What to expect before, during and after menopause

Menopause is the time in a woman’s life when her ovaries stop producing estrogen, the primary female sex hormone. This causes menstrual periods to end.¹ But it’s a gradual, years-long process that has 3 phases — perimenopause, menopause and postmenopause.

Despite the different phases, the symptoms of each may overlap. And because estrogen plays such a big role in women’s overall health, these symptoms can catch women off guard, says Samantha Dunham, M.D., co-director of the Center for Midlife Health and Menopause at NYU Langone Health in New York City.

“Women may not really feel like themselves, and that sends off feelings of surprise when they start to realize things are changing with their bodies,” Dr. Dunham explains. That’s why it’s important to know the symptoms — and how they might be related — so that women can better manage them, she says.

Read on for what to expect before, during and after menopause — and potential ways to deal with the physical and emotional symptoms.

The years leading up to menopause are called perimenopause. Typically, this stage starts when women are in their mid to late 40s.² It can last anywhere from 2 to 8 years, though the average is 4 years.²

As the ovaries produce less estrogen, levels of the hormone begin to fluctuate and the menstrual cycle becomes less predictable, explains Dr. Dunham. Instead of a 28-day cycle, women may have a cycle that spans 21 to 35 days, she explains. The bleeding varies too, from very light to very heavy.² Sometimes months go by without a period. Or, women can have 2 periods in a month.

Besides irregular periods, the rise and fall in estrogen levels can trigger a number of other symptoms, says Dr. Dunham, including:^1,2,3

• Hot flashes. Unexpected waves of heat can rise in the body, affecting the upper body, including the neck and face.
  
• Night sweats. These are hot flashes that happen while sleeping. Some women wake up drenched in sweat.
• Physical changes. A few typical examples are joint and muscle aches and a racing heartbeat.
• Changes in mood. This can include becoming more irritable, depressed or anxious.
• Sleep problems. This may include trouble falling asleep or staying asleep, perhaps due to night sweats or anxious thoughts.
• Memory issues. Sometimes there can be brain fog and memory issues, though some of these symptoms may be caused by a lack of sleep.

Symptoms during perimenopause can be unpredictable. ¹ Some women have no symptoms or mild ones, while others may experience symptoms more intensely.

Menopause means a woman has gone 12 months in a row without having a period, including spotting. The average age is 52, says Dr. Dunham.² But women can go through this transitional phase anytime between the ages of 45 and 55.³

The ovaries stop producing estrogen. This marks the end of the childbearing years.

The tricky part of this stage? Knowing that you’ve actually moved into it. “People realize retrospectively—‘Oh, that was my last period,’” says Dr. Dunham.

The increased drop in estrogen also causes changes in the tissues of the bladder, urethra and vagina, says Dr. Dunham. The whole area can become more sensitive and less elastic, and vaginal secretions decrease, Dr. Dunham explains.

• Painful sex. This may occur because of vaginal dryness and sensitivity, says Dr. Dunham.
• Frequent urination. With the urethra and bladder being more sensitive and easily irritated, women may have to pee more often during menopause. These body changes might also lead to urinary tract infections.¹
• Weight gain. Around this time, “women typically gain between 1 to 1.5 pounds per year, which can come on suddenly,” says Dr. Dunham. Women may find that they have more fat around the belly and less lean muscle.⁴

The years after exiting menopause are known as the postmenopausal stage. “Almost 40% of a woman’s life may be spent in postmenopause,” says Dr. Dunham.

It’s a good time for women to review their health. Understanding any risks may help prompt lifestyle changes that can positively impact long-term health, she explains.

Because estrogen plays a role in bone density and cholesterol levels,² postmenopausal women are at higher risk of heart disease and bone loss, known as osteporosis.³ In fact, postmenopausal women can lose up to 20% of their bone mass, which can lead to more broken bones, including hip fractures.⁵

Don’t be surprised to still have hot flashes, which can continue for up to 14 years after periods have stopped.² Vaginal dryness and urinary incontinence may also be issues during this time.³

The most important thing is to get help from a health care provider for the symptoms you’re having, explains Dr. Dunham. Lifestyle changes and medications can help ease symptoms. Some to try:

• Stop smoking, if you still do. Smoking can make menopause symptoms worse.⁶ That includes hot flashes, explains Dr. Dunham.
  
• Consider eating a heart-healthy diet, such as the Mediterranean diet, suggests Dr. Dunham. This can lower the risk of heart disease and may prevent weight gain.
• Add in regular exercise. “Weight-bearing exercises and strength training really help with muscle mass and metabolism,” says Dr. Dunham. Exercise also helps keep bones strong, she adds.
  
• Discuss medications with your provider. There are many U.S. Food and Drug Administration approved treatments to help manage symptoms, notes Dr. Dunham. These include hormone-replacement therapies, which come in pills, patches, creams, gels and rings.⁷ There are also medications to help prevent bone loss, as well as antidepressants for mood changes.
  

The bottom line, says Dr. Dunham: “Seek help. Don’t suffer in silence.” And while you may be ending one chapter in your life, you’re also entering another — one that can be filled with many healthy and happy years.