Menopause is a natural stage of life that can bring changes in sleep, mood, temperature regulation, sexual and vaginal health, body composition, and overall well-being. Every person's experience is different. Some have few symptoms, while others experience changes that significantly affect daily life.
You do not have to simply live with bothersome symptoms. There are many effective treatment options available, and care can be individualized based on your symptoms, health history, and personal preferences.
Menopause marks the end of the reproductive years and occurs when the ovaries stop regularly releasing eggs and producing significant amounts of estrogen and progesterone. Natural menopause is reached after 12 consecutive months without a menstrual period, as long as there is not another explanation for the absence of periods.
The years leading up to menopause are called perimenopause, when hormone levels and menstrual cycles become more unpredictable. Postmenopause refers to the years after menopause has occurred.
Natural menopause most commonly occurs between ages 45 and 55, with the average age around 51 in the United States.
Menopause occurring between ages 40 - 45 is considered early menopause.
Loss of ovarian function before age 40 is generally referred to as premature ovarian insufficiency (POI).
Earlier loss of estrogen has additional implications for bone, cardiovascular, and overall health, so evaluation and treatment recommendations may be different.
Surgical menopause occurs when both ovaries are removed before natural menopause. Unlike natural menopause, which develops gradually, hormone levels fall abruptly after surgery, so symptoms may begin suddenly and can sometimes be more noticeable. Importantly, removal of the uterus alone does not cause surgical menopause if the ovaries remain in place.
For most people, menopause is diagnosed based on menstrual history rather than blood work. If you are over age 45 and have gone 12 consecutive months without a period, without another explanation for your periods stopping, you have reached menopause.
Hormone testing is usually not necessary when the history is clear. Levels such as FSH and estrogen can fluctuate during the menopause transition, so a single blood test does not always give a definitive answer. In certain situations, however, blood work can provide helpful additional information.
Sometimes menstrual periods cannot be used to determine whether menopause has occurred. This may be the case if you:
Have had a hysterectomy but still have your ovaries
Have had an endometrial ablation
Use a hormonal IUD or another medication that stops or significantly reduces your periods
In these situations, we may consider your age, symptoms, medical history, and sometimes hormone levels together to help determine whether you are likely to have reached menopause.
Hormonal medications, including some forms of birth control and hormone therapy, can also affect hormone levels and make testing more difficult to interpret.
Menopause can affect many different parts of the body. Symptoms vary widely from person to person and may also change over time. Some people experience few symptoms, while others have changes that significantly affect sleep, mood, relationships, sexual health, or quality of life.
Hot flashes and night sweats, sometimes called vasomotor symptoms, are among the most common symptoms of menopause. They can range from occasional warmth or flushing to frequent episodes that interfere with sleep and daily activities.
Changes in sleep, mood, memory, and concentration are common during the menopause transition. Some people experience difficulty sleeping, irritability, anxiety, mood changes, fatigue, forgetfulness, or “brain fog.” Night sweats and disrupted sleep can make some of these symptoms worse.
Lower estrogen levels can cause changes in the vaginal and urinary tissues, sometimes referred to as genitourinary syndrome of menopause (GSM). Symptoms may include vaginal dryness or irritation, discomfort with intercourse, urinary urgency or frequency, recurrent urinary tract infections, and changes in sexual function or desire.
Unlike some menopause symptoms, vaginal and urinary symptoms may persist or worsen over time without treatment, but many effective treatment options are available.
Menopause may also be accompanied by changes in headaches or migraines, hair and skin, weight or body composition, breast tissue, joints and muscles, and overall energy levels. Some of these changes are related to aging as well as hormonal changes, and not everyone experiences them in the same way.
Bleeding after menopause is not considered a normal menopause symptom. If you experience vaginal bleeding or spotting after you have gone 12 months without a period, please contact us so that we can evaluate the cause.
Treatment during menopause is individualized based on your symptoms, medical history, and personal preferences. Some people need little or no treatment, while others benefit significantly from treatment when symptoms affect sleep, mood, work, relationships, sexual health, or quality of life. There is no single “best” treatment. Options may include lifestyle and supportive measures, nonhormonal treatments, hormone replacement therapy, or treatments targeted to specific symptoms.
Regular physical activity, balanced nutrition, adequate sleep, and stress management can support overall health during and after menopause. Certain changes may also help with specific symptoms, although lifestyle measures alone may not be enough for everyone.
Novant Health Virtual Weight Management Clinic: A convenient virtual option focused primarily on medical and medication-based weight management.
Nourish: offers virtual visits with registered dietitians, including providers who specialize in menopause. Please let us know if you would like a referral.
Menopause Explained: Hormones, Glucose & What You Can Do (Glucose Revolution)
The Body Reset: How Women Should Eat & Exercise (Mel Robbins Podcast)
Self-Care for Women in Midlife And Menopause (Heather Hirsch, MD. video)
Novant Health Integrative Medicine Clinic: Offers complementary approaches to symptom management, including acupuncture, which some patients choose to try for menopausal symptoms.
Cognitive Behavioral Therapy and Menopause (Menopause Society)
Hormone therapy is not the only option for managing menopausal symptoms. Several nonhormonal prescription medications can help, particularly with hot flashes and night sweats. The best option depends on your symptoms, other medications, medical history, and personal preferences.
Certain antidepressants (SSRIs or SNRIs): Can reduce hot flashes and may be especially helpful when mood or anxiety symptoms are also present.
Gabapentin: Can reduce hot flashes and night sweats and may be particularly helpful when symptoms interfere with sleep.
Veozah® (fezolinetant): A nonhormonal medication specifically designed to treat moderate to severe hot flashes.
Lynkuet® (elinzanetant): A nonhormonal medication for moderate to severe hot flashes that may also help with sleep disturbance associated with menopause symptoms.
Over-the-Counter Options
Some people prefer to try an over-the-counter supplement. Estroven® is one commonly available option that I often recommend. Several formulations are available for different menopause-related symptoms. As a reminder, supplements do not work for everyone and are not regulated in the same way as prescription medications.
Nonhormonal Medications for Menopause (Heather Hirsch, MD, video)
Hormone replacement therapy (HRT) is the most effective treatment for hot flashes and night sweats associated with menopause and can also help with several other menopausal symptoms. Treatment is individualized based on your symptoms, age, medical history, whether you have a uterus, and your personal preferences.
For many healthy women who are younger than 60 or within 10 years of menopause, the benefits of hormone therapy may outweigh the risks when treatment is appropriate. The type, dose, and route of hormone therapy can be tailored to the individual.
Some menopausal symptoms may benefit from more targeted treatment. Vaginal and urinary symptoms, sexual concerns, sleep problems, mood symptoms, migraines, and hair or skin changes may each require a different approach. Treatment can be tailored to the symptoms that matter most to you.
After menopause, lower estrogen levels can affect bone, cardiovascular, metabolic, vaginal, and urinary health. Aging and other health factors also play an important role, so this is a good time to focus on preventive care and healthy habits that support long-term health.
Bone Health: Bone loss accelerates during the menopause transition and in the years after menopause, increasing the risk of osteoporosis and fractures over time. Weight-bearing and resistance exercise, adequate calcium and vitamin D, and appropriate bone-density screening can help protect bone health.
Heart & Metabolic Health: After menopause, changes in cholesterol, blood pressure, body composition, and metabolism can contribute to increasing cardiovascular risk. Regular physical activity, balanced nutrition, maintaining a healthy weight, avoiding tobacco, and keeping up with routine screening for blood pressure, cholesterol, and diabetes are important parts of long-term health.
Vaginal, Urinary & Sexual Health: Vaginal and urinary changes related to lower estrogen levels can persist or become more noticeable over time. Symptoms such as vaginal dryness, discomfort with intercourse, urinary symptoms, or recurrent urinary tract infections are common and treatable.
Regular preventive care remains important after menopause, including recommended cancer screenings, vaccinations, and routine primary care.
Menopause is a natural stage of life and does not need to be treated unless symptoms are bothersome to you. If symptoms are affecting your sleep, mood, work, relationships, sexual health, or overall quality of life, please reach out.
You do not need to wait until symptoms become severe to ask about treatment options. Depending on your symptoms, we may also recommend blood work or other evaluation to look for additional factors that could be contributing to how you feel.
Any vaginal bleeding or spotting after menopause should be evaluated. If you have gone 12 months without a period and then experience bleeding, even if it is light or happens only once, please contact us so we can determine whether additional evaluation is needed.