What Every Woman Needs to Know about Menopause

Every woman with ovaries experiences menopause. And yet, many enter this stage of life without a clear understanding of what is happening in their bodies. 

From hot flashes and sleep disturbances to changes in heart health, bone health, mood, and cognition, menopause can have a profound impact on overall well-being.

Sabrina Hofmeister, DO, FAAFP, a family medicine doctor and associate professor at the Medical College of Wisconsin, joined Coffee Conversations with Scientists to uncover the causes of common symptoms, discuss evidence-based treatment options, and educate listeners about this natural transition.

Key Takeaways

• Menopause occurs in stages—perimenopause, menopause, and post-menopause. The average age that women experience menopause is 51. The entire transition lasts from 3-5 years.
• There is no universal menopause "syndrome" that affects all women. Common symptoms include mood swings, sleep disruption, cognitive disfunction (e.g., "brain fog"), joint pain, skin changes, hair loss, headaches, and urinary symptoms resulting from vaginal dryness.
• Menopause accelerates bone loss. Estrogen deficiency starting in perimenopause hits the spine the hardest.
• Open communication with a physician is the best way to address symptoms related to menopause.

The Ovary-Brain Connection

Dr. Hofmeister explained that menopause is the permanent cessation of menses, which is confirmed after a woman goes 12 months without having a period. This happens as the ovarian follicles decline and the ovaries become less sensitive to hormonal stimulation from the brain. As a result, estrogen production drops, starting the menopause process.

When Does Menopause Typically Occur?

Menopause is a universal transition for anyone with ovaries who reaches midlife. The transition consists of three stages.

Perimenopause – The period of time preceding menopause, usually starting in the 40s, during which common symptoms associated with menopause occur: irregular periods; hot flashes; mood swings; brain fog; trouble sleeping, etc. Perimenopause can last from a few months to years.

Menopause – The point marked by a woman’s final menstrual period. The average age that women experience menopause is 51. Dr. Hofmeister advises women to ask their mothers, if they are living, when they experienced menopause to get an idea what their own future holds.

Post-Menopause – Because women are living a lot longer than they used to, it is not uncommon to spend 40% of one’s life in the post-menopause phase. Dr. Hofmeister noted that menopause symptoms are often very severe in the early years, but they do get better. A decrease in estrogen can lead to or coincide with other health risks that should be monitored during this period: osteoporosis; heart disease; and a slower metabolism, which can result in weight gain.

Treating Menopause Symptoms

Dr. Hofmeister explained that women with pre-existing anxiety my find that this condition worsens during menopause. Anxiety, mood changes, and insomnia can be treated with cognitive behavioral therapy or antidepressant medications. She added that natural endorphins produced by exercise can help as well.

Dr. Hofmeister added that many symptoms associated with menopause could be rooted in other medical conditions, so it is important to talk with your physician about such changes to your health and what may be causing them. Hot flashes, for example, could be a sign of a thyroid disfunction. Changes in weight, too, may signal that something else is going on that is worth evaluation.

Bone loss, which begins in women around the age of 20, accelerates in late perimenopause and continues into early menopause due to estrogen deficiency. For this reason, Dr. Hofmeister stresses the importance of maintaining bone density with adequate calcium and vitamin D intake based on age. She also recommends weight-bearing exercise to maintain bone health.

Regular exercise and a healthy diet also help address other changes happening in women’s bodies that coincide with menopause.

Is Hormone Replacement Therapy Right for You?

Dr. Hofmeister stressed the importance of speaking to one’s doctor about the risks and potential benefits of hormone replacement therapy for treating menopause symptoms. She said it is generally safe and well tolerated if initiated right around the time of menopause or shortly thereafter. There are, however, significant risks if it is pursued many years later. She also noted that perimenopausal women at high risk for breast cancer should consult their doctor about this treatment, particularly if they have a history of a hormone sensitive tumor. “It’s a conversation you should have because not all genetic mutations are created equally. And often in those cases, it could still be perfectly safe for you to do the hormone therapy for a limited period of time to help with symptoms,” she said.

Take Action to Stay Healthy

Dr. Hofmeister advises women to contact their doctors if they experience bleeding 12 months after menses has stopped. Scheduling and attending age-appropriate preventative screenings is also important.

When speaking with your physician, share all symptoms you are experiencing. This will help identify the source of any ailments you are experiencing.

Finally, carefully consider the risks and benefits of hormone replacement therapy based on your personal medical history.

To learn more about the science menopause, watch the full Coffee Conversations with Scientists episode featuring Dr. Hofmeister.