April 5, 2023
Your Menopause Transition Roadmap
The journey through menopause can be challenging. Here’s a checklist to help smooth the way.
By Selene Yeager
Welcome to the menopause transition, a time when you travel from premenopause to postmenopause. The transition is the result of your reproductive system shutting down shop and the hormonal fluctuation and decline that ensues. The menopause transition can bring about a host of symptoms and health challenges during and afterward. Some women travel through relatively smoothly. Others have a turbulent time. Most are impacted at least moderately. And pretty much everyone finds themselves at least a little confused along the way. To help, we’ve created a little road map to help keep you on track.
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The first step in the process is figuring out where you are on the journey. Menopause is the point in time exactly one year following your final period. It typically occurs between the ages of 40 and 58. The average age of natural menopause is about 52. Perimenopause refers to the menopause transition when symptoms start showing up and your cycles become irregular. That generally happens between the ages of 45 and 52. There are women who also go into menopause early, and surgeries such as total hysterectomy and some cancer therapies can put you into menopause. (Medical menopause can be especially challenging. Learn more about smoothing that transition here.)
There’s no definitive test for perimenopause, but rather doctors generally make the call based on the symptoms you’re experiencing. Common symptoms include:
- Irregular periods*
- Anxiety, low mood, anger, and/or irritability
- Difficulty sleeping
- Hot flashes and/or night sweats
- Brain fog, problems with memory
- Body composition changes (muscle loss, fat gain)
- Vaginal dryness, discomfort during sex
- Low libido
- Hair loss or thinning
- Headaches or migraines.
- Increase in facial hair
- Joint stiffness, aches, and pains
- Heart palpitations
- Recurrent urinary tract infections
* If you’re on certain hormonal contraceptives like the pill, you won’t be able to use your periods as an indicator.
A full list of symptoms is here. Check off the symptoms you’re experiencing to see where you are.
The early signs of perimenopause are generally mood changes, such as increased anxiety and/or feeling more depressed, brain fog, and increasingly irregular periods (especially getting closer together), as past Hit Play Not Pause guest Dr. Heather Hirsch explains in her YouTube video here. (Of course, other symptoms can occur here as well; this is a very general guide.) If you’re starting to notice the first inklings of perimenopause, take the following steps:
➡️ Get in the weight room! Research shows the menopause transition is a “vulnerable period for the loss of muscle mass.” In a 2021 study, researchers found that compared to women in early perimenopause, those in late perimenopause had 10 percent less appendicular (aka arms and legs) muscle mass. Late perimenopausal and postmenopausal women were also overwhelmingly more likely to have sarcopenia (involuntary muscle loss) than premenopausal or early perimenopausal women. Though it’s never too late to start lifting weights, if you’re perimenopausal, especially early perimenopausal, and haven’t started yet, now is prime time.
➡️ Incorporate jumping for your bones, short HIIT work for your metabolism, and be sure to get adequate recovery in your training.
➡️ Schedule a checkup. Now’s the time to get on top of the basics. See your doctor for a checkup that includes blood pressure, blood screening, and other basic health assessments (including your menopausal status and symptoms) to evaluate your risk. Research shows menopause is associated with a progressive increase in total cholesterol, especially LDL, lipoprotein-α, and triglycerides and a decrease in high-density lipoprotein (HDL). Having a baseline can help you navigate your care (it can also help rule out if any of your symptoms are related to health issues not related to menopause). While you’re at it, make a plan to start scheduling mammograms and colon cancer screening.
➡️ Consider your options. Now is a good time to do your research on therapies and methods to manage your symptoms such as menopausal hormone therapy (MHT), other pharmaceuticals, cognitive behavioral therapy, and/or adaptogens, like ashwagandha.
As you get further into perimenopause and closer to menopause, your periods start to space out into longer intervals and, as Hirsch notes in her video, other symptoms crop up, such as hot flashes, night sweats, vaginal dryness, more mood and sleep disturbances, as well as myriad other potential symptoms. The following steps can ease the way as you get further into this transition.
➡️ Follow the training and medical advice from early perimenopause if you haven’t already. The advice from early perimenopause still applies here.
➡️ Do a symptom check. Vasomotor symptoms like hot flashes and night sweats affect up to 80 percent of menopausal women. Severe vasomotor symptoms have been linked to an increased risk for cardiovascular disease, white matter hyperintensities (lesions in the white matter of the brain — early markers of later risk for cognitive decline, dementia, and stroke), depression, and memory issues (especially when they disrupt sleep). They’ve also been linked to weight gain. If your symptoms are moderate to severe and especially severe, do not just suffer through or “tough it out.” Seek help from a menopause-informed healthcare provider.
How do you know if your symptoms are severe? There’s no official rating scale, but research generally classifies them according to how much they disrupt your daily life (and that includes sleep), as follows:
Mild — no interference with usual daily activities
Moderate — some interference with usual daily activities
Severe — disrupts or prevents usual daily activities
➡️ Get serious about the small stuff. All the stuff you used to be able to let slide becomes more important now. Prioritize stress management, sleep hygiene, mobility work, good nutrition, and preventative care to set yourself up for success as you enter this next phase of your active life.
➡️ Work with an informed doctor. If you don’t have one already, find a doctor who is informed on the latest research on menopause and hormone therapy and who listens to you.
Once you’ve been 12 months without a menstrual period, you’ve reached the end of the transition and you’ve hit menopause. The rest of your life is considered postmenopause. Women may find that many of their symptoms improve postmenopause, whether or not they’re on hormones. Mood swings generally calm down. Hot flashes and night sweats generally wane. Brain fog generally lifts. Though it’s important to note that not all women enjoy an improvement in symptoms. Hot flashes can persist for years, and not all women experience a cognitive rebound. Symptoms like vaginal dryness can get worse. The following steps can help as you exit the transition and enter this phase of life.
➡️ Follow the training and medical advice from early and mid to late perimenopause if you haven’t already. That advice still applies here.
➡️ Check in on your skeletal health. You can lose up to 20% of your bone density during the five to seven years following menopause. That loss evens out and becomes more gradual again after that point, but left unchecked, you’re still facing more loss. DEXA bone scans are generally not medically recommended for women under the age of 65. But if we wait until the recommended age, we’ve missed an opportunity to intervene during the critical window of bone loss in the menopausal transition. That’s why some researchers recommend DEXA scans for postmenopausal women as young as 50. If osteoporosis runs in your family, you’ve had a fracture, and/or you’ve been on medications that hinder bone metabolism, definitely get a bone density scan.
➡️ Consider vaginal estrogen. Some medical experts like past Hit Play Not Pause guest Dr. Kelly Casperson believe that pretty much all women should start using vaginal estrogen after menopause as a way to preserve vaginal health.
➡️ Get annual checkups. Getting regular checkups can help you catch health issues when they start. If you’re considering hormone therapy, the best time is within 10 years of reaching menopause or before age 60. If you’re on hormone therapy, there’s no set age at which you have to stop. If you’re getting regular checkups and everything looks good, the current NAMS guidelines say it’s safe to continue MHT.