Navigating the menopause transition

What is menopause?

Menopause marks the end of menstrual periods and fertility. You have reached menopause when you have gone one full year without a period. It usually happens between ages 45 and 55, though it can occur earlier or later. Certain medications, surgeries, or medical treatments can trigger early menopause.

Menopause is a natural part of life. You don’t always need treatment, but learning what to expect can help you stay healthy and feel prepared

What is perimenopause?

Perimenopause is the transition leading up to menopause. It can start several years before your last period. During this time, hormone levels rise and fall unevenly, causing menstrual changes and symptoms. Perimenopause typically lasts 2 to 8 years.

What happens during this transition?

• Estrogen and progesterone levels change from month to month.

• Menstrual cycles may get shorter, longer, or irregular.

• You may notice symptoms such as hot flashes, night sweats, sleep problems, or mood changes.

After menopause, estrogen levels stay low. This can increase the long-term risk of bone loss (osteoporosis) and heart disease, especially without healthy lifestyle habits.

Preventive health strategies:

#1 Regular Exercise

The goal is 150 minutes of moderate to vigorous exercise per week which should include:

• Mobility or stretching exercises 2–3 times per week reduce joint pain and improve function.

• Strength or resistance training 2–3 times per week helps prevent muscle and bone loss.

#2 Stay Connected

• Staying connected to your family, friends, and community is one of the best predictors of quality of life and longevity.

• Try to keep a regular schedule of calls, texts, or visits with your support network.

#3 Nutrition that supports your body through menopause

• There is no single diet that works for everyone. Pay attention to what feels best for your body.

• As we age, protein helps prevent muscle loss. Most people need about 70g per day (0.5–1g per kg).

• Read more about protein content: Johns Hopkins: Protein Content of Common Foods

• Calcium supports bone strength and is found in dairy products, legumes, and fortified juices.

• Vitamin D comes from sunlight and fortified foods. Daily recommendations:

– 600 IU (< age 70)

– 800 IU (age 70+)

Common Symptoms during Menopause Transition

Changes in vaginal bleeding or menses

This is usually caused by irregular ovulation and hormone changes that affect the uterine lining. Evaluation may include a uterine biopsy and lab testing. Treatments may include hormones such as a progestin IUD, injection, or pill. Once you have gone one year without bleeding, any new bleeding should be evaluated.

Urinary incontinence or urgency

Behavioral changes that can help include avoiding constipation (increase fiber and fluids), urinating on a regular schedule, and pelvic floor physical therapy. Sometimes vaginal estrogen therapy can help.

Hot flashes (also called vasomotor symptoms)

Medical treatments include hormone therapy (estrogen and progestin), as well as non-hormonal options such as antidepressants (SSRI, SNRI), gabapentin, oxybutynin, and NK3 or dual NK3/NK1 receptor antagonists (e.g., fezolinetant/Veozah; elinzanetant/Lynkuet).

Vaginal dryness or discomfort

With lower estrogen levels, vaginal tissues become thinner and more easily irritated. The best treatment is adding back estrogen to the vagina. This can be done with local or systemic estrogen (cream, ring, or vaginal tablet). Over-the-counter vaginal moisturizers can also help. Avoid douching, which can make irritation and odors worse. Silicone or oil-based lubricants last longer and can improve comfort during intimacy. Careful using them with silicone sex tools because they can shorten their shelf lives

Sleep disruption

Often related to hot flashes or other causes.

Behavioral changes that can help include:

• Keep a regular sleep and wake schedule.

• Create a nightly ritual such as a warm shower, stretching, or meditation.

• Avoid screens (phones, tablets, computers) 3–4 hours before bed.

• Melatonin supplements can be tried first for sleep; available over the counter.

Learn more about cognitive behavioral therapy for sleep: Cognitive Behavioral Therapy for Insomnia

Mood changes

Mood changes are common with hormonal shifts, life transitions, and aging. These vary from person to person and can be managed individually.

Some people benefit from talk therapy with a counselor or social worker. Please let me know if you’d like a referral.

Some people also benefit from medications for anxiety or depression. If you’re interested in exploring these, we can address it during one of our visits, or I can connect you with one of our psychiatrists.

Brain fog

Many people notice mild memory or focus changes during the menopause transition. This is common and often related to sleep, stress, or hormone changes.

Behavioral changes that can help include:

• Prioritize regular sleep and exercise.

• Use lists or reminders to stay organized.

• Practice mindfulness or relaxation to reduce stress.

Learn more about menopause and brain health: The Menopause Society: Brain Fog

Options for Menopausal Hormone Therapy (MHT)

What is MHT used to treat?

Menopausal hormone therapy uses estrogen to treat hot flashes and other symptoms. It typically includes estrogen (the main active ingredient) and progesterone (to protect the uterus).

I am in early perimenopause...

If you’re still having regular or frequent periods and need contraception, birth control pills can be a great first option. They regulate cycles, provide contraception, and relieve symptoms. For many people, this helps achieve the "hormone balance" that they are looking for!

How is it administered?

Estrogen therapy can be taken as a pill, skin patch, gel, cream, spray, or vaginal ring. Non-pill forms may lower the risk of blood clots compared to oral forms. Pills remain safe but can slightly raise triglycerides or clot risk.

Estrogen Options

Topical (patch, gel, spray)

Provides steady estrogen levels and very low clot risk. The patch is most common.

Oral pills:

A reasonable alternative for many people if preferred over the patch.

Vaginal estrogen ring (FemRing)

Inserted in the vagina and changed every three months; provides systemic estrogen.

Progesterone Options

Micronized progesterone

Common brand: Prometrium

Taken nightly or for 12 days per month; may help with sleep. This is the bioidentical option and is not associated with an increased risk of breast cancer in most studies