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So, menopause isn’t exactly the hottest topic at happy hour.
Even though more women are comfortable talking about bodily changes nowadays, anything regarding periods (and the cessation of them) has been wrapped up in so much shame and taboo that many of us don’t know what to expect when it comes to going through this natural phase of life.
Unless you’ve already seen a keen menopause specialist who has given you the low-down, you may be feeling a bit in the dark as you approach this next chapter; and being that space of not-knowing can be puzzling, frustrating and a little scary when your body is establishing a new equilibrium.
So, to give you an idea of what the menopause journey looks like (which can be more than just sweating through hot flashes, by the way) we’ve asked women’s health experts to describe what they have found to be the most common symptoms associated with menopause.
But first, let’s set the record straight on some frequently confused menopause lingo:
What exactly is menopause?
Basically, menopause is the time that marks the moment doctors know for sure that Aunt Flo has said goodbye for good.
Physicians will tell you that you’ve officially arrived at menopause once you’ve gone without your period 12 months — unless you’ve had a hysterectomy, are taking birth control or have some other medical condition affecting your menstrual cycle that can make identifying menopause a bit more complicated, says Hadine Joffe, M.D., the executive director of Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital.
For the average American woman, menopause occurs between ages 40 and 58, but it can occur much earlier or later (like in a woman’s 30s or 60s), according to the North American Menopause Society. It’s sparked by the natural change in your body’s hormones, namely: the fluctuating levels of ovary-produced estrogen and progesterone that eventually decrease altogether. This process, on average, lasts four years, says Dr. Joffe.
Entering menopause, then, is like “puberty in reverse,” as Jen Gunter, M.D, an OB/GYN the author of The Menopause Manifesto likes to say, presenting itself with physical symptoms that vary from person to person.
So then, what is perimenopause?
This menopause transition — or what some practitioners call “perimenopause”— is when your estrogen levels are more unpredictable, according to Dr. Gunter. And there’s no telling when that rollercoaster will start exactly since there’s no definitive start date. In other words, you won’t “realize you’re in it until you’re in it,” says Dr. Gunter.
But there are some signs that may tip you off to the fact that your body is making the shift.
What are the early signs of menopause?
Your period is off schedule.
Irregular menstrual periods are the hallmark indicator that you’ve entered the menopause transition, according to Dr. Gunter. But catching those irregularities — especially if you don’t keep track of your cycles — can be a little tricky to identify at first, adds Dr. Joffe.
“Oftentimes, the first sign is that the cycles get a little bit shorter by a few days and most people don’t even notice that because it’s kind of subtle,” she says. “Women usually start to notice when their periods are seven or more days off schedule.” And this schedule can change in a very unpredictable manner. So, if you’re usually a 32-day cycler (give or take a few days), the next month you could be a 25-day cycler, and the next, a 30.
“You can also have bleeding in between periods and have heavier periods,” says Dr. Gunter. “Those would be the most common symptoms of ‘menstrual chaos’, if you will.”
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You feel warmer than usual.
Now we are not talking about hot flashes just yet (we’ll get to that in a bit). We’re talking about just overall feeling like you don’t need to wear a sweater at temperatures that you normally find chilly.
“A lot of women say they feel cold in their younger years,” says Dr. Joffe. “And then when they reach their 40s, they say that they say they’re not having hot flashes but they just feel warmer in general.”
Hot flashes — while still an early sign — typically come a little later in the menopause transition, adds Dr. Joffe. They can range from mild to severe and can last from one to five minutes. With these, you may feel a sudden increase in body heat especially around the face, neck and chest; you may start sweating, look as if you’re blushing, feel anxious or nauseous, and when the spell lets up you might even get the chills.
Why all this extra heat? While scientists don’t fully understand why hot flashes occur, experts have recently discovered that “the part of the brain that regulates your temperature (the hypothalamus) is also the part of the brain that regulates reproduction,” says Dr. Joffe.
So as your brain is rewiring for your non-reproductive years, your body’s thermostat becomes more sensitive to slight changes in body temp. When the hypothalamus thinks you’re too warm (even though you’re not), it will usher blood to the surface of your skin to release heat. That’s why your body gets so hot to the touch when you’re in the middle of a flush.
Your heart occasionally beats faster than usual.
Oftentimes hot flashes can cause your heart rate to speed up a bit, but sometimes you may find your heart goes aflutter without rhyme or reason. Experts can’t fully explain why this happens, but know that during the menopause transition there’s a lot of changes that are happening in the autonomic nervous system (the part of your that controls, for example, your fight or flight response), says Dr. Gunter.
“So we think [heart palpitations] might be related to a little bit of what’s called ‘autonomic instability,’” she says. “But again, we don’t know for sure.”
You’re having trouble sleeping.
Getting some good old shut-eye can be a lot tougher when you’re sweating and burning up like a furnace while your heart is beating out of your chest. But hot flashes and heart palpitations aren’t the only factors that can disturb your sleep. According to the National Sleep Foundation, the risk of insomnia increases as a woman moves into menopause. However, most women report having insomnia post-menopause (i.e. after that 12 month period without menstruation).
Your skin looks and feels different.
Because of all of the hormonal fluctuations, your skin and other tissues within your body may change. “Some people notice that their skin is drier, that their eyes are drier,” says Dr. Joffe. Some women also get a little bit of acne, she adds, although maybe not as full blown as it may have been in high school.
Having sex, sitting and/or going to the bathroom is painful.
Vaginal dryness can make a lot of activities uncomfortable, especially intercourse. This condition, however, typically occurs after menopause, says Dr. Joffe, but it can occur earlier. Vaginal dryness usually manifests when estrogen levels drop.
Estrogen is important for increasing blood flow to the vaginal lining, says Dr. Gunter, but as the amount of the hormone decreases, less blood gets to the cells of the lining, causing them to get thinner, more fragile, and less elastic.
Estrogen also feeds the healthy bacteria, which produce lactic acid and hydrogen peroxide that maintains your vagina’s pH balance and protects your vagina from germs. “Estrogen makes sugar and deposits it in the cells of the lining, and when those cells turn over, the sugar breaks down and feeds the bacteria,” says Dr. Gunter. A decline in estrogen starves the “good” microbes, which may make things more irritated down there as well as render you more vulnerable to infections.
Your memory isn’t as sharp as it used to be.
If you find that you’re forgetting names more often than usual or that you keep misplacing your glasses, don’t assume that it’s some form of dementia. Brain fog is actually very common during the menopause transition. In fact, about 66% of women report having difficulty taking in and remembering new information around this time, according to Dr. Gunter.
When you think about your brain rewiring itself for a non-child-bearing existence, these extra brain-blips makes sense.
“It’s probably better to call it a ‘brain reboot’ than brain fog,” says Dr. Gunter. “All of that stuff that’s wired in your brain for reproduction, it doesn’t need it anymore.” So, during the menopause transition, your brain prunes pathways that are no longer necessary while uploading “a new operating system,” she adds. The fogginess is your body adjusting to the new update.
The good news: “Even when women have brain fog, they still perform as well or even outperform men on memory tests,” says Dr. Gunter. Plus memory recall usually recovers after menopause. However, if dementia runs in your family, talk to your doctor who can monitor your symptoms to make sure you don’t have a serious condition.
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You feel more anxious or depressed.
Between the hormone fluctuations and adjusting to a new phase in life, many women experience various levels of anxiety and depression, according to Dr. Joffe. “For some people, they just feel like they’re not as in control of their emotions,” she said. “Sometimes they say they feel PMS-y all the time.” What’s more: Some of the other symptoms mentioned before — like hot flashes that make your heart race as well as poor sleep — can also negatively impact your mood.
Your joints are achy.
This is probably the most mysterious symptom of them all, but Dr. Gunter has found that some women do complain of their joints being more sensitive than they were before they entered the menopause transition.
What should I do when I realize I’m in the menopause transition?
When you start noticing any of the symptoms mentioned above, remember that menopause is not a disease to be cured, but a natural process with its own growing pains. Of course, if any of your symptoms are bothersome, don’t hesitate to see your primary care physician or OB/GYN. Journal your symptoms or track them on your favorite app so that when you meet with your M.D. they can home in on what’s going on and find ways to make menopause as comfortable as possible for you.
There’s absolutely no need to bear and grin it for four-odd years — especially when there’s smart doctors and effective treatments out there that can help you move through what can be a challenging transition.
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