Lately, something incredible has been happening. More women are talking openly about menopause. Selma Hayek shared her experience with mood swings on a podcast. Gayle King discussed the annoyance of hot flashes on CBS. Even Michelle Obama opened up about menopause to People. 

It’s about time we talk about it: Literally half the population experiences menopause. But until recently, it was one of those whispered-about things clouded in embarrassment and shame. No more! 

Menopause is irritating and uncomfortable enough—so let’s try and make the transition as smooth as possible. That starts with giving you the key information in this guide. Everything you want to know about perimenopause and menopause is covered here. 

What Is Menopause? 

If there has been any women’s reproductive issue less talked about than menopause, it’s perimenopause. No wonder some women think they’re going through the big M when they are actually in the PM. We talked to Winifred Soufi, M.D., Ph.D., an obstetrician/gynecologist in Atlanta, Georgia, to clarify the terms.

• Menopause: When you no longer have a period for 12 consecutive months, you are officially in menopause. During this time, the ovaries stop releasing eggs and a woman can no longer get pregnant. The average age a woman starts menopause is 51. 
• Perimenopause: Also called premenopause, these are the months or years leading up to menopause. On average, a woman starts going through perimenopause around age 47, and it typically lasts four years. 

What Causes Menopause?

Menopause is a completely natural and normal part of aging. In other words, it’s supposed to happen. Physiological changes serve as the spark. 

“During menopause, the hormones that the ovaries were producing when a woman was fertile and ovulating every month—including estrogen, progesterone, and testosterone—start to fluctuate,” explains Annelise Swigert, M.D., an obstetrician/gynecologist at Southdale Obgyn in Minnesota. These fluctuations set off a domino effect of side effects that can make menopause tricky (and distressing) to navigate.

As a woman’s age goes up, the number of ovarian follicles she has goes down. Ovarian follicles are little sacs filled with fluid, found inside the ovaries. Over the course of the menstrual cycle each month, these follicles release hormones and an egg. When you have fewer ovarian follicles, you produce fewer reproductive hormones. This eventually causes menstruation to stop.

Hormonal fluctuations start during perimenopause, Dr. Swigert notes. So being in perimenopause can mean both having a period and experiencing many of the side effects of menopause. (Ugh.) The hormonal roller coaster continues through menopause. By postmenopause, the hormones stay at a low level. 

Menopause can happen prematurely, though it isn’t very common. Only 1% of women go through menopause before age 40. This is usually the result of chemotherapy, surgery that removes the ovaries, or certain autoimmune conditions. “Sometimes, family history can play a role in when a woman goes through menopause, so it can be helpful to know when your mom or [older] sisters went through it,” Dr. Swigert says.   

Signs That You Might Be in Perimenopause

As your hormones take a bumpy ride through your body, you can experience a whole pu pu platter of side effects. These signs of perimenopause can continue into menopause as well (with the exception of irregular periods). 

Irregular Periods in Perimenopause

With hormone levels all over the place, your period likes to keep you guessing (and not in a fun way). It may be longer or shorter than usual. Typically, shorter periods occur at the beginning of perimenopause, and longer periods at the end of perimenopause. 

Your period can also be heavier or lighter than it used to be. And it can change things up from month to month: One month, it could be short and heavy, the next long and light.

Hot Flashes in Perimenopause

Hot flashes may feel like they’re out to get you, but they’re actually trying to help. The changes in estrogen and progesterone cause your body temperature to rise. Your blood vessels start to dilate as a way to increase blood flow and reduce your internal temp. That triggers your heart to beat faster and a rush of heat—a.k.a. the hot flash—which, ultimately, cools you down.

Night sweats are basically hot flashes that happen at night. Yours may show up as a few extra beads of perspiration, or fully damp clothes. This doesn’t exactly create optimal bedtime conditions, so enter stage left: sleep troubles.

Mood Changes in Perimenopause

Feeling cranky, sad, or anxious or going through mood swings are all common during perimenopause. What’s the connection between mind and meno? Inconsistent levels of estrogen and progesterone disrupt the production of another hormone: the brain chemical serotonin, which plays a key role in mood. 

Changes in Sexual Desire in Perimenopause

Speaking of mood (of another kind)… You might be “in the mood” less often. As estrogen decreases, so does sexual desire. It’s more difficult to get aroused.   

Trouble Concentrating in Perimenopause 

If you feel scatterbrained, Tracee Ellis Ross is with you! (The actress told Harper’s Bazaar that perimenopause made her feel this way, too.) Estrogen helps different parts of the brain communicate with each other, and that includes focus. Some studies show that plummeting estrogen is linked to low cognitive performance. 

Headaches in Perimenopause 

Hormonal fluctuations can bring on head pounders, even migraines. Scientists aren’t sure exactly why this happens.

Vaginal Dryness in Perimenopause

Blame that estrogen slump again. It can cause the outermost layer of the vagina to become dryer and thinner. This can make the area less elastic and more fragile, and for some, penetrative sex can hurt. The simplest first-line fix is a good lubricant.

Hair Loss in Perimenopause 

You’ve likely heard about (or experienced) the hair boost many women get during pregnancy. Well, here we’ve got the opposite. With less estrogen and progesterone in the body, hair follicles can shrink. This can lead to hair loss. 

 

Symptoms of Menopause

All of the above? Yep, they can keep going during menopause, minus the period wackiness. (Remember: Menopause is defined as not having a period at all for 12 months.) Plus, additional symptoms can crop up during menopause. These include:

Stress Urinary Incontinence in Menopause

Vaginal muscles become weaker during menopause, which can make it harder to hold your pee. Don’t be surprised if you leak a little when sneezing, laughing, or lifting heavy objects. This can continue in postmenopause as well. 

Weight Gain in Menopause 

It’s very common to gain weight during this time period, especially around the belly. But for the record, it isn’t typically caused by hormones—it’s more about age and being less active.

Depression in Menopause 

When you think about everything happening to your body (it’s a lot) and in your life at this age, it’s no shocker that women in meno and perimeno have a higher risk of depression.

Consider the external factors. For example, many adults become “empty nesters” in their 40s and 50s, which can be an entire identity shift. At the same time, people are coping with their own parents aging, which can be emotionally taxing. All this on top of disruptive sleep? Like we said: It’s a lot. 

Weaker Bones in Menopause

The dip in estrogen can sap strength from your bones. Prioritizing bone strength is important to help ward off the chances of osteoporosis. Eat your probiotic yogurt!

Higher Cholesterol in Menopause

We feel like a broken record but… Less estrogen can increase LDL cholesterol (the “bad” kind). This puts postmenopausal women at an increased risk for cardiovascular disease.

 

How to Treat the Side Effects of Perimenopause and Menopause

If you feel overwhelmed at facing—or just reading about—the potential side effects, guess what? That’s normal! And completely understandable. Maybe you’re already in the thick of it, and it’s become unbearable. 

Here’s some good news: There are plenty of ways to make the transition easier, and your ob/gyn will be happy to talk to you about each and every one. Below are some different treatment options to consider.

Diet and Exercise

Is there a health story that doesn’t mention eating healthy? This is no exception. Studies show that following a plant-based diet can reduce the frequency and severity of hot flashes. Why? Plant-based foods give you fiber, which can help prevent insulin spikes that contribute to hot flashes. This type of eating plan helps thwart weight gain and menopause-related cholesterol issues, as well. 

In particular, consuming soy daily can have a potent impact, since soy is high in isoflavones, a type of plant estrogen that acts as a weaker form of estrogen in the body. Putting tofu, edamame, and tempeh on rotation can help balance you out.

And of course, doctors also recommend regular exercise. Weight training, specifically, can play a crucial role in fortifying bones. And if you’re not snoozing soundly, yoga may offer some relief.

Natural Remedies

You’ve likely seen all manner of natural “remedies” on drugstore shelves. A bunch are snake oil, but the herb black cohosh may be helpful, says Luisa Vera, M.D., an obstetrician/gynecologist at UNC Rex Hospital in Raleigh, North Carolina. One study found that black cohosh decreased the severity of hot flashes when used as an oil. Another study showed it works as a capsule. Be sure to talk to your doctor before taking any form.

Therapy 

You see doctors to navigate your physical issues. A therapist is there to help you wade through the mental muck. Cognitive behavioral therapy (CBT) is a classic way of dealing with mood changes or depression, and it might even reduce hot flashes, too, says Dr. Vera. The connection? In CBT, you learn how to manage emotional responses to symptoms, which can make them less intense.  

Prescription Medications

• For vaginal dryness and painful sex: If you need more than a lubricant, your doc may suggest vaginal estrogen. It’s safe to use as long as a woman has not had any type of gynecological cancer, Dr. Vera says.
• For mental health issues: You don’t have to white-knuckle it through depression or anxiety. Talk to your doctor to see if medication could lessen these feelings.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) works on a simple equation: You take estrogen to replace lost estrogen. This can be done using a pill, skin patch, ring, gel, or spray. 

The context surrounding HRT is less clear-cut. Generally, HRT can be very helpful in reducing the side effects of perimenopause and menopause, but it is riskier, says Dr. Vera. “A [woman] is a good candidate for hormone replacement therapy if she is in her 40s or 50s,” she explains. “Once you reach your 60s, the risks may outweigh the benefits.” 

With HRT, there’s a higher chance of blood clots, cardiovascular disease, and breast cancer (in women with a uterus). It’s important to tell your doctor whether you’ve had a hysterectomy, because that may play a role in the type of HRT that’s best for you.

Menopause is a huge transition in every woman’s life—one of the biggest. If you feel overwhelmed or are struggling, that’s okay. This isn’t something you have to navigate alone. Talk to your doctor about your specific worries and ask for help. Whatever it is, there are ways to make it easier. 

 

4 (Very Specific) Things That Can Soothe Menopause Symptoms

1. Tofu and edamame. Soy is high in isoflavones, a type of plant estrogen that acts as a weaker form of estrogen in the body. So eating soy-rich foods can help balance you out.
2. Black cohosh. Most natural “remedies” are hardly remedies at all. But this herb has been shown in some studies to reduce hot flashes.
3. Cognitive behavioral therapy (CBT). Not only can it help with mood changes or depression, CBT also teaches you to manage your responses to menopause symptoms—making them less intense.
4. Lifting weights. As estrogen dips, bones can get weaker. Strength training helps fortify them.