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Menopause Basics: What You Should Know Before It Starts

By Sheryl Kraft
Reviewed by Alyssa Quimby, M.D.
February 05, 2024
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It’s usually in your 40s when you notice that your body, your moods, and your general self is changing.

You gaze into the mirror and wonder: Who is that stranger staring back at me?

Some months, your periods are as erratic as your moods, veering from light and breezy to serious and willful. (That favorite pair of white pants? Might want to think twice.)

Other times—usually when it’s least convenient—your body temperature spikes faster than it takes to utter those three words: What. Is. Happening?

You’ve entered the menopause years.

Menopause gets a bad rap. And mostly, it deserves it, with its barrage of symptoms that can make you question your sanity (you’ll be okay) and wonder if you’ll get through it in one piece (you will). It tends to begin earlier than you might have thought, and takes you on a journey studded with bumpy roads and some wild roller coasters thrown into the mix.

There are plenty of surprises along the way, but we hope you don't mind if we offer up a few spoilers. Because knowing in advance what to expect can help prepare you for the unexpected.

How It Begins

Much like starting a new job, getting married, or buying a home, menopause is a transition. It begins with the phase known as perimenopause: the beginning of the march toward menopause. Most times, perimenopause is pretty easy to spot because the menstrual cycle changes—it can become shorter, longer, heavier, or more irregular.

Practicing gynecologist Mary Jane Minkin, M.D., a leader in women’s health education and author of the blog Madame Ovary, likes to tell her patients that menopause is “the pooping out of the ovaries.” What she’s describing is the gradual decline of ovarian function. At the same time—usually around a person’s mid-to-late 40s, but it can happen as early as the 30s—estrogen levels begin to drop, according to The American College of Obstetricians and Gynecologists.

This transitional period can last an average of four years before your menstrual cycle stops for good. And while four years is the average, there’s no real way to predict how long this stage will last for you. For some, it’s just a few months; for others, it could be 10 years.

How It All Unfolds

You’ve likely heard many stories. The friend who never had a hot flash. Or the relative who had every menopause symptom under the sun.

Perimenopause isn’t a universal or predictable experience. You may not get a period for seven months straight, and you’ll think you’re done. But then, you get one. “The process is not necessarily smooth,” says Minkin. “The ovaries may stop working for a few weeks, then kick in full tilt for several months.”

Sixty-five percent of women say they feel unprepared for what menopause brings, according to a study in the journal Maturitas. There are some common scenarios you may find yourself in—and some, if not all, can be easily confused with PMS.

1. Your Period Plays Hide and Seek

Your period may become erratic; unreliable and different than before. Some months your ovaries won’t release an egg at all, and you’ll skip a period completely. Other times, your flow is inconsistent; much lighter than normal or so heavy that it’s tough to control. Tip: It’s a good idea to keep your healthcare provider aware of what’s happening, since there could be other issues—like fibroids or polyps—that are responsible.

2. Sleep Takes a Holiday

Hormonal fluctuations can make falling and staying asleep especially difficult, according to a recent study. Other research found that up to 50 percent of women experience insomnia during menopause.

Women’s risk for sleep disorders increases during the menopausal transition, says sleep specialist Michael Breus, Ph.D. (also known as The Sleep Doctor), who practices in Los Angeles. One big reason? Declining levels of estrogen and progesterone which can lead to night sweats.

Breus advises keeping your bedroom a cool 65 degrees Fahrenheit, and establishing a relaxing nighttime routine before turning in. He also says that adopting a positive mindset, by challenging negative thoughts and stereotypes about menopause, may help ease some of the stress that keeps you up.

3. Your Body Temperature Goes Haywire

You might consider packing away your sweaters for the winter and dressing in layers, since hot flashes (scientifically known as “vasomotor symptoms”) can hit at any time. These surges of warmth heat up your scalp, face, neck, and chest. Hot flashes happen to up to 80 percent of perimenopausal women in the U.S., and they can be tough to deal with. Some people get just an occasional slight flush, while others will have ferocious flashes around the clock, lasting from 10 seconds to 10 (very long) minutes.

Fortunately, hot flashes become less frequent as you progress in your menopause journey. Unfortunately, recent research has found that they can hang around for as long as 10 years or more for some.

Women who are significantly overweight tend to suffer from worse hot flashes than women who are not overweight. And smokers get significantly worse hot flashes than women who do not smoke, says Minkin. So, if you’d like help losing weight or quitting smoking, talk to your doctor.

4. You’re Feeling Dry in All the Wrong Places

Lower estrogen levels mean thinner and drier vaginal tissue. In turn, you’re more prone to itchiness, painful intercourse, urinary tract infections, and even incontinence. Over-the-counter lubricants, vaginal moisturizers, and low-dose prescription estrogen preparations can help ease the discomfort.

5. Happy, Sad. Happy, Sad.

It’s common to feel like you’re playing emotional ping-pong. Some women will even experience full-blown panic attacks around this time. Although any woman can be hit with anxiety, moodiness, and depression, if you’ve had a history of depression in the past, you’re more prone to struggle with it now, according to the UNC School of Medicine. The good news? As hormones level out, so will your moods.

In the interim, you can manage stress with yoga, exercise, deep breathing, and meditation. Call a friend to vent (and maybe even scream). Research shows that just as stress worsens symptoms, social support can help ease them.

Don’t be surprised if perimenopause brings on other symptoms, too, like a racing heart, headaches, changes in your sex drive, weight gain, and hair loss or thinning. Though less common, these symptoms are all possible during this time, according to experts at the Cleveland Clinic. Minkin adds that muscle and joint aches can also be a symptom of perimenopause. And while there are many symptoms that can be linked to perimenopause, don’t let this prevent you from seeking medical care for any symptom you find particularly troubling. It may be menopause, but there’s a chance it could be something else more serious, too.

When It’s Official

The average age of menopause—when you have no menstrual cycle for 12 consecutive months—is 51. If your periods stop for six months, for example, and then start up again, you need to reset the clock and start counting all over again.

Unfortunately, there’s no surefire way to predict when you’ll hit menopause. Minkin says the best predictor is family history. If your mom had no more periods at, say, 54, chances are you’ll be finished with yours around the same age.

After this transition, you can toss your tampons and rejoice. But remember to pay close attention to caring for your body, even if you’re overall healthy, as post-menopausal women are more vulnerable to certain conditions, like heart disease and osteoporosis.

  • Eat a balanced diet filled with fruits, veggies, and whole grains. Make sure it includes plenty of calcium and vitamin D to keep bones strong.
  • Get regular exercise. There’s a lot of bang for your buck with exercise: It keeps your heart strong, slows down bone loss, helps maintain strong bones, keeps your weight in check, and boosts your mood. Aim for 30 minutes of moderate-intensity exercise five days each week, or at least 20 minutes of vigorous aerobic activity 3 days per week. The North American Menopause Society stresses the importance of weight-bearing, strength-training, and balance exercises to maintain good posture and strong bones.
  • See your doctors for regular checkups. That includes mammograms, colonoscopies, bone-density and pap tests. Also, screenings for cholesterol and blood pressure are important, as are blood, urine, and other tests to check for diabetes, colorectal cancer, and heart disease.
  • Let your doctor know if you experience any bleeding after you’re officially in menopause. This can be from the thinning of the lining of the uterus, which is common but can also be a sign of something more serious like uterine cancer.