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Surefire Signs You're in Menopause

Experts explain what the symptoms of menopause are and offer encouraging advice. 
FACT CHECKED BY Emilia Paluszek

The thought of never having another menstrual cycle is exciting for many women, but the transition of your period ending can be difficult. While going through menopause is a natural part of aging, it can have a major impact on a woman's daily life. Depression, mood swings, hot flashes and weight gain are just some of the changes that can happen, but not everyone will have the same experience. "Menopause can affect women very differently. Some are completely asymptomatic and don't even realize they are in menopause while others have severe debilitating symptoms," Dr. Adi Davidov, MD, Associate Chair and Director of Obstetrics and Gynecology at Staten Island University Hospital tells Eat This, Not That! Health. According the National Library of Medicine, an estimated 1.3 million women will start menopause and we spoke with several experts who explain the signs of menopause and how to help sooth the symptoms. As always, please consult your physician for medical advice. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.


What is Menopause and When Does it Start?

woman consulting with her female doctor

Dr. Fred Pescatore explains, "Menopause is the natural journey women experience as they reach their 40s or 50s when levels of reproductive hormones decline in the body. Technically, menopause is when a woman has gone 12 months without a menstrual period. Most of my patients reach menopause around age 50, but it's normal for it to happen earlier or later." 


Difference Between Perimenopausal and Menopause

Tired woman lying in bed can't sleep late at night with insomnia

Dr. Pescatore says, "Changes in a woman's body begin years before they reach menopause– this is the perimenopause phase. During perimenopause, which can begin a decade before a woman reached menopause, the ovaries produce less estrogen, which can bring hot flashes, disrupted sleep, mood changes, fatigue, and dry skin." 

Dr. Sherry Ross, MD, OB/GYN and Women's Health Expert at Providence Saint John's Health Center in Santa Monica, CA adds, "Perimenopause refers to those years in the reproductive life cycle where the ovarian function becomes irregular. It occurs between 40-55 years.  This hormonal cycle can last a few months or up to 10 years before the official onset of menopause. Estrogen production from the ovaries is erratic and unpredictable causing menopausal symptoms. Perimenopause are hormonal changes that occur before you are officially in menopause. The most common symptoms of perimenopause include irregular periods, hot flashes, sweating, insomnia, depression, anxiety, feeling apprehensive, weight gain or loss, fatigue, bloating, poor concentration, memory loss, vaginal dryness and heart palpitations. These symptoms mimic the symptoms of menopause but tend to come and go unlike symptoms associated with menopause. All of these disruptive symptoms can affect your quality of life. Perimenopause is a very common hormonal phenomenon but some women experience symptoms much worse than others for unknown reasons. Perimenopause happens when your ovaries do not function consistently which upsets a woman's normal hormonal rhythm. As long as you have ovaries you are fair game for premenopausal symptoms. Women who have breast cancer and are receiving chemotherapy may experience perimenopause symptoms earlier than the average woman. Also women who smoke cigarettes may also experience these symptoms sooner than women who do not smoke. Certain medications can make the ovaries not function properly bringing perimenopause and menopause on sooner than later. Thin women, genetic predisposition, chromosomal abnormalities such as Turner syndrome may also bring on premature ovarian failure.

Regular exercise 4-6 times a week for a minimum of 30minutes is helpful to reduce weight gain, fatigue, bloating and water retention. Ideally, exercise should be part of your daily routine. When you exercise there is a release of mood boosting endorphins and serotonin which are the "feel good" hormones. Exercise helps women emotionally and physically during perimenopause. There are many treatment options including medications, lifestyle and dietary modifications. Also, reassurance, patience and an explanation about what is happening physiologically is comforting and effective in getting women through this hormonal storm. Heavy and irregular periods are best treated with hormones. Since there is a hormonal disruption during perimenopause, these hormone treatments are perfect options for regaining control of your periods.

Low dose oral contraception is at the top of the list to control your periods best. There are many different pills available so if the side effects make you feel awful then keep switching until you find the right one.

–Cyclic progesterone taken 10 days a month

–The IUD with progesterone (Mirena, Kyleena, Sklya, Liletta)

–Hormone replacement therapy (HRT)

–Non-hormonal alternatives include acupressure and herbal therapy."


How Long Can Menopause Last?

unhappy woman sits on couch, hand on forehead

According to Dr. Pescatore, "Everyone experiences menopause differently. On average, symptoms subside after several years. Women can experience over 30 different symptoms through perimenopause and menopause. Symptoms and their time span vary due to a variety of factors like genetics, lifestyle, and diet. Some women may have few or no symptoms at all throughout perimenopause and menopause, while others may experience severe symptoms. Everyone's journey is unique." 


Irregular Menstrual Cycle

Close-up of woman on toilet

"Irregular periods are often the first sign of menopausal transition," says Dr. Pescatore. "Take notes of changes to your menstrual cycle and share them with your physician. I encourage my patients to log their changes, making it easier to understand and track their cycle. Your periods may become less frequent. Some women experience more frequent periods. You may notice other changes, such as lighter or heavier bleeding or more cramping." 


Hot Flashes

woman holds forehead while sitting at a table with coffee mug

"What can I do to stop sudden hot flashes? They come at the worst times!" I hear this from my female patients frequently, " Dr. Pescatore shares. "Hot flashes are a common symptom of the menopausal transition. They are caused by changes in the body's circulation process, resulting in sudden, uncomfortable spikes in body temperature."


Mood Changes

angry middle aged woman

Dr. Pescatore says, "If you are going through menopause and feel like you're on an emotional rollercoaster, you're not alone. There are scientific reasons why you're having mood swings. Declining estrogen levels can impact the way the brain manages serotonin and norepinephrine, two chemicals linked to our emotions. It is also possible that these mood shifts are intensified by life events that occur during this stage of a woman's life, such as concerns about aging or children growing into adults." 


Sleep Disruptions

woman not able to sleep in bed

"Sleep disruptions are a major symptom of the menopause journey," Dr. Pescatore states. "Many women report sleep disruptions, which may continue for years. Through the perimenopause, menopause, and post-menopause periods, you may find yourself waking up at night, having trouble falling asleep, or struggling to get quality sleep. Estrogen plays a role in the metabolism of serotonin and other neurotransmitters that affect our sleep-wake cycle and, as estrogen levels decline, your sleep cycle can be impacted." 


Unusual Signs of Menopause

Close up of mature woman look in distance thinking.

Dr. Ross Says, The most common symptoms include irregular periods, hot flashes, sweating, insomnia, depression, anxiety, mood swings, feeling apprehensive, weight gain or loss, fatigue, poor concentration, memory loss, vaginal dryness and heart palpitations. Here are five things that many women do not connect to this second chapter of life!"


Many women experience a worsening of their allergies during menopause. Some women even develop a new onset of allergies as a result of increased production of histamines that cause allergic reactions.

Joint Pain

Estrogen is a great body hydrator and also fights inflammation throughout the body, especially in the joints. When a woman goes into menopause and loses estrogen production, the joints can become less lubricated and more inflamed causing aches, pains and menopausal arthritis. 

Brittle Nails

Keratin is the substance responsible for keeping nails strong and healthy. Estrogen also helps hydrate and nourish the nails. With menopause, the loss of estrogen and a decrease in keratin, the nails become drier, weaker and break more easily.

Change in the Mouth

Changes in taste, a burning tongue and dry mouth are not unusual during menopause. There are estrogen receptors in the mouth that that are disrupted by menopause causing these symptoms. Dryness of mucous membranes throughout the body is common. A dry mouth and low production of saliva can increase the risk of getting cavities and gum disease.


Since estrogen is the perfect body hydrator. Estrogen helps hydrate the skin. When there is a decrease in estrogen the skin can become drier and itchier. The vulva is especially more prone to dryness and itching as a result."


How to Alleviate Menopausal Symptoms?


Dr. Sharon Malone, Chief Medical Officer Alloy shares, "All women should approach perimenopause with the understanding that a healthy lifestyle will help mitigate some of the symptoms of menopause. Women should exercise regularly, eat a healthy diet, stop smoking, cut back on alcohol (fewer than 5 drinks/week), maintain a healthy weight, and stay mentally and socially engaged. Finding a supportive community is essential in coping with many of the bothersome symptoms of menopause. But sometimes, that is not enough. And for healthy women who are distressed by the symptoms of menopause, estrogen therapy can be often a godsend."

Dr. Davidov says, "There are many ways to alleviate symptoms of menopause and there is no "one size fits all" therapy. For most women with severe symptoms and no contraindications – I prescribed hormone replacement therapy after I counsel the patient in detail about the pros and cons. For women who are no candidates for hormones, I often prescribe an antidepressant. If the patient has mostly vaginal symptoms – I usually prescribe vaginal estrogen."

Dr. Pescatore explains, "There are steps women can take to naturally reduce the severity of menopausal symptoms, without hormone replacement therapy, which can have bothersome side effects. Researchers are making important strides in expanding effective natural options for menopause relief. As a physician, I regularly keep up with studies to help my patients navigate their menopause journey. One supplement that has demonstrated efficacy and safety is Pycnogenol®, a super antioxidant derived from French maritime pine bark. Research shows that women who supplement with Pycnogenol daily report a reduction of their menopausal symptoms, including fewer and less intense hot flushes and less nightly sweating, improved memory and concentration, and more quality sleep."


Encouraging Advice

happy doctor with patient

Dr. Malone says, "The first step is to understand for yourself what you are going through. Hot flashes, mood swings, and decreased libido are not uncommon as are bouts of inexplicable rage. You should simply explain to your partners or family members what you are going through. A little bit of forbearance and understanding at this point in your life goes a long way. It makes it easier for people around you not to take it personally. I simply cannot emphasize enough that women need not suffer, particularly when the solutions are simple and at hand. The American College of Obstetricians and Gynecologists and the North American Menopause Society agree that menopausal hormone therapy is not only safe for most healthy women, it is also the most effective treatment for the symptoms of menopause. Menopause is mandatory. Suffering is optional."

Susan Willson, RN, CNM, a Yale-educated Certified Nurse Midwife and Certified Clinical Thermographer with more than 40 years of experience in the women's health field and author of Making Sense of Menopause: Harnessing the Power and Potency of Your Wisdom Years offers this advice. "Often when in the thick of menopause, women can feel like they are living in a parallel universe to those around them. They are not sleeping well, so their brains aren't functioning at full speed, they are physically uncomfortable and less able to be fully present because of that, and they are unsettled about how they fit into social situations, because they are going through the cultural shaming process that women experience during this time, telling them that they are suddenly "less than." I like to remind women that they have gone through similar experiences in the past – puberty, pregnancy – have navigated it and come out the other side to find their footing in the next phase of their lives. This will happen again. Menopause is purposeful and evolutionary and this next phase of our lives has much to be positive about. Nature is preparing us for the most creative time of our lives. However, sometimes knowing that doesn't help at the moment. Since stress, and the way it imbalances our hormones, is at the root of most menopausal symptoms, I encourage women to start there. Look at the stressors in their lives and what they might be able to let go of for the time being. Prioritize sleep and regeneration time, delegate. Just changing one's bedtime or not spending time on screens for an hour before bed can have a huge ripple effect on how the coming day unfolds. Finally, support each other. Allow others to help you out. Don't just focus on the harsher aspects of what you are experiencing and share only that. Women can find insight, support and transformation when sharing their stories about this time of life, and the earlier times that led up to it. Just as the caterpillar and butterfly have exactly the same DNA and are in different parts of their lifespans, the same thing applies here. Menopause is the chrysalis, where we are melted down into mush in order to emerge beautiful, free and more authentically ourselves."

Heather Newgen
Heather Newgen has two decades of experience reporting and writing about health, fitness, entertainment and travel. Heather currently freelances for several publications. Read more about Heather
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