What to expect through the stages of menopause

Looking at the chapter of life after menopause and what women can, should expect

What to expect through the stages of menopause

Let’s talk about a woman’s natural transition away from her reproductive years.

This is the extended period in life that takes place over the course of several years in three stages: perimenopause, menopause and postmenopause.

Perimenopause, or the menopausal transition, marks the end of reproductive years and signals the natural transition into menopause. This typically occurs in most women during their 40s.

Symptoms that begin during this time include irregular periods, hot flashes, sleep troubles, decreasing fertility, mood changes and vaginal or bladder problems.

Menopause is when a woman permanently stops having menstrual periods, signaling the end of her ability to have children. During this time, hormone levels start to change.

Find primary care: Search Sanford Health women’s, family medicine or internal medicine providers

Fast forward to the last of the three: postmenopause.

According to Jean Marie McGowan, M.D.,  an internal medicine specialist at Sanford Health, postmenopause is after a woman hasn’t experienced a menstrual period in 12 months or a full calendar year.

“Menopausal symptoms really can occur at various ages ranging, on average, from 45 to 55 years old,” Dr. McGowan told Sanford Health News.

During the natural course of menopause, which occurs to majority of women, the average age of menopause in the United States is 52.

Not all women undergo natural menopause

Sometimes there are medical reasons for someone to reach menopause.

“I think it’s important to mention that there are other kinds of menopause, such as surgically induced, where the ovaries — with or without the uterus — are removed,” said Dr. McGowan.

Menopause also can occur with premature ovarian insufficiency, a rare endocrine disease where a woman’s ovaries stop functioning before age 40.

Lastly, there is chemo- or medication-induced menopause, when a certain treatment may cause the ovaries to fail.

“The women who go through other types of menopause may have similar symptoms, but they may be more pronounced and come with other health issues, such as early-onset osteoporosis and heart disease,” Dr. McGowan said.

Common symptoms during postmenopause

Symptoms from menopause can start in the perimenopause stage, up to 10 years before your last menstrual period. But symptoms are usually most intense within the two years prior and two years after that last period, Dr. McGowan said.

Symptoms such as hot flashes will usually get better and resolve for about 90% of women within two to five years after their last menstrual period.

For many postmenopausal women though, Dr. McGowan said symptoms that occurred with menopause could be more permanent and sometimes more intense, such as:

  • Vaginal dryness
  • Loss of bone density
  • Loss of elasticity in skin
  • Hair texture changes
  • Trouble sleeping

“These symptoms can be found in different illnesses, and we can’t disregard them thinking it’s just menopause,” Dr. McGowan said. “It’s important to sort out with your provider where these symptoms are coming from — for example, diabetes, thyroid abnormalities, gastrointestinal issues and so on.”

Emotional symptoms may include mental fog, insomnia, irritability, tearfulness, anxiety, depressive symptoms and mood swings.

Keeping up with routine care

If any of those symptoms become too disruptive, patients are encouraged to call their health care provider and not wait for that wellness visit or routine screening.

“It’s important to follow age-appropriate screenings including the mammogram for breast cancer, colonoscopy and hyperlipidemia (high cholesterol),” she said. “Changes in women’s life can lead to osteoporosis and osteopenia which is why a bone density screening, or DEXA scan, is also important during this time.”

At her routine wellness visit, a woman and her provider will review health status, necessary screening tests and labs, and check her body thoroughly for any symptoms that need to be addressed.

Typically the DEXA scan starts at age 65 but depending on the patient’s status and other health conditions, the provider will evaluate calcium and vitamin D levels among others to determine if the scan is needed sooner to diagnose and provide appropriate treatment.

To find the best treatment for symptoms and individual health, women should discuss options with their doctor. Some options:

  • Hormone therapy prescribes a combination of the female hormone estrogen with or without progesterone. Any woman who still has her uterus will need to take progesterone if on estrogen, Dr. McGowan said. It is commonly taken in pill form; however, estrogen can also be given by using skin patches and vaginal creams. Estrogen-only therapy is a prescription for estrogen, which the body no longer makes after menopause. This type of therapy is often prescribed for women who have had a hysterectomy.
  • Estrogen alternatives, such as ospemifene, can be used to improve the symptoms of vaginal atrophy without affecting uterine cancer risk.
  • Non-hormonal treatments include other medications and alternative therapies. Before receiving alternative therapy, women should talk to their doctor about potency, safety, purity, and effectiveness concerns.

Sanford Health offers advanced urogynecology treatments including the Mona Lisa. Reach out to your primary care provider or find an internal medicine provider to schedule an appointment and learn more about your options.

Welcoming the postmenopausal stage

“We all go through different phases in life,” Dr. McGowan explained. “Hormone levels begin to change during those early adolescent years into adulthood, through pregnancy and beyond.

“Now we turn the page and enter another chapter, and it’s one that millions of women go through, so they should know they’re not alone, even with that common fear of aging.”

She encourages women to share their concerns and know they are valid. They have resources available to them and can rest assured this is an expected time of life.

During this chapter, a well-balanced diet, regular activity, and adequate sleep are all still important parts of maintaining a healthy lifestyle.

“If your symptoms are bothersome, things will get better,” Dr. McGowan said. “Some of my happiest patients well into their 70s and 80s don’t have hot flashes, take care of their grandchildren and great-grandchildren, play bingo or pickleball and are still very active.”

This new chapter in life can still be fulfilling and happy, she added. If not, she said patients shouldn’t suffer from disruptive symptoms in silence and reach out to a provider for support and guidance.

“Every journey is different for each woman.”

Medical review by Christina Tinguely, M.D., a specialist in obstetrics and gynecology at Sanford Health in Fargo, North Dakota.

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Posted In Gynecology, Internal Medicine, Menopause Care, Women's