Navigating Menopause:

Menopause is a life event that women reach when they have gone one full year without a period. It signals the end of your reproductive years and typically occurs around the age of 51.⁽¹⁾

The years leading up to menopause is a stage called perimenopause. This is when you’ll often start to experience symptoms. Perimenopause typically begins in the mid-40s, with about 1.5 million women going through the menopausal transition every year.⁽¹⁾

So what causes menopause? Throughout a woman’s life, the sex steroid hormones estrogen and progesterone are responsible for reproductive health. These key hormones also support physical health and mental well-being. Estrogen and progesterone are produced in the ovaries, but over time, production of these hormones slows down as a woman’s supply of eggs in the ovaries rapidly declines. This is what causes you to enter the menopause transition.

Could you have reached menopause? Take Winona’s short Health Quiz to find out.

The driving force behind menopause is changes in levels of key reproductive hormones that naturally decline over time. Let’s break down everything that happens inside your body as hormone levels shift.

The Key Players: Estrogen, Progesterone, and FSH

Estrogen, progesterone, and follicle-stimulating hormone (FSH) are three important menopause-related hormones that help regulate many of your body’s systems.

• Estrogen: As the main sex steroid hormone in your body, most people think of estrogen in connection with puberty, pregnancy, and regulating the menstrual cycle — but it does a lot more than that. It also supports your heart, bone, and muscle health. Estrogen also helps ensure your nervous system and immune system are functioning properly and that your blood sugar levels stay balanced. Your mood is also influenced by estrogen.⁽²⁾

• Progesterone: Progesterone is your other main sex steroid hormone. One of its most important jobs is to prepare the uterus for pregnancy, but it also supports bone health and helps you process and manage your emotions.⁽³⁾⁽⁴⁾

• Follicle-stimulating hormone (FSH): FSH is not a sex steroid hormone but it’s still a key player in women’s sexual development and reproductive health. FSH is released by the brain and helps the ovary produce estrogen and maintain the health of your menstrual cycle.⁽⁵⁾

Throughout different stages of the menopause transition, your levels of estrogen and progesterone will rise and fall before gradually declining, while your FSH levels will increase.⁽⁶⁾

Why are my FSH levels rising during menopause?

Menopause is caused by declining hormone levels, so the rise in FSH levels can be a bit confusing. Here’s how it works.

Before menopause, estrogen tells your brain when to increase or suppress the release of hormones like FSH. However, menopause disrupts this communication between the ovaries and the brain. As your ovaries produce less estrogen, this triggers your brain to produce more FSH. Rising levels of FSH, along with other hormonal fluctuations, cause changes to your menstrual cycle. Ovulation becomes less frequent, and you'll eventually have your last period.⁽⁵⁾⁽⁷⁾

Other Causes (Surgical & Medical Menopause)

While some women go through natural menopause, others may experience medical or surgically-induced menopause. This happens when medical treatments like chemotherapy or procedures like surgical removal of the ovaries (bilateral oophorectomy) reduce or stop your ovaries from functioning. Medical menopause can sometimes be temporary, but women who have surgery to remove both of their ovaries will immediately reach menopause and then be permanently in postmenopause.⁽⁸⁾

Over the course of your life, you'll navigate three different stages of the menopause transition: perimenopause, menopause, and postmenopause.

Your menopause journey may be similar or completely different from another woman’s experience. But knowing what to expect during each stage can help you determine where you are in the process and alleviate anxiety about what’s to come.

You can think of perimenopause as the “on-ramp” to menopause. This is usually when things start to feel “off” as hormone levels begin to fluctuate like a hormonal rollercoaster. Most women enter perimenopause around the age of 47, although it can start earlier or later.⁽⁹⁾

Perimenopause lasts an average of four years, although some women experience symptoms for anywhere from two years to eight years or more. This stage tends to last longer if you enter the menopause transition at an earlier age.⁽¹⁰⁾

The first sign of perimenopause you’ll likely notice is changes in your menstrual cycle. This may include changes in bleeding patterns or menstrual flow. Periods may be closer together, further apart, or last for a shorter or longer amount of time. You may bleed more than usual, while other women may have lighter periods. You may also skip periods.⁽¹⁰⁾ Even though your periods may be irregular, you can still get pregnant during perimenopause. That’s why it’s important to continue using birth control until the age of 50.

If premenstrual syndrome (PMS) symptoms become more intense, this can also be a sign of perimenopause.⁽¹¹⁾ You may also begin to experience hot flashes and night sweats. Perimenopause can bring about changes in cognition, emotional well-being, and energy levels. Fatigue, brain fog, and mood shifts are all hallmark signs of the menopausal transition

Menopause is a point women reach in their lives when they have not had a period for 12 consecutive months. This milestone signifies that women can no longer become pregnant. The average age of menopause is 51 in the United States (U.S.).⁽¹⁾

Although menopause is often categorized as a separate stage, menopause itself is a life event, not a phase. This means that, unlike perimenopause, it doesn’t last for years. The day you reach menopause, you’ve entered the next chapter of the journey: postmenopause.

Postmenopause is the final stage of the menopause transition, and it continues for the rest of your life. Many women begin to finally feel like themselves again during this stage as symptoms subside and hormone levels stabilize at a new low. However, some symptoms may linger for longer than expected. Hot flashes, vaginal dryness, low sex drive, and painful sex are all symptoms that can persist in postmenopause.⁽¹²⁾

Wondering which stage you’re in? Get answers with Winona’s free Menopause Quiz.

Over 80% of women navigating the menopausal transition experience symptoms.⁽⁷⁾ With more than 100 known symptoms, let’s break down the most common menopause symptoms into groups based on which body systems are affected.

Vasomotor Symptoms

Vasomotor symptoms are the most common symptoms of menopause. It’s believed that drops in estrogen alter the body’s system of thermoregulation.⁽¹³⁾ Menopausal vasomotor symptoms include the following:⁽¹²⁾

Hot Flashes: You may experience a sudden wave of heat in the chest, neck, or face that can last anywhere from less than one minute to more than five minutes. This can also be accompanied by intense sweating, chills, or flushing. The frequency of hot flashes varies, with some women experiencing upwards of ten a day.

Night Sweats: These involve excessive nighttime sweating that can leave your sheets drenched and interrupt sleep.

Mental & Emotional Impact

Menopause doesn’t only affect the body. It can also affect emotional and mental health in the following ways:⁽¹²⁾

Mood Swings: Your mood may shift suddenly throughout the day from feelings of happiness to sadness to irritability.

Anxiety: Estrogen helps regulate your body’s “fight-or-flight” stress response. As estrogen levels fall, you may feel increased fear, worry, or anxiety.

Depression: Women who experience more intense menopausal symptoms may be more prone to depression during perimenopause.

Sleep Problems: Night sweats and increased stress can make it harder to fall and stay asleep. It’s also not uncommon for sleep disorders to develop during this phase of life.

Physical Changes Throughout Your Body

Menopause can have wide-reaching effects across the entire body:^{(12)(14)(15)(16)(17)}

Irregular Periods: Your periods will become more irregular as you progress from early perimenopause to late perimenopause.

Joint & Muscle Pain: You may feel joint or muscle aches as hormonal shifts cause structural changes to your body’s tissues.

Weight Gain: You may notice weight gain around your midsection, as low estrogen levels can affect metabolism, appetite, and weight distribution.

Hair & Skin Changes: Due to the drop in estrogen levels, your hair may start falling out and become thinner. These hormonal changes also cause dry skin as it loses collagen and elasticity. As a result, you may notice the appearance of fine lines and wrinkles.

Changes in Vaginal Health and Libido (GSM)

The following symptoms are part of what’s called the genitourinary syndrome of menopause (GSM):⁽¹²⁾

Vaginal Dryness: The vaginal tissues become thinner and drier as estrogen levels decline, making it harder for the vagina to self-lubricate.

Painful Sex: Vaginal dryness and irritation may cause physical discomfort during sex (dyspareunia).

Urinary Incontinence: Estrogen deficiency can cause the muscles of the pelvic floor to weaken, increasing the risk of bladder leaks.

Low Libido: It’s common to lose interest in sexual activity due to mood changes, vaginal dryness, or painful sex.

Menopause is not a medical condition. Understandably, this can cause confusion about how menopause is diagnosed. Knowing how the diagnostic process works can help you feel empowered when seeking help.

How a Doctor Diagnoses Menopause: Your symptoms tell the story.

The menopause transition cannot be diagnosed with a test. To determine whether you may be going through perimenopause, clinicians will rely on your personal experience. That’s why it’s important to report any symptoms you’ve been experiencing from hot flashes to mood swings, menstrual irregularities, changes in sexual desire, and anything else that feels unusual or disruptive to your daily life.

Your age, medical history, medication use, and menstrual history are also important factors. This comprehensive assessment will give your doctor the information they need to make a proper diagnosis and treatment plan that fits your lifestyle.

Want to consult a board-certified menopause specialist? Start your free visit with Winona.

Why Hormone Blood Tests (Like FSH) Can Be Misleading

You may have heard about hormone blood tests to diagnose the menopause transition — but hormone testing doesn’t tell the whole story. Because FSH levels rise during perimenopause, it’s sometimes assumed that FSH testing is needed for an official diagnosis. The problem is that hormone levels are not consistent; they fluctuate widely throughout the day. A blood test will only give your healthcare provider an idea of what your hormones are doing at that moment. More information is needed to get a clearer picture of what’s happening inside your body.

The American College of Obstetricians and Gynecologists (ACOG) and the Menopause Society do not recommend hormone testing. Similarly, Winona relies on your story to diagnose and treat menopausal symptoms with menopause hormone therapy (MHT).^(18)(19)

Your 3-Step Plan for a Productive Doctor Consult

Having as much information at the ready as possible can help you feel confident and prepared when it’s time to connect with your doctor.

1. Track your symptoms: Spend a week tracking your symptoms in a journal or using a menopause symptom tracker. Include what you felt, how long it lasted, and how severe it was. You’ll also want to track your periods, including any changes in flow, cycle length, and frequency.

2. Prepare the necessary information: Be ready to share your individual and family medical history. Keep your symptom journal and an up-to-date list of all medications and supplements you’re currently taking on-hand.

3. Write down your questions: Prepare in advance by jotting down a list of questions to ask or any concerns you have for your doctor to address.

While symptom management is the primary focus of perimenopause, maintaining long-term health is the focus of the postmenopause stage. Menopause-related health risks increase as women age, but taking steps to prioritize your wellness can make a big difference.

Protecting Your Bones (Osteoporosis Risk)

Bones naturally weaken with age, and menopause can accelerate bone loss. According to the Endocrine Society, women can lose up to 20% of their bone mineral density (BMD) throughout the perimenopausal and postmenopausal stages.⁽²⁰⁾ This can increase the risk of osteoporosis and fractures later in life. 

Eating calcium-rich foods like milk, cheese, yogurt, and spinach can support your long-term musculoskeletal health. Weight-lifting, resistance training, or balance exercises can also help maintain bone strength. Keeping up with annual doctor’s appointments is also important for catching early warning signs of osteoporosis.

Caring for Your Heart (Cardiovascular Risk) 

Estrogen supports heart health by helping maintain healthy cholesterol levels. However, these protective effects may lessen as hormone levels change, making diet and exercise all the more important to prevent heart disease.

Eating a healthy diet of whole grains, fish, fruit, and vegetables can help keep cholesterol levels in check. Aerobic exercise also supports heart health, which can include fun activities like walking, dancing, biking, or water aerobics.

Supporting Your Brain (Cognitive Health)

Keeping your mind active is just as important as keeping your body active. Some research suggests a link between menopause and an increased risk of cognitive decline and dementia.⁽²¹⁾ Socializing, learning new skills, or taking up new hobbies can help maintain your cognitive health later in life.

Pelvic & Urogenital Health (GSM)

GSM symptoms like urinary incontinence or vaginal dryness can get worse without treatment. Doing Kegel exercises can help strengthen the pelvic floor muscles and reduce bladder leaks, while hormone therapy, vaginal moisturizing creams, and lubricant products are a few of many effective treatments for vaginal dryness.^(22)(23)

You don’t have to “muscle through” menopausal symptoms alone. With the help of a menopause specialist, you can find relief with a holistic treatment plan tailored to meet your individual needs.

Menopause Hormone Therapy (MHT): The Most Effective Treatment

MHT is the gold standard of menopause treatments because it gets to the root cause of the problem: hormonal changes. By increasing low levels of estrogen and progesterone, many women begin to feel better in about four to six weeks.

Hormone therapy is the most effective treatment for menopausal hot flashes and vaginal symptoms. It may also reduce bone loss. It’s recommended to start treatment before the age of 60 or within ten years of the final menstrual period.⁽¹⁹⁾

There are two different types of MHT:

• Systemic treatments (treat the whole body)

• Localized treatments (treat a specific area of the body)

The following are the most common forms of MHT:

• Tablets

• Capsules

• Patches

• Body creams

• Vaginal creams

Is MHT right for you? Take Winona’s free Menopause Quiz to find out.

Lifestyle and Holistic Approaches

Maintaining your physical and mental health can make it easier to manage menopausal symptoms. The following lifestyle and holistic treatment approaches can help:

• Getting weekly physical activity

• Optimizing for sleep by keeping the bedroom cool

• Managing stress levels with meditation, deep breathing exercises, or yoga 

• Seeking emotional support from friends, support groups, or a mental health professional

• Avoiding caffeine, alcohol, and spicy foods to reduce hot flashes

• Drinking plenty of water

• Wearing clothes and pajamas made of light fabrics 

• Eating foods rich in essential vitamins and minerals

• Not smoking

What should I do next? How to Take Control of Your Menopause Journey

Menopause may be inevitable, but discomfort doesn’t have to be. Now that you understand how the menopause transition works, the changes you might experience, and what treatment options exist, you can seek help and take the next steps with confidence.