What Is Menopause? A Guide to Hormone Changes and Talking to Your Doctor
Anyone who’s gone through menopause is likely familiar with the hot flashes, brain fog and irritability it can cause. But what is menopause, really? And how does it affect your health? Here, experts explain what age menopause typically starts, symptoms to watch for and how to talk to your doctor about this important transitional phase of life.
What is menopause?
Menopause marks the end of the reproductive period of your life. “It’s a natural biological process that happens the moment you’ve gone 12 consecutive months (one year) without having a menstrual period,” explains Marissa Messore, MD, a menopause and female sexual health specialist at The Center for Women’s Sexual Health and Medicine. “During this time, there’s a decline in hormone production.”
Bruce Dorr, MD, a board-certified ob-gyn and senior medical advisor at BioTE, says the decline in hormones starts before menopause, during a transitional phase called perimenopause.
The difference between perimenopause and menopause
Perimenopause is the lead-up to menopause. It takes seven to 10 years on average, according to Dr. Dorr. During this time, hormones like estrogen and progesterone start declining and your menstrual cycle becomes increasingly unpredictable.
Menopause, on the other hand, is a single point in time. You enter it the day after going a full year without having a period. After menopause happens, you stop ovulating and can’t get pregnant. It signifies a new chapter, called postmenopause, that lasts for the rest of your life.
What age is menopause?
“In the United States, most women enter menopause at [around] 51 years old,” Dr. Dorr says. Keep in mind this number is just an average. Some women enter menopause earlier, in their mid-40s, while others continue having a period into their late 50s and don’t reach menopause until after 60.
Some women even experience early menopause, also called premature menopause. This occurs when you go through menopause before age 40. It’s common among women who’ve undergone cancer treatment, had an hysterectomy (removal of the uterus) or who have certain health conditions like rheumatoid arthritis or thyroid disease.
Regardless of when the transition happens, genetics seem to play a role. A study published in the journal Menopause found that mothers and daughters tend to enter menopause around the same time.
Symptoms of menopause
Even though menopause is a single point in time, after the transition occurs, many women continue experiencing symptoms. These can include:
Hot flashes
Difficulty sleeping
Irritability
Brain fog
Headaches
Dizziness
Dry skin
Vaginal dryness
Urinary incontinence
No two people experience these symptoms in the same way. According to Dr. Messore, some women’s symptoms are severe, while a lucky few experience mild symptoms or no symptoms at all.
Another thing to keep in mind: Some women continue to experience vaginal bleeding after menopause. This is called postmenopausal bleeding, and although usually harmless, it can sometimes point to more serious health problems. Make an appointment with your doctor if this happens to you.
Changes in hormone levels during menopause
Menopause symptoms can be attributed to the decline of three key hormones: estrogen, progesterone and testosterone, Dr. Dorr says. Since these chemical messengers contribute to various bodily functions, the drop in their production affects your well-being.
For instance, “menopause reduces brain blood flow, slows glucose metabolism and affects nerve conduction and transmission,” Dr. Dorr explains. “This can create a perfect storm for [mental health conditions] like anxiety and depression.”
Menopause can also impact your physical and sexual health, adds Dr. Messore. About 50 percent of menopausal women experience vaginal dryness while 13 to 84 percent report painful intercourse. Further, the decline in estrogen increases the risk of osteoporosis, heart disease and weight gain.
How is menopause diagnosed?
Unfortunately, there isn’t a specific test that confirms menopause. The experts we interviewed say it’s diagnosed retrospectively after a woman goes a full year without having a menstrual period.
Therefore, if you’ve gone 12 months without having a period, are in the age range for menopause to occur and have multiple symptoms such as hot flashes, night sweats and difficulty sleeping, you’ve likely gone through menopause and are now in postmenopause.
Hormone testing can provide additional insights if you’re still unsure. Research shows that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels increase just before and after menopause, so blood work can help confirm the diagnosis.
Tips for talking to your doctor about menopause
Unfortunately, some doctors may dismiss menopause concerns as simply a normal part of aging. But there are things you can do to help manage menopause symptoms. To ensure you get the best possible care and recommendations for your specific needs, follow these guidelines when talking to your doctor:
1. Schedule a menopause-specific appointment
The majority of primary care physicians (51 percent) report spending an average of 16 minutes per patient exam. That isn’t much time, especially if you have questions or concerns you’d like to discuss.
“I recommend [scheduling] a separate consultation, distinct from a preventive annual gynecologic visit [so you can] dedicate adequate time and focus on perimenopause or menopause,” says Alyssa Dweck, MS, MD, FACOG, a practicing ob-gyn and chief medical officer at Bonafide Health. “Bring a list of symptoms to address and a menstrual calendar for reference.”
2. Prepare a list of questions
When it’s time for your appointment, Dr. Dweck says to “bring a list of symptoms to address and a menstrual calendar for reference.” And come ready with questions and concerns, too. Some you might ask include:
What types of lifestyle changes can I make to reduce my symptoms?
How can I reduce my risk of osteoporosis and cardiovascular disease (both of which increase post-menopause)?
Can nutritional supplements or botanicals support my efforts?
Do I still need preventive screenings like Pap tests and breast exams after menopause?
Don’t be afraid to bring up concerns about sexual health and/or urinary incontinence, too. “Menopause specialists have heard it all before,” Dr. Dweck assures.
3. Ask your doctor if hormone replacement therapy (HRT) is right for you
Not all gynecologists have specialized menopause training. Dr. Dorr says women may be prescribed medications like sleep aids and antidepressants that mask uncomfortable symptoms.
“While this is well intended, these prescriptions can lead to additional problems such as libido loss, sexual dysfunction and weight gain,” he explains. “At the end of the day, it’s crucial to treat the root cause of menopause symptoms, which is hormone imbalance.”
Traditional hormone replacement therapy (HRT) and bioidentical hormone replacement therapy (BHRT) both address hormone imbalances by putting chemical messengers like estrogen and progesterone back inside the body.
“Many of my patients can gradually wean off all prior prescription medications once we’ve replaced and balanced their hormones,” Dr. Dorr notes. “They feel better, and long-term, experience positive heart, brain, bone and mobility improvements.”
Although not everyone qualifies for hormone replacement therapy, it’s worth discussing with your healthcare provider.
The bottom line
“The great thing is that there’s been a lot of [menopause] research recently,” Dr. Messore says. “Women are talking about it and it’s become a much more popular topic. There are many treatment options available, and you don’t have to suffer.”
More on supporting menopause:
What Are Some Early Signs of Menopause? Doctors Share 1st Symptoms
How To Get Rid of Menopause Belly Fat and Lose Weight Naturally
This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.
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