Nerlandes’ Story

Nerlandes Themistocle is a pharmacist and Pharmacy Manager at CVS Caremark, having worked in pharmaceuticals for over 25 years. She is a wife and a mother of two, currently residing in Rhode Island and finds joy with her family, listening to music, dancing, traveling, and exploring new foods. Nelandes Themistocle shares her truth about menopause, from what she experienced to what she wishes she knew about this important part of the reproductive health journey.

Can you tell us a little bit about your menopause experience?

I didn’t experience symptoms or body changes during the perimenopause stage as many others have. All of the symptoms started once my periods stopped very suddenly at the age of 50. What I’ve learned throughout this process and when talking with others is that not everyone experiences menopause in the same ways. Some may experience vaginal dryness, while others may feel more irritable or depressed. No experiences are one and the same.

What symptoms did you experience?

My symptoms were mainly hot flashes and night sweats, as well as trouble sleeping. The hot flashes, however, were pretty severe for me. I’d have to have fans on me at all times at work and when I go to bed.

Were there any other symptoms that caught you by surprise?

The symptom that really caught me by surprise was anxiety. I started to feel anxious about things I normally wouldn’t. For instance, I never felt or experienced anxiousness when it came to my work, especially because I have worked at the same place for years, however, one day I had such an overwhelming experience I had to call my husband. The palpitations were very intense, and this lasted for an entire week. I still feel anxiety from time to time, but I find ways to manage.

Did you feel prepared going into menopause?

Going into menopause is not something any woman can ever be fully prepared for. It took me an entire year to realize that I was going through the change . I definitely was not prepared. I did not have any idea what to expect or even how to identify if I was really experiencing it.

What do you wish more people knew about menopause?

Menopause is not as simple as people think. It is a very complex process that can be long and at times frustrating. The symptoms can last several years after your period stops and can be disruptive to your everyday life. Everyone experiences menopause differently, like I mentioned earlier, no experience is one and the same, so be patient with yourselves.

What do you think is the biggest misconception about menopause?

Menopause is still considered a very sensitive topic. I think that a lot of women struggle with this idea that once they go into menopause, their womanhood is stripped away. They may feel life is going to change forever, and people, including their spouses, will not look at them the same way. I felt that at one point, but my husband still treats me the same. Life may change in some ways, but the most important things don’t. People, not just women, need to be more educated about menopause to help with these feelings.

Is there any message you’d like to give to someone going through or preparing for menopause — maybe someone experiencing the same symptoms as you?

Menopause is not a medical condition but a natural process that will become a part of your life. Our bodies go through a lot of changes during this time, but there are so many ways to manage it. Don’t be afraid of talking about your symptoms; there is absolutely nothing to be ashamed of. Challenge yourself, change your lifestyle, exercise, keep yourself hydrated, lastly and most importantly, seek medical advice or talk to your provider. There are also so many drugs on the market that can help with the symptoms. I have learned to live with it and be happy.

Learn more about menopause

Menopause

Menopause 101

Menopause symptoms

The background

For a good portion of our life, menopause is one of those “out of sight, out of mind” concepts.

Of course, we all know it’ll happen eventually, but it just seems so far off until it isn’t. 

It’s common for menopause to catch you by surprise and while we don’t talk menopause prep enough, knowing what you can expect is very helpful. Let’s break down all the need-to-knows when it comes to causes, timing, and symptom management. 

When, how, and why

During the menopausal transition, the body’s production of two key female hormones, estrogen and progesterone, begins to progressively decline. This happens until you hit menopause. You’ve officially reached menopause when you’ve gone 12 consecutive months without a period.

As you can see here, progesterone starts to decline first, and the decline is steep. Estrogen follows the same course but fluctuates a lot as it decreases. Testosterone also declines on a gradual slope. 

In Western societies, the average person hit menopause 51, but many start experiencing symptoms — like irregular periods and hot flashes — upwards of 8-10 years beforehand. This stage is known as perimenopause (aka “around menopause”). Once you’ve hit menopause, ovaries stop releasing eggs and stop producing estrogen.

Many of us assume menopause means we’re destined to feel tired, deflated, and, well, “meh” for years on end, which is simply not the case. As Oprah Winfrey once said, “So many women I’ve talked to see menopause as an ending. But I’ve discovered this is your moment to reinvent yourself after years of focusing on the needs of everyone else. It’s your opportunity to get clear about what matters to you and then to pursue that with all of your energy, time, and talent.” 

Perimenopause and menopause symptoms: what to expect

In an ideal world, we’d be able to package the symptoms of perimenopause, menopause, and postmenopause into neat, well-organized boxes and unpack them one at a time. Unfortunately, menopause isn’t one-size-fits-all, and every woman experiences the transition differently.

“The experience can vary from individual to individual as well as across ethnic and cultural groups and different countries and regions of the world,” says Dr. Barbieri.

That said, research does point toward certain patterns and trends. For example, we know that the symptoms typically associated with menopause (there are roughly 34) are actually experienced by most women during late perimenopause, peaking during the last two years due to an accelerated drop in estrogen levels. Below are the most common:

• Hot flashes/night sweats
• Irregular periods
• Vaginal dryness and discomfort during sex
• Urinary urgency and incontinence
• Difficulty sleeping
• Emotional changes (e.g., irritability, mood changes, anxiety/depression)
• Dry skin, eyes, or mouth

Postmenopause

After you hit the menopause mark (12 months without a period), you officially enter post-menopause. Many women will go 8-9-10 months and think they are in the clear and then they get a period, at which point the clock starts over.

Once you are post-menopausal, many symptoms tend to subside and some may persist, like vaginal and urinary symptoms. And, unfortunately, there are some longer-term health implications that come with being post-menopausal. Post-menopausal women have a higher risk of developing heart disease, diabetes, and osteoporosis.

The menopause transition is therefore the time to take action to help prevent those conditions by establishing healthy habits, caring for yourself, and being proactive about getting the healthcare you deserve.

Unless we go through “sudden” or premature menopause for medical reasons, we’ll spend a third or more of our lives in postmenopause. This is a long time, so it’s important to understand what treatments are out there. Sure, some symptoms may be unavoidable, but there are still ways to have agency and manage the impact they have on your life. It’s all about optimizing your health for the long term.

Lifestyle changes for menopause

Lifestyle changes are paramount to temper the symptoms of menopause and postmenopause, whether or not you’re considering additional treatments, like hormone replacement therapy. Fortunately, research shows they can be as effective as medication, sometimes even eliminating the need for it. And the good news is that it doesn’t matter if you’re just starting perimenopause, beginning full-fledged menopause, or enjoying what many regard as the period-free liberation of postmenopause.

Leaning into healthy lifestyle changes at any age can greatly improve your symptoms, energy levels, and overall health. In other news, it’s never too early and it’s never too late.

“Hormones are very much affected by your mood, stress levels, sleep, exercise, and nutrition,” says Dr. Eva Selhub, MD, a physician, author, and resiliency expert — so much so, in fact, that studies have shown that a diet high in whole foods, especially vegetables is inversely correlated with menopause symptoms.

Tapping into your community 

We also recommend building a “menopause support team.” Start by reviewing the list of symptoms, recording your experience with each on a scale of 1-10 (least disruptive to most disruptive), and prioritizing which to tackle first. You can track all of this information in your Ovia app. Bring the list to your next doctor’s appointment to discuss

It’s essential that you have provider who listens to you and is informed about the menopause journey. And it’s very possible that a provider you have loved isn’t the right fit for this new stage. Evaluate how comfortable you feel asking questions about your symptoms, how confident you feel in the answers, and how you feel leaving appointments. 

Do you leave feeling informed and confident about your next steps? If not, or if you don’t feel like your provider is listening to you, then find a new one! Having a provider on your team with deep menopause training and understanding is key to thriving during this period of life. 

Reach out to family and friends for support — the more conversations you have, the more you’re helping to break down the stigma around menopause that prevents so many people from sharing their experiences. 

At any given moment, 50 million or more women in the U.S. are experiencing menopause, and a whopping 16% never discuss it with anyone at all. That needs to change!

Lifestyle changes 

In addition to building a “menopause support team,” consider meditation and mindfulness for stress management and other psychological symptoms associated with menopause. “These techniques,” explains Dr. Selhub, “…allow one to manage them better without distress.”

Alongside nutrition, physical activity, sleep, and mind-body interventions, there are a number of botanical and supplement solutions that can help, including soy isoflavones, black cohosh, and vitamin B6. Like hormone replacement therapy, however, some come with risks, side effects, and medication interactions, so it’s important to carefully evaluate your options and consult your healthcare provider first.

Menopause treatments

One of the most effective therapies for menopause is hormone replacement therapy (HRT), which involves taking a supplemental form of either estrogen — or estrogen and progesterone — to balance out the two and replace what the body is no longer naturally producing.

As with all medications, there are benefits and risks. For HRT, the benefits can include improving hot flashes, night sweats, sleep, mood, sex drive, and bone density, among others. 

Despite the fact that today, the North American Menopause Society (NAMS) considers HRT to be safe and effective for most women in menopause (especially when started prior to age 60 or within 10 years of menopause), it is still a hotly debated and often misunderstood topic. When factors such as health history and medical conditions, as well as the type, dose, and duration of therapy are considered, benefits of HRT can outweigh the risks. Speak with your provider to find the right option for you. 

Remember that there are also non-hormonal prescription options, including certain antidepressants, that can be used for severe symptoms, especially for women who cannot or do not wish to try hormonal therapies.

The bottom line? Yes, menopause comes with symptoms. No, you’re not alone in what you’re experiencing. Medications and supplements can play an important role, but don’t underestimate the power of nutrition, exercise, quality sleep, and stress management.

Reframing how you think about menopause is also incredibly powerful. For example, you can turn this time into an opportunity to step back, renew your identity, and set future goals.

Many of us will be retired and/or empty nesters with more time on our hands — perfect for considering what pursuits we used to love that we’ve not had time for lately Or, what new interests do you want to dive into? Not only will challenging ourselves in new ways keep our brain healthy, but it’ll also help us combat stress, stay present, and pursue long-overdue passions.

No matter how you’re feeling about this transition, the first step is finding a knowledgeable who can help you navigate the journey ahead. 

While most of us are familiar with the idea of menopause, understanding of perimenopause is less common. Perimenopause means “around menopause” and is used to describe the transition period between the onset of your first symptoms and the onset of menopause, which is technically marked by 12 consecutive months without a period. A doctor would say that you’re “in perimenopause” when your cycles are irregular (i.e. varying by 7 days from your baseline, for example, a cycle of 33 days followed by a 26-day one) or when you skip cycles altogether.

Knowing what’s happening in your body and why it’s happening is so powerful. When you have this information, you’re able to be proactive and preventive — and if you need support along the way, you know how to access it. 

Before we get into preparing for menopause, let’s talk a bit about some perimenopause specifics. 

When, how, and why?

Perimenopause can be unpredictable. Periods change dramatically — they can become heavier and more frequent or lighter and intermittent. It’s generally a confusing time that catches many people by surprise. 

Perimenopause is often broken down into two general phases: early perimenopause (when periods can still be regular) and late perimenopause (marked by skipped and/or irregular periods — more aligned with what people typically think of when they hear perimenopause or menopause). The full transition through menopause takes 8-10 years. And while most of us will start in our mid-40s, some may begin years earlier.

The takeaway? There’s no such thing as a one-size-fits-all experience when it comes to timing. 

Perimenopause symptoms: what to expect

Some of the telltale signs of perimenopause — think hot flashes, night sweats, and mood swings — actually begin to subside once you reach menopause. 

Below are common symptoms that signal the beginning of perimenopause, all of which can be traced back to changing hormone levels. (Though not everyone will experience any or all of these symptoms.)

• Weight gain
• Worsening PMS with both emotional and physical changes (e.g., breast tenderness and heightened anxiety)
• Irregular periods: This is an  umbrella term that can include short or skipped menstrual cycles and heavy bleeding (often one of the earliest symptoms)

Throughout the remainder of your journey, you may notice a number of the following perimenopausal symptoms (but not always, and not all at once): hot flashes and night sweats,  irregular periods, difficulty sleeping, emotional changes (e.g., irritability, mood swings, and mild depression, especially before your period), difficulty with concentration and short-term memory, vaginal dryness and/or discomfort during sex, and dry skin.

This might sound overwhelming, but there are lots of ways to mitigate these symptoms. First, we’ll explain a bit more about them. 

Are the symptoms constant for the entire duration of menopause?!

It depends. Some symptoms come and go and others are more constant. What you can expect, however, is for symptoms to peak about 1-2 years before the onset of menopause. This happens because of an accelerated drop in estrogen. 

How long will these symptoms last?

Typically five years — but remember, the perimenopausal experience isn’t one-size-fits-all for everyone. Some people may only experience a change in their period when nearing menopause, while others will experience it for upwards of 10 years.

Are these symptoms *always* due to perimenopause?

Not always, no. There are several common conditions, including thyroid abnormalities and even medication side effects that can cause similar symptoms, so be sure to check in regularly with your healthcare provider. 

Is there a test for perimenopause?

Not really. Doctors may order tests to check your hormone levels and thyroid function, but these tests are imperfect at best since hormones fluctuate during perimenopause.

The low-down on hormones during perimenopause…what’s really happening?

Hormonal fluctuations are to blame for the symptoms listed above. But let’s break it down further. 

In your 20s and 30s (i.e. during premenopausal cycles), hormones enjoy a predictable ebb and flow. During postmenopause, hormones are low but steady. But the in-between perimenopausal period is marked by one long hormonal fluctuation, with levels of the two key female hormones (estrogen and progesterone) varying quite a bit. 

Progesterone starts to decline first, followed by estrogen, which fluctuates quite a bit as it does so. Testosterone also slowly declines. Those aren’t the only hormones that play a role.

Pre-menopause, FSH (follicle-stimulating hormone), and LH (luteinizing hormone) work together to produce a period. FSH causes eggs to mature in the ovaries and LH triggers the egg’s release. During perimenopause, FSH levels also fluctuate significantly.

Wondering what hormones you should keep an eye on and/or test to determine (around) when you’ll hit menopause?

Estrogen

Menopause occurs when ovaries don’t produce enough estrogen for ovulation (which means no periods).

FSH

Although FSH was once considered the “test” for menopause, it’s not the most useful in perimenopause. Levels vary far too much to rely on it as a predictor of the last period.

AMH

AMH (the anti-mullerian hormone) can help gauge the level of remaining egg cells (aka “ovarian reserve”). AMH decreases with age until it becomes essentially undetectable around menopause. 

There are AMH tests in development, which can be used to assess whether a person’s last period will occur in the next 18 months or so (via a blood test). While it’s possible to do an AMH test now, we don’t know that it can accurately ballpark your menopause “ETA”. So for the time being, AMH testing is not a typical part of the menopausal hormonal assessment.

Interested in learning more about treatments? Tap here. 

Here are three common menopause myths, along with the actual (much less alarming) facts.

1. I’ll have all the symptoms of menopause, from hot flashes to mood swings

The truth is that each woman’s path to menopause is unique. Some go through with hardly a blip, and others have more noticeable symptoms. Most of us will see a few changes — experts estimate that 85 percent of women who’ve been through menopause have had at least one menopause-related symptom.

One of the first signs of perimenopause for most women is irregular periods. This is common and lasts until periods stop. (Once you’ve gone a full year without a period, you’ve reached menopause.) 

Hot flashes are another relatively common symptom — about 75 percent of women have them, and they can vary anywhere from short (10 seconds) and mild to longer (up to 10 minutes) and more intense. For 80 percent of women, the hot-flash phase lasts for just two years or less. 

About 23 percent of women experience mood changes during menopause. Some women also report disrupted sleep (sometimes hot flashes are the culprit, but the life stressors around midlife can also be a factor). Vaginal dryness, bladder changes, and weight gain can also happen with perimenopause.

There’s no sure way to predict what symptoms you’ll have. But there is one sure thing to know: there are lots of ways to reduce or eliminate symptoms — you don’t have to just gut it out. 

Some approaches are simple, like using an over-the-counter lubricant for vaginal dryness or wearing layers and sleeping with a fan to help with hot flashes. 

Lifestyle changes, including eating well, exercising, reducing stress, and getting enough sleep, can also go a long way toward reducing symptoms and helping you feel well through perimenopause. 

There are natural remedies (check with your doctor to find proven, safe ones) and hormone therapy that can make a big difference, too.

If you have symptoms that bother you, talk to your healthcare provider to find the treatments that are right for you.

2. Menopause is the end of my sex life.

While it’s true that, in general, libido decreases for both men and women as we age, menopause certainly doesn’t have to be the end of your sex life. In fact, some women report an increase in sexual desire. After all, once you’re through menopause, you don’t have to worry about unwanted pregnancy anymore. And it’s a time of life that might feel freer in general, with fewer obligations to care for others or prove yourself to the world. If you have kids who’ve left home, the new privacy may feel like a real boost for your sex life, too. 

But more than a third of women report some libido challenges, from lack of interest in sex to having a harder time reaching orgasm. This is often related to hormonal changes, including the decrease of estrogen in our bodies. Talk to your doctor about treatments, such as estrogen replacement or testosterone therapy. If you have vaginal dryness that’s making sex uncomfortable, try a vaginal lubricant (available at most drug stores and grocery stores). 

Sometimes, decreased desire has as much to do with relationship strain as physical changes. If you’re in a relationship that could use some support, consider couples therapy to help rekindle intimacy and desire.

And keep in mind that, since some change in libido is normal for everyone, now is a good time to talk with your partner. You might find that you are both evolving when it comes to your needs, desires, and what fulfilling intimacy means for you. 

3. Menopause brain fog is my new reality.

It’s true that some women report cognitive changes during perimenopause, such as being forgetful or easily distracted. This “brain fog” can have a lot of causes, from hormonal ups and downs, to disrupted sleep, and the high levels of stress many women experience around midlife. 

If you’re noticing mild symptoms, it’s probably not anything to worry about. And it’s temporary — studies show that cognitive function rebounds after menopause. 

In the meantime, a few lifestyle changes — such as reducing stress, exercising, and getting plenty of sleep — may help your brain function its best. 

If cognitive changes worry you, come on suddenly, or put your safety at risk, talk with your healthcare provider about possible causes and treatments.

Reviewed by the Ovia Health Clinical Team

Sources

• “Introduction to Menopause.” Johns Hopkins Medicine. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/introduction-to-menopause. 
• Sussman, M., Trocio, J., Best, C., Mirkin, S., Bushmakin, A. G., Yood, R., Friedman, M., Menzin, J., & Louie, M. (2015). Prevalence of menopausal symptoms among mid-life women: findings from electronic medical records. BMC women’s health, 15, 58. https://doi.org/10.1186/s12905-015-0217-y.
• “Depression, Mood Swings, Anxiety.” North American Menopause Society. North American Menopause Society. https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/depression-mood-swings-anxiety. 
• “Decreased Desire.” North American Menopause Society. North American Menopause Society. https://www.menopause.org/for-women/sexual-health-menopause-online/sexual-problems-at-midlife/decreased-desire. 
• Leventhal J. L. (2000). Management of Libido Problems in Menopause. The Permanente Journal, 4(3), 29–34.
• “How Sex Changes After Menopause.” Johns Hopkins Medicine. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/how-sex-changes-after-menopause. 
• Kelly Bilodeau. “Sleep, stress, or hormones? Brain fog during perimenopause.” Harvard Health Publishing. Harvard Medical School. April 9, 2021, https://www.health.harvard.edu/blog/sleep-stress-or-hormones-brain-fog-during-perimenopause-202104092429. 
• Greendale, G. A., Huang, M. H., Wight, R. G., Seeman, T., Luetters, C., Avis, N. E., Johnston, J., & Karlamangla, A. S. (2009). Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology, 72(21), 1850–1857. https://doi.org/10.1212/WNL.0b013e3181a71193. 

The good news is that many people go through menopause without noticing very many changes at all. The other good news is that, if you do have symptoms, there are lots of treatments to help. 

Here’s a peek at what to expect and how you can start preparing for menopause

Before there’s menopause, there’s perimenopause

A lot of what you hear about menopause is really about perimenopause — the time before menopause when your hormone levels start to fluctuate, your cycle becomes less regular, and eventually, your periods stop altogether. 

Perimenopause can start as early as your 30s or as late as your 50s, but for most women, the first signs appear in their mid-40s. On average, this transition phase lasts about four years, but there is a lot of variation between women. Once you’ve gone a full year without a period, you’ve reached menopause.

Preparing for menopause: The most common signs of perimenopause

While each person experiences perimenopause differently, these are the most common things you might notice:

Changes in your menstrual cycle

For many people, the first sign of perimenopause is irregular periods. Your cycle might become longer or shorter, and your periods may be lighter or heavier. You may skip periods. Eventually, periods stop.

Hot flashes

About 75 percent of women experience hot flashes around the time of menopause. When a hot flash happens, your face and body suddenly feel hot and you may sweat or develop red blotches. Hot flashes vary in intensity and duration — they can last 30 seconds or up to 10 minutes — and they can happen anytime. When hot flashes happen at night, they’re called night sweats. 

For most women (about 80 percent), the hot-flash phase lasts two years or less. But it’s not uncommon to have an occasional hot flash later, even after menopause.

Mood changes

Studies show that up to 23 percent of women have mood changes during and after perimenopause. Changing hormones and sleep disruptions can contribute to mood swings or a lower mood for some people. Menopause also happens at a time when life can be packed with stressors — from aging parents to children getting ready to leave home and careers in full swing. 

There’s no simple way to untangle exactly what causes any one person’s mood changes. If you’re concerned about your mood — and especially if you have symptoms of depression — please talk to your healthcare provider for support.

Trouble sleeping

Nighttime hot flashes, mood changes, and major life events can all make it harder to sleep well. Managing the things that keep you from sleeping (like stress and hot flashes) and building healthy sleep habits, can help. 

Vaginal dryness

Estrogen helps keep the vagina elastic and moisturized. As estrogen levels fluctuate, some women notice vaginal dryness and discomfort during sex. An over-the-counter lubricant can make a huge difference.

Bladder changes

As menopause approaches, some women find that they need to urinate more often, or notice that they leak some urine when laughing or sneezing. 

Hair changes

With hormonal shifts, some women develop more facial hair. The hair on the scalp may become thinner. 

Weight gain

Some people have weight gain around menopause, especially in the stomach, hips, and thighs. This can be related to menopause, but it’s also just easier to gain weight as we age. 

Taking care of yourself during perimenopause and beyond

If you notice perimenopause symptoms that bother you, there are lots of approaches to help. Some lifestyle adjustments, like eating well, exercising regularly, or sleeping with a fan and dressing in layers can bring relief. There are also some proven natural remedies (keep in mind that some “natural” treatments make big promises and don’t deliver — so always check with your healthcare provider first). Many women also opt for hormone therapy to ease symptoms and reduce health risks. 

If the changes around menopause are frustrating or uncomfortable for you, talk to your healthcare provider. You can work together to find an approach that matches your symptoms, preferences, and lifestyle. 

Approaching menopause in an anti-aging world

Menopause might be happening in your body, but it also happens in a society that has a lot to say about aging. Flip open any fashion magazine and you’re likely to be bombarded with images of very young women and ads for anti-aging miracle cures. It’s easy to internalize the message that aging is a problem to manage or hide. And from there, it’s not far to feeling like menopause is embarrassing or shameful. 

If those negative messages have seeped in, it may be worth considering some other perspectives. In study after study, researchers have found that menopause has a lot of good sides. Here are just a few examples:

• The Massachusetts Women’s Health Study of 2,565 middle-aged women found that most were either relieved or neutral about the end of their cycles.
• In a review of studies about body image, a researcher discovered a trend: while menopausal women tended to judge themselves negatively if they were asked about their appearance, open-ended questions showed that women overall were highly satisfied with their lives. 
• In a smaller study of Australian women at middle-age, respondents reported some sadness about aging, but the more notable finding was greater confidence and wisdom, more self-awareness, and higher feelings of self-worth.

It’s normal to have complicated feelings, and some worry, about menopause and getting older. But please remember that menopause is a natural process, and there are lots of ways to think about it – and many options for treatments if you need them. 

Reviewed by the Ovia Health Clinical Team

Sources

• “Perimenopause.” Cleveland Clinic. Cleveland Clinic. October 5, 2021. https://my.clevelandclinic.org/health/diseases/21608-perimenopause. 
•  “Introduction to Menopause.” Johns Hopkins Medicine. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/introduction-to-menopause. 
• “Depression, Mood Swings, Anxiety.” North American Menopause Society. North American Menopause Society. https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/depression-mood-swings-anxiety. 
• Tori DeAngelis. “Menopause, the makeover.” American Psychological Association. American Psychological Association. March 2010. https://www.apa.org/monitor/2010/03/menopause.

Here’s a closer look at how your hormones may be changing, and the possible impacts on your body and mind.

Menopause hormones

Estrogen levels are going down — and up and down

During perimenopause, estrogen levels start to fluctuate more and become less predictable. Since estrogen plays a lot of roles, changing estrogen levels can have a noticeable impact. 

High estrogen can lead to bloating, breast tenderness, and heavier periods.

Low estrogen can cause hot flashes (also known as night sweats when they happen during the sleeping hours), headaches, and vaginal dryness.

Estrogen also plays a part in the production of serotonin, a chemical that helps regulate moods. This is why changing estrogen levels can contribute to mood swings, or lower moods, around menopause.

Progesterone is decreasing, too

Progesterone is another hormone produced by the ovaries. It plays a key role in helping the uterus prepare for a fertilized egg and it’s critical in the early stages of a pregnancy. 

As the ovaries produce less progesterone on the way toward menopause, periods become irregular and sometimes heavier. 

Testosterone has already been changing for quite a while

When you hear the word “testosterone,” you might think of men, but women’s bodies also produce the hormone. Women’s testosterone levels peak in our 20s and then begin to decline slowly. Testosterone may help support bone and muscle mass. And some researchers believe that declining testosterone levels can impact the libido.

After menopause, hormones settle back down

Once a person reaches menopause (a year after the last period), hormone levels stabilize again. For many people, it’s a welcome relief to find that bothersome symptoms of perimenopause — including hot flashes and mood swings — decrease or go away altogether. 

Our bodies keep producing estrogen after menopause, but at lower levels than before. Since estrogen helps protect our heart and bones, lower levels mean our risks for heart disease and osteoporosis go up.

There are a few important steps to help lower your health risks, including eating a healthy balance of foods (make sure you are getting calcium and vitamin D), getting plenty of exercise, treating health conditions like high blood pressure and diabetes, and keeping up with your regular healthcare visits. 

If you’re in the middle of hormonal ups and downs and the physical or emotional symptoms are bothering you, talk with your healthcare provider. Lifestyle changes and natural remedies can help, and hormone replacement can ease symptoms and lower health risks. You and your provider can work together to find just the right approach for you. 

Reviewed by the Ovia Health Clinical Team

Sources

• “Changes in Hormone Levels.” The North American Menopause Society. The North American Menopause Society. https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-hormone-levels. 
• “Menopause.” Endocrine Society. Endocrine Society. January 24, 2022. https://www.endocrine.org/patient-engagement/endocrine-library/menopause.

No matter how your own menopause journey unfolds, a little preparation can go a long way. Here are six steps to help get your body and mind ready. 

1. Get in a healthy groove now 

Most of the lifestyle changes that help ease menopause symptoms will sound pretty familiar. That’s because they’re the same things that help people feel well and stay well at any age. If you’re getting ready for menopause, it’s the perfect opportunity to go back to the wellness basics: 

• Eat a nutrient dense diet with plenty of fruits and vegetables, whole grains, protein, and healthy fats. Include calcium to help keep your bones strong.
• Get regular exercise. Find physical activities that you really enjoy — and that fit with your schedule and lifestyle — so it’s easy to stick with your routine. 
• Explore healthy ways to lower your stress. Popular strategies include deep breathing, meditation, walking outdoors, connecting with friends, or finding quiet time to be alone with your thoughts.
• Adopt good sleep habits. Consider moving electronics out of the bedroom, setting aside time to unwind at the end of the day, and sticking to a regular sleep schedule.

2. Know your menopause symptoms — and check in with your healthcare provider if you notice anything new

The signs of approaching menopause don’t have to take you by surprise. Even though each person’s menopause is unique, these symptoms are among the most common: 

• Changes in your menstrual cycle
• Hot flashes
• Vaginal dryness
• Urinating more often or having less bladder control
• Trouble sleeping
• Mood changes
• Weight gain

Keep in mind that the symptoms of menopause can also be signs of other health changes, so it’s always a good idea to talk to your healthcare provider when you notice something new about your body or mood.

3. Be ready to treat symptoms if they bother you 

If you start to have bothersome symptoms, don’t wait to get support. There are lifestyle changes and proven natural remedies that can make a big difference. Medications can ease more severe symptoms and prevent health risks. You can work with your healthcare provider to find the approach that’s right for you. 

4. Make a plan for your emotional health

Not everyone experiences mood changes with menopause, but some of us do. People with a history of depression, PMS, and postpartum depression seem to be more likely to experience depression again around the time of menopause. So if this is part of your history, consider talking to your healthcare provider about the signs and symptoms that can help you catch a mood problem early. Then, set up a plan so you can act right away if you need to. 

Even if you’ve never had depression before, talk with your healthcare provider if you notice mood changes that bother you. 

5. Don’t go it alone

There’s still a taboo around talking about women’s health in general, and menopause especially. But we have the opportunity to help break that taboo. We don’t have to be ashamed or go through menopause all alone. Instead, reach out to friends going through the same life changes and share your own experiences.

6. Embrace what’s next

One of the best kept secrets about menopause is that there’s a lot to look forward to: the end of periods, PMS, and cramps; no more worrying about unwanted pregnancies; and goodbye to hormonal headaches, to name a few. And it’s not just physical changes. Many women feel more sure of themselves, more content, and more motivated after menopause than they ever have before. 

Oprah Winfrey said it well: “So many women I’ve talked to see menopause as an ending. But I’ve discovered this is your moment to reinvent yourself after years of focusing on the needs of everyone else. It’s your opportunity to get clear about what matters to you and then to pursue that with all of your energy, time, and talent.” 

If you have questions about what to expect during menopause, how to get ready, or what to do about symptoms, talk with your healthcare provider. 

Reviewed by the Ovia Health Clinical Team

Sources

• Mayo Clinic Staff. “Menopause.” Mayo Clinic. Mayo Clinic. October 14, 2020. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397. 
• “How To Tell You’re Near the End of Perimenopause.” Health Essentials. Cleveland Clinic. October 17, 2022.  https://health.clevelandclinic.org/the-change-before-the-change-5-facts-to-help-you-prepare-for-menopause-symptoms/. 
• “Preparing for Menopause.” Department of Health and Human Services. National Institutes of Health. July 2018. https://newsinhealth.nih.gov/sites/nihNIH/files/2018/July/NIHNiHJul2018.pdf. 
• “Healthy Eating Plate.” Harvard T.H. Chan School of Public Health. Harvard University.  https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/. 
• “Sticking with your exercise program.” Harvard Health Publishing. Harvard Medical School. April 11, 2017. https://www.health.harvard.edu/staying-healthy/sticking-with-your-exercise-program. 
• “Managing stress.” National Alliance on Mental Health (NAMI). NAMI.  https://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/Taking-Care-of-Your-Body/Managing-Stress. 
• “Tips for Better Sleep.” Center for Disease Control and Prevention. CDC. September 13, 2022. https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html. 
• Kaitlin Vogel. “Whether You’re 25 or 65, Here Are 50 Quotes About Menopause That Will Resonate With Every Woman.” Parade. Parade. July 26, 2021. https://parade.com/1239990/kaitlin-vogel/menopause-quotes/. 
• “Menopause FAQs: Understanding the Symptoms.” The North American Menopause Society. The North American Menopause Society. https://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/menopause-faqs-understanding-the-symptoms.

Why do some people start menopause early?

For some, menopause is induced as part of a medical treatment. This happens if the ovaries are surgically removed, or as a side effect of some types of chemotherapy or radiation. There are also medications that cause menopause to help treat an illness. 

Sometimes menopause is the result of premature ovarian insufficiency (POI), a term that simply means the ovaries have stopped producing eggs. POI can be related to genetic factors or an autoimmune disease. For many people, the cause of POI is never discovered.

What are the signs of early or premature menopause? 

The symptoms of early or premature menopause are similar to the symptoms of menopause at any other age. If you’re having symptoms and you’re under 45, it could be a sign of early or premature menopause.

Some of the most common menopause symptoms are:

• Changes in your menstrual cycle (your periods might be longer or shorter than usual, or you may skip periods)
• Hot flashes
• Vaginal dryness
• Bladder changes, including needing to urinate more often or having less bladder control
• Trouble sleeping
• Mood changes
• Weight gain

These symptoms can also be signs of other health issues. If you have symptoms, talk to your healthcare provider to determine the underlying cause. 

Taking care of your body when menopause comes early

With menopause, the ovaries produce less estrogen and other hormones. Since these hormones help protect the heart, bones, and brain, your doctor will likely recommend a prescription for hormone therapy. Taking hormones (usually until the average age of natural menopause) can help lower your risk for heart disease, dementia, and osteoporosis. 

If you have side effects that impact your sex life — such as vaginal dryness or low libido — let your doctor know. Estrogen can be an effective treatment for vaginal dryness and some women use testosterone therapy to boost their libidos. 

Options for building a family

If you’ve been planning to start a family, early or premature menopause can be a devastating diagnosis. You may need to re-imagine your plans. Some women are able to freeze eggs or embryos. Others choose in vitro fertilization with donor eggs, and some women choose surrogacy or adoption. Your healthcare provider can help you understand your options. 

Taking care of your mental health when menopause comes early

Early menopause can have a deep impact on a person’s emotional wellbeing. You may find yourself thinking about aging more seriously than you’ve ever done before, seeing your body in a different way, and having to re-imagine your plans for parenthood. And there are also unexpected new health risks to balance. All of this is a lot to process.

Please reach out to friends and family to talk about how you’re feeling. If you have a partner, it can help to be open with each other about how menopause may be changing your physical relationship and your family plans. 

If you are struggling, please also talk with your healthcare provider or a therapist. You are not alone, and there are lots of ways to help with the emotional and physical challenges that can come with early menopause. 

Reviewed by the Ovia Health Clinical Team

Sources

• “Perimenopause & Premature Menopause FAQS.” The North American Menopause Society. The North American Menopause Society. https://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/perimenopause-premature-menopause-faqs.
• Mayo Clinic Staff. “Menopause.” Mayo Clinic. Mayo Clinic. October 14, 2020. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#
• Dana Sparks. “Women’s Wellness: 5 Things To Know About Early Menopause.” Mayo Clinic. Mayo Clinic. November 2, 2016. https://newsnetwork.mayoclinic.org/discussion/womens-wellness-5-things-you-need-to-know-about-early-menopause/.

In addition to hitting the one-year mark with no periods, your doctor may also check your hormone levels with a blood test to confirm that you’re through menopause. 

Once you’re in postmenopause, you won’t ovulate or have periods, and you can no longer become pregnant. But it’s important to know that you can become pregnant during perimenopause (the years leading up to menopause when your cycles are less regular). If you don’t want to become pregnant, keep up with a reliable your birth control method until you’re sure you’ve reached menopause. 

The physical signs of postmenopause might feel familiar

Many people experience symptoms during perimenopause — the infamous hot flashes, trouble sleeping, or mood changes, to name a few. After menopause, symptoms tend to go away or become milder. But it’s not uncommon to have a rogue hot flash now and then, even years after menopause. 

For some people, symptoms that started in perimenopause can stick around for a decade or longer, including: 

• Mood changes
• Changes in libido
• Trouble sleeping 
• Dry skin
• Weight changes
• Hair loss
• Urinary incontinence 
• Vaginal dryness 
• Hot flashes

Just as with perimenopause, lifestyle changes, including healthy eating and regular exercise can ease symptoms during postmenopause. Reducing caffeine and alcohol can help with sleep. And if vaginal dryness is making sex uncomfortable, a water-based lubricant (available at most grocery stores or drug stores) can make a big difference. 

If you’re past menopause and symptoms are bothering you, talk with your doctor to rule out other causes — and find ways to help. There are lots of options for natural remedies and medications to ease symptoms.

Postmenopause is the right time for self-care

This is the perfect time to up your self-care game. For many people, menopause comes after years of caring for others — sometimes without the time to take good care of themselves. In addition to eating well and exercising, set aside some time to catch up on wellness visits with your primary care doctor, dentist, and eye doctor. 

In postmenopause, your body produces less estrogen, and this hormonal change raises a few health risks. So now’s also a good time to invest in some prevention. 

Here’s how to lower your risk for heart disease

Estrogen helps protect against heart disease, so it’s especially important to care for your heart once your estrogen levels are lower after menopause. The most powerful steps you can take are:

• Eating well
• Quitting smoking
• Exercising regularly
• Treating high blood pressure, high cholesterol, or diabetes if you have them

Here’s how to protect your bones

With less estrogen, people also lose bone mass more quickly. In fact, people who are postmenoapausal can lose up to 1 to 2 percent of their bone mass each year. As bones become less dense, the risk for fractures goes up. 

To protect your bones:

• Get plenty of calcium from foods such as cheese, yogurt, spinach, and fortified cereals. You may also choose to add a calcium supplement. In addition, a vitamin D supplement can help you absorb calcium. 
• Practice weight-bearing exercises to strengthen your bones and muscles. Popular weight-bearing exercises include walking, hiking, dancing, and playing tennis. Resistance exercises, such as weightlifting, can also help keep bones strong.
• Add some balance exercises, such as yoga or tai chi. Keeping your balance sharp can help prevent falls.

It’s normal to have a lot of questions about life after menopause. If you’d like some expert guidance, contact your provider for support. 

Reviewed by the Ovia Health Clinical Team

Sources

• “Postmenopause.” Cleveland Clinic. Cleveland Clinic. October 5, 2021. https://my.clevelandclinic.org/health/diseases/21837-postmenopause
• “The Menopause Years.” American College of Obstetricians and Gynecologists. ACOG. November 2021. https://www.acog.org/womens-health/faqs/the-menopause-years.
• “Menopause FAQs: An Introduction to Menopause.” The North American Menopause Society. The North American Menopause Society. https://www.menopause.org/for-women/menopause-faqs-an-introduction-to-menopause.
• “Exercise for Your Bone Health.” The National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center. National Institutes of Health. https://www.bones.nih.gov/health-info/bone/bone-health/exercise/exercise-your-bone-health.

But if you don’t want to become pregnant, being a bit older isn’t a reliable form of birth control. Even when your periods become irregular during perimenopause (the time before menopause), it’s still possible to conceive. So, until you’ve gone a full year without a period — which marks the official start of menopause — experts recommend a reliable form of birth control if you’re sexually active with someone who could get you pregnant.

There are a lot of birth control options to choose from, and a few important things to consider if you’re in perimenopause.

Common birth control choices in perimenopause

There are lots of popular birth control methods that work well at perimenopause: 

• Hormonal oral contraceptives (the pill)
• Hormonal injections, patches, or vaginal rings
• Intrauterine devices (IUDs)
• Sterilization, including tubal ligation or fallopian implants for women and vasectomies for men
• Barrier methods, including diaphragms, condoms, and spermicides

Benefits and drawbacks of oral contraceptives at perimenopause

Oral contraceptives may come with a few extra perks if you’re having symptoms of perimenopause. In addition to preventing pregnancy, the pill can reduce hot flashes, regulate your cycle, and help prevent bone loss.

But it’s important to know that oral contraceptives might keep you from noticing the changes in your cycle that tell you when you’ve reached menopause. That’s because birth control pills may cause regular bleeding that seems like a period, even if you’re already in menopause. If you take oral contraceptives, make a plan with your doctor about how long you’ll keep using them. 

It’s also important to let your doctor know about your personal risk factors if you’re considering hormonal contraception, including cancer history, heart health, diabetes, and whether you’re a smoker.

The rhythm method (natural family planning) stops being effective at perimenopause

The rhythm method — tracking cycles to avoid sex during fertile days — doesn’t work well once perimenopause starts. That’s because cycles become irregular. Even with meticulous attention, it’s hard to predict when you’ll ovulate. 

If you use the rhythm method, it may be time to consider adding another form of birth control to your routine. 

What if you want to become pregnant?

If you are experiencing perimenopause and want to become pregnant, talk about your risks and options with your provider.

The bottom line on fertility during perimenopause and beyond

Many people look forward to the time when they don’t have to worry about unplanned pregnancies anymore. But until menopause, you still have a chance of getting pregnant. So stick with a safe, effective method of birth control until you’ve reached that menopause milestone — 12 months without a period. 

Do you have questions about fertility, birth control, or menopause in general? Reach out to your provider for support.

Reviewed by the Ovia Health Clinical Team

Sources

• “Contraception: You Need It Longer Than You May Think.” The North American Menopause Society. The North American Menopause Society. https://www.menopause.org/for-women/sexual-health-menopause-online/reminders-and-resources/contraception-you-need-it-longer-than-you-may-think. 
• “Menopause FAQs: An Introduction to Menopause.”The North American Menopause Society. The North American Menopause Society. https://www.menopause.org/for-women/menopause-faqs-an-introduction-to-menopause. 
• “Chapter 3: Clinical Issues”. The North American Menopause Society. The North American Menopause Society. https://www.menopause.org/publications/clinical-care-recommendations/chapter-3-clinical-issues. 
• “Perimenopause.” Cleveland Clinic. Cleveland Clinic. October 5, 2021. https://my.clevelandclinic.org/health/diseases/21608-perimenopause. 
• “Age and Fertility (booklet).”American Society for Reproductive Medicine. American Society for Reproductive Medicine. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/age-and-fertility/.