The most important things to know about menopause

File menopause under women’s experiences that no one really talks about, right next to periods and miscarriages. (You might have learned about hot flashes through pop culture osmosis, but that’s pretty much the extent of our collective education on the topic.) There's still a long way to go in dispelling the misconceptions, understanding the truly effective treatment options, and demystifying the rarely-discussed aspects of this phase of life. Yet it’s important to talk about, since it can last for a decade, impact our bodies in major ways, and will affect everyone with ovaries.

The simple bio backstory: People assigned female at birth have a finite number of eggs, and once you run out, your body responds by reducing your production of estrogen. This then triggers a hormonal rollercoaster that impacts parts of your body well beyond your reproductive system, since estrogen also helps you focus, keeps skin moisturised, and regulates your metabolism, among many other roles. Eventually, the estrogen wind-down process ends and 12 months go by without having a period — which means you’re in menopause. The average age for menopause in the U.S. is 51.

Since estrogen controls so many other functions in our bodies outside of our reproductive system, a drop in estrogen can cause symptoms including:

• hot flashes

• night sweats

• trouble sleeping

• Irritability and mood swings

• vaginal dryness

• hormonal weight gain especially in the belly

• fatigue

• pain with sex

• acne

• facial hair growth

• dry, thin skin

• loss of bone density

• increased risk of heart disease

• higher blood pressure

• higher cholesterol

• increased risk of dementia.

If you’re not sure where you are in the transition, but you’re experiencing any of these bothersome symptoms, talk with your doctor. Unfortunately, there’s not a single test that can reveal exactly where you are on the journey. Blood tests can be unreliable since there are such major variations in hormones from day to day. “We could do the same test two days in a row and get completely different results,” says Dr. Stephanie Faubion, M.D., the director for the Center for Women's Health at the Mayo Clinic, medical director for The North American Menopause Society, and member of the WeightWatchers scientific advisory board.

Being on hormonal birth control (including the ring, oral pills, or hormonal IUDs such as Mirena) won't delay menopause. But your cycle isn’t going to be able to give you much information about where you are in the menopause process, and the hormones from birth control may stop symptoms. “You can’t use the marker of bleeding or not to tell if you are menopausal. All bets are off because of the hormonal manipulation,” says Faubion.

The transition is less like a lightswitch instantly flicking on or off and more like a dimmer, since it can stretch over the course of years. You may also experience different issues at each stage. The stages include:

Premenopause. Also called “late reproductive stage,” this is when you have regular monthly periods (even if your cycle varies by up to seven days).

Perimenopause. This is the stage when the difference in your period cycle is greater than seven days or you completely miss a period.

Postmenopause. Once you haven’t had your period for 12 months, you’re officially in menopause (also called postmenopause).

Learn more about the three phases of menopause

The goal with treatment isn’t to hold off going through menopause, but to address your symptoms with treatments that can help you feel better as your body adjusts. Medication options will vary depending on your symptoms and your stage. They include:

Birth control for pre- and perimenopause. A low-dose oral contraceptive pill can help with symptoms like hot flashes, or an IUD that has a progestin can help with heavy periods.

Menopause hormone therapy (MHT), more commonly known as hormone replacement therapy, for perimenopause and menopause. MHT is the gold standard for treating symptoms of menopause with estrogen and progesterone; it’s typically delivered through a stick-on patch. Consult your healthcare provider for advice.

Learn more about safe, effective medication treatments for menopause

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