Menopause is often associated with feelings of dread. In part, that’s because of the myriad of symptoms people have come to expect with menopause, but it’s also because of tropes that have long told us as soon as a woman enters menopause, she is past her prime.
But this outlook is far from the truth.
While there are hormonal changes and symptoms that can accompany menopause, it’s a phase, not an illness. Dr. Jen Gunter, a San Francisco Bay Area-based OBGYN and author of “The Menopause Manifesto,” shares that a good analogy for menopause is puberty. You’re going through some physical changes, and sometimes you have bothersome symptoms like acne or depression, and those issues can be treated. But if you’re not having any symptoms, nothing needs to be done.
Here, there is no stigma – only facts. Read on to find out everything you need to know about when menopause starts, what to expect and what can be done to ease symptoms.
What are the 3 stages of menopause?
Gunter says, “Most people just colloquially refer to the time from when your period has stopped for a year onwards to be menopause. That would be a very fine working definition.”
From a medical perspective, there are three phases of menopause:
- The menopause transition or pre-menopause. This is the time leading up to your last period when your levels of estrogen begin to drop and symptoms typically begin. These symptoms can include irregular periods, vaginal dryness, hot flashes, night sweats, irritability, depression and more.
- Menopause, which is defined as one year after your last period. You can also experience symptoms of the menopause transition in this phase. Perimenopause is another term that may be used – it refers to the menopause transition and the first year after your last period.
- Post-menopause, all of the time in your life after you have experienced menopause.
Gunter adds that since you don’t know what day is going to be one year after your last period, this whole sequence is usually generally referred to as “menopause.” She also says, “I like to call the whole process the menopause continuum.”
When does menopause start?
Gunter says that the average onset of menopause is about age 45, but that can vary widely.
Its length is also dependent on the individual person. “The length of menopause or transitioning menopause can really kind of be anywhere sort of from 4 to 10 years. And the best way to think about that is again, puberty. You didn’t really know how long puberty, and you probably didn’t even really know you were in it until you were, like, really in it. So it’s a bit like that,” she explains.
Menopause symptoms and treatment
Gunter is critical of treatment discussions that are limited to estrogen and menopausal hormone therapy. While they are an important part of the treatment repertoire, they do not holistically address a woman’s health.
“First, it’s important for people to know that if you’re not having any symptoms and you’re doing great and you’re perfectly fine, you don’t need to have any treatment,” she explains. “It’s also important to see your doctor and get an evaluation because menopause is also happening while you’re aging and you want to make sure it’s not something else, right? Or it could be two things at once. So you just always want to be mindful of that,” she emphasizes.
Next, Gunter explains that the approach to treatment depends on the most bothersome symptoms.
Dig deeperWhy some doctors shy away from hormone therapy for menopause – and what to know about risks
Some of the most common symptoms like hot flashes and night sweats respond best to menopausal hormone therapy. And while there is some risk, it is a safe option and may help with many menopause symptoms. But it may not be right for everyone, such as women who have had breast cancer or are at risk of getting breast cancer.
“There’s a small percentage of people who can’t take it. There are also some people who don’t want to take hormones for a variety of reasons or don’t like how they feel while taking them. So, it’s important that we don’t just talk about hormones, and it’s a problem. It’s just become a conversation about estrogen. It hasn’t been a conversation about the wider experience and about all of the things that we can do,” Gunter argues.
In her substack blog, The Vajenda, Gunter has described some of the other treatment options, like gabapentin and a new medication, fezolinetant that have shown to be beneficial for vasomotor (autonomic nervous system) symptoms like hot flashes and night sweats.
Menopause is simply a biological transition, not unlike puberty. It can be mild, harsh or somewhere in between. Staying active, practicing self-care and talking to your physician can ease symptoms.
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