Menopause: What to Expect, How to Manage Symptoms

Many women watched their mother suffer through “the change” with her flushed red face hiding inside the open refrigerator. Thankfully, today women can approach menopause (and the years just before and after it, called perimenopause and postmenopause) better prepared to manage these transitional stages and the hormonal changes they cause. 

Now that the men have left the room. Ladies, let’s address your questions, concerns and misconceptions about menopause. 

When will I enter menopause?”

Menopause officially starts when your menstrual periods completely stop for one full year. If you’re wondering what’s the first sign that you’ve reached menopause — this is it. This typically happens after age 45 and by age 55. Unfortunately, the age when your mother or sister went through menopause doesn’t tell you when you can expect it.

You may notice changes in your menstrual cycle and your body in the months or years leading up to menopause. In your mid-40s, your periods may become heavier and/or longer, and you may experience night sweats and/or hot flashes.

These changes mean you’re going through the transitional stage of perimenopause, which happens after your peak fertility years and before menopause. Even though your period may be inconsistent during this time, you can still get pregnant during this time. Some women’s bodies naturally skip this phase, or their symptoms are mild, and they suddenly enter menopause by age 55.

Menopause typically lasts about 7 to 14 years, after which women will enter postmenopause.

What can I expect when going through menopause?

As your ovaries age, they produce less active ovarian follicles and lower levels of the following reproductive hormones: estrogen, progesterone and testosterone. When you go through menopause, these hormonal dips trigger changes in the body.

The signs and severity of menopause symptoms vary from woman to woman. Common symptoms include:

• anxiety
• bone loss
• changes in mood
• decreased sex drive
• depression
• difficulty concentrating
• difficulty losing weight / weight gain
• difficulty sleeping
• dry skin, mouth and eyes
• flushing (sudden appearance of redness on the face and chest)
• hair thinning or loss
• headaches
• heart racing
• hot flashes (sudden, temporary rushes of upper-body heat)
• increased hair growth on the face, neck, chest or upper back
• increased urination
• insomnia
• joint stiffness / pain
• less full breasts
• less muscle mass
• memory problems
• sore or tender breasts
• urinary tract infections
• vaginal dryness / decrease in self-lubrication
• vaginal skin thinning

How can I relieve menopause symptoms?

Watch your weight. 

Though it’s harder to lose weight as you age, doing so is one way to help ease the signs and symptoms of perimenopause and menopause.

Maintaining a healthy weight may reduce the severity of hot flashes and night sweats, improve your sleep, regulate your mood and restore your energy. Reducing your caloric intake, eating less sugar and exercising more can help you lose weight.

Quit smoking. 

Smoking and secondhand smoke are not only dangerous to your lungs, the exposure can also worsen menopause symptoms (and raise your risk for cervical cancer). 

Find ways to stay cool and dry. 

Hot flashes, night sweats and getting flushed in the face and chest can be bothersome. But carrying a portable fan can help keep you cool and dry. You can also dress in light layers that are easy to remove when your body temperature suddenly rises. Try a lightweight blanket at night or a mattress cover if you tend to sweat through your sheets.

Some women find it helpful to avoid caffeine and alcohol, which can temporarily warm your body. If hot flashes, flushing and night sweats continue to affect your quality of life, a low-dose selective serotonin reuptake inhibitor (SSRI) medication may be prescribed.

Limit alcohol. 

Heavy or frequent drinking isn’t good for you at any age. During menopause, your alcohol consumption may worsen symptoms, including the quality of your sleep, and make it harder to maintain a healthy weight. 

Prioritize your emotional well-being. 

During menopause, some women develop anxiety and/or depression (or these conditions worsen), and many others experience changes in mood.

If your mental health and emotional state are affecting your quality of life, speak with a therapist or psychiatrist, communicate honestly with your loved ones about what you’re going through, and find ways to lower your stress level. Maybe this is the motivation you need to try meditation, yoga or journaling. Psychoactive medications (like SSRIs) are appropriate and helpful for some women struggling with menopause-induced anxiety and/or depression.

Care for your skin, hair and bones. 

Hormonal changes during menopause can lead to osteoporosis, hair loss and thinner, dry skin. A thicker facial moisturizer with hyaluronic acid and serums with vitamin C, retinol, ceramides, vitamin E, collagen and peptides can help skin retain moisture and reduce the appearance of wrinkles. Minoxidil foam can be applied daily to the scalp, and antidandruff shampoos (with ketoconazole and zinc pyrithione) may help reduce hair loss. 

Taking a biotin supplement may also restore strength and thickness to hair, skin and nails. Lifting weights and resistance training can naturally strengthen bones and help prevent fractures. To lower your risk for osteoporosis, increase the amount of calcium and Vitamin D in your diet. You can also take prescription oral therapies like denosumab, teriparatide, raloxifene and calcitonin to prevent bone loss.

Don’t ignore the power of sleep. 

Regularly getting a good night’s sleep supports your overall health. It can help ease hunger cravings and menopausal moodiness while giving you the energy to exercise and more mental clarity to make healthy choices. Sleeping throughout the night is more challenging during menopause with the interruption of night sweats, and some women experience insomnia during this time. 

To help you fall and stay asleep naturally, try the following: 

• “box breathing” exercises
• listen to ASMR recordings before bed
• cardiovascular exercise during the day to expend energy
• practice good “sleep hygiene” (complete your nighttime routine before entering your bed, get in bed only when ready for sleep, sleep in a cool room, get exposure to natural light as soon as you wake up and avoid naps)
• avoid alcohol and caffeine
• avoid mentally stimulating activities before bed

If getting quality sleep continues to be a problem, a sleep specialist may recommend temporarily taking melatonin supplements or a prescription sleep aide.

Reinvigorate your sex life. 

Your sexual relationship with your partner(s) and your own body can change during menopause. Many women in this stage experience vaginal dryness and decreased sexual desire or interest. You may feel differently about your body and your appearance. But, this part of your life can still be enjoyable, lift your mood, improve your confidence in your body and help you maintain a romantic and physical bond with your partner(s).

To improve vaginal dryness, try hormone-free vaginal moisturizers and lubricants, low-dose estrogen-based vaginal lubricants or a medication called ospemifene (for painful vaginal intercourse) after medical evaluation. Using vibrators and communicating openly with your partner can also help improve your physical response to sex.

What does hormone replacement therapy do?

Hormone replacement therapies (HRT) are prescription treatments that replace some of the fertility hormones (estrogen alone or estrogen plus progesterone) that your body produces less of as you age.

You may assume that taking HRT will stop or reverse menopause. While it can be helpful for many women in reducing menopausal symptoms and lowering the risk for some age-related disorders, this treatment isn’t right for every woman.

Certain conditions (including a history of certain cancers and a high risk for stroke) can make it unsafe to take estrogen.

Like any other treatment, HRT increases the risk for some conditions, including endometrial cancer, blood clots, stroke, gallbladder problems and breast cancer.

Long-term use or starting HRT more than 10 years after menopause onset raises other health concerns. If you’re considering HRT, speak with your doctor about realistic expectations and your individual risk factors.

Written by Dana Kantrowitz, a contributor for UHealth’s news service. Medically reviewed by Flavia Fairbanks Lima de Oliveira, M.D., Ph.D., a gynecologist with the University of Miami Health System.

South Florida women can benefit from a new “one-stop” Comprehensive Comprehensive Women’s Health Alliance provided by the University of Miami Health System, the first such fully coordinated program in the region.

Tags: Dr. Flavia Fairbanks Lima de Oliveira, experience symptoms, fallopian tubes, hormone levels, menstrual bleeding