progesterone therapy is available in pill and patch form.

For those who cannot use systemic hormone therapy or only need help with genital and urinary symptoms, topical low-dose estrogen creams, tablets, or rings are safe to use for all postmenopausal women, including cancer survivors.

Ross notes, “The decision as to which type of hormone therapy to use and in what form should be a shared decision with your health care provider based on your individual health history, the benefits and potential side effects associated with each option, and the ideal timing for treatment.”

Non-Hormonal Treatment Options for Menopause

For those individuals who prefer not to use hormones or have a medical contraindication to taking hormone therapy, there are other options for addressing symptoms. Several medications FDA-approved for other conditions have been shown to help with hot flashes. And a new non-hormonal medication called Veozah was FDA-approved last year specifically for the treatment of hot flashes and night sweats.

Again, you should discuss your options with your health care provider.

If you’re looking to find relief for some symptoms without medication, there are a few proven options worth trying.

To relieve hot flashes, try hypnosis, cognitive behavioral therapy, and weight loss, all of which are supported by research and evidence. An app called Evia offers guided hypnotherapy which has been shown in numerous studies to reduce the frequency and severity of hot flashes.

Exercise brings the biggest non-medication benefits for menopause symptoms. Just 30 minutes of exercise five days a week has been shown to:

• Prevent cognitive decline
• Improve heart health
• Decrease obesity
• Decrease anxiety and depression
• Improve sleep
• Improve sexual function
• Prevent loss of or maintain bone and muscle mass

Engaging in stress-reducing practices may also help people feel better during the menopause transition. Yoga, journaling, spending time outdoors, meditation, breathing exercises, and even long hugs can all work to bring stress under control.

Menopause Help: Resources

“The great thing for people going through menopause today is that it’s no longer a taboo subject,” says Ross. “More time is being devoted to educating people in healthcare about menopause, and there’s a lot of great information and resources readily available to patients—much of it free.”

Everyone's Menopause is Unique

“Everyone’s menopause experience is unique to them,” Ross adds. “How you choose to manage it is also unique and totally up to you. I encourage my patients to have candid conversations with me and others going through the menopause transition and to be open to trying different things to manage symptoms and feel better. Menopause can be an empowering time. If we see this transition as an invitation to take better care of our physical and mental health, we will not just survive menopause but thrive in the next half of our lives.”