What to Expect in Menopause

The first time I heard about menopause was when I was in grade school. My family was visiting my great aunt who is always theatrical and fun, and I remember seeing her have a hot flash. She got up and walked around fanning herself vigorously and all of the adult women in my family giggled together. Since my aunt is already so theatrical, I thought she was just being silly. I didn’t understand what a hot flash was or how intense it could be.

Menopause is something I suppose I have always known I would experience one day, but other than knowing my baby-making hormones will slow down, I’ll stop getting my period, and I’ll have horrible hot flashes, this period of time seems almost like a caricature or something scary and unknown. So other than feeling uncomfortable and having intense hot flashes, what really happens to our bodies during menopause, and what are all of the side effects?

What is menopause?

First thing’s first: menopause is when your period stops permanently and your estrogen and progesterone levels go down. You are officially in menopause when you haven’t had your period for one year. The time leading up to the last menstrual cycle that we typically think of having hot flashes and other side effects are actually called perimenopause or the menopausal transition. This transition into menopause can happen anywhere from four to seven years before your last period, and after you’re in menopause, many symptoms can last for up to 14 years!!! That’s crazy to me! That means that even after your body has gone through these hormonal changes and you’re officially not producing reproductive hormones, you can still experience these pesky symptoms for up to over a decade. How did no one ever tell me this?!

People typically enter into perimenopause between ages 45 and 55, although it could be a little earlier or a little later. This transition begins when your body naturally starts producing less estrogen and progesterone, which are your reproductive hormones. During this transition, you’ll still get a period and can still become pregnant, although your periods might be irregular due to the hormonal shifts. Other side effects during this transition period include hot flashes, migraines, anxiety or depression, vaginal dryness which can lead to pain during sex, memory loss, and trouble sleeping. 

All about hot flashes

Hot flashes are due to these dropping hormone levels and can come and go at any time. Many women will experience really bad hot flashes at night, waking them up from their sleep. These can be treated with hormones, so you can see your doctor and get help managing those. The fluctuating hormones can also cause mood changes and anxiety or depression. Similarly, you can see your doctor about this and find a treatment plan.

Because your reproductive hormones are significantly decreasing, your vagina no longer produces natural lubrication. This can lead to pain during penetrative sex for many women, and can even lead to a lower desire for sex because of how uncomfortable it is. This can be treated by using a water-based lubricant during sex, and can even be treated with vaginal moisturizers, which are put into the vagina and can be used daily or every other day to treat dryness—not just for sex-related purposes. You can also use estrogen cream or talk with your doctor about taking hormones as well. Your sex life doesn’t have to end just because you’re hormones are shifting!

Some women experience memory loss during perimenopause or feel foggy-headed and confused. Getting enough sleep, staying active, and staying social can help with this, but if memory loss is a big problem for you, talk with your doctor. These symptoms slowly start happening as you approach your last period, and like I said they can start four to seven years before that even happens. Once you do have your last period and are officially in menopause after a year of no periods, these symptoms persist. Just like any other hormonal-related thing, some people are affected more than others. Some women experience minor menopause symptoms and are generally unaffected, while other women experience hot flashes so intense they have to eat dinner outside on a cold November day to cool off (a true story my mom told me).

Talking more about menopause

Regarding menopause, I’m most struck by how no one has ever really talked to me about perimenopause and menopause, and what exactly these symptoms look like. I had no idea these symptoms lasted so long and could carry on way past your last period. From the time I was a kid, I remember hearing all about when I would get my first period and what that would be like, but no one talked with me about this transition as well. I spend a lot of time reading and writing about women’s sexual health, yet I somehow still knew very little on this topic. 

I’m honestly quite overwhelmed thinking about all of these symptoms and anticipating this time in my own life, and I think talking about menopause openly with young women could help make this time seem less scary. Women already have to work to manage their periods and period symptoms as well as their fertility during their whole reproductive life, and then after that time winds down, we then have to manage a whole new set of symptoms. We should talk more openly about our reproductive hormones and what all menopause entails. This not only will empower women as they enter menopause themselves, but will also offer support for those women who are already experiencing it.