How to Work with Your PCP to Manage Menopause

Understanding Menopause 

Menopause is the biological process marking the natural decline of reproductive hormones that ends a woman’s menstrual cycles and prime fertility years for having children. It signals the time when the ovaries lose follicular function, which is the ability to release eggs. 

Signs and symptoms of menopause can vary greatly, from mild or unnoticeable to severe and debilitating. While there are hormonal and non-hormonal treatments for symptoms that may impact general health and well-being, it’s important to know and understand menopause so you can partner with your healthcare practitioner to help you manage the menopause transition, which can be highly emotionally charged. 

Read on to understand what menopause means, recognize early signs and symptoms, learn about menopause self-care, and how best to manage your menopause experience.

When does menopause start?

The timing of menopause onset differs from woman to woman depending on a combination of factors. It can happen as early as age 30 and as late as in your 80s, though it typically happens in your 40s and 50s. World Health Organization statistics show that most women go through it between the ages of 45 and 55, with 51 being the average age for menopause in the United States. 

Women who enter menopause early tend to be underweight or lean; being overweight or obese women can cause later onset. Early onset also has been linked to an increased risk of type 2 diabetes. 

Medically defined, menopause occurs when you’ve not had a period for 12 consecutive months. If you have not menstruated for, say, 10 months and then have a period, the 12-month countdown starts over again. 

Perimenopause occurs first in a woman’s late 40s, when the ovaries start to wind down and periods may become irregular. A very low percentage of women enter perimenopause or menopause younger than age 40. This is called primary menopause or POI – primary ovarian insufficiency (formerly known as primary ovarian failure) – when women experience irregular or very few periods for years but may still get pregnant.

Symptoms of menopause

Menopause symptoms typically start during perimenopause, most notably menstruation becoming irregular; you may skip periods for a couple of months, or skip one a few times, or have very short, light, long or heavy periods. Hot flashes are another primary symptom when your body’s temperature regulation capability is impacted by decreasing levels of estrogen and progesterone.

Some women report that besides their periods ceasing, they experience no other signs or symptoms of menopause. Others endure severe symptoms during perimenopause and menopause that can even continue into postmenopausal years, though for most women symptoms last only three to five years. A full list of potential symptoms includes:

• Common symptoms
  • Irregular periods 
  • Hot flashes
  • Night sweats
  • Chills 
  • Skin flushing (redness)
  • Chills 
  • Insomnia or sleep problems 
  • Daytime drowsiness 
• Other potential symptoms 
  • Headaches
  • Mood swings 
  • Forgetfulness
  • Loss of Libido, changes in sexual response or decreased interest
  • Vaginal infections, dryness and painful intercourse 
  • Urine Leakage 
  • Decreased breast fullness
  • Slowing metabolism and weight gain
  • Dry skin
  • Thinning hair
  • Aching or painful joints 
  • Heart palpitations
  • Skin breakouts referred to as menopause acne

Fast facts and stats 

• 45% of older women in the U.S. in 2023 reported that menopause had “extremely impacted” their sleep. Additionally, one in three said their mood or mental health had been “extremely impacted.”
• The National Institutes of Health reports that 50 to 75% experience menopausal genitourinary syndrome – reduced vaginal elasticity that can cause vaginal dryness, irritation of pruritus (menopause itching cause by skin irritation resulting from reduced estrogen levels).
• UCLA’s SWAN longitudinal that study began in 1994 found in 2023 that premenopausal women of color experience heavier bleeding. The study also revealed that most women (80%) suffer hot flashes during menopause, two-thirds suffer from loss of memory, and that fast bone loss (risking osteoporosis in later years) starts one year before the final menstrual period.
• A 2021 University of London survey found that 49% didn’t feel they were informed enough about the realities of menopause, and 62.7% said their experience was difficult or very difficult, using the words “nightmare” and “awful.”

Stages of Menopause

In common vernacular, menopause is the overall general term used for three specific medically defined stages experienced over several years as the body loses its ability to reproduce:

Stage 1: Perimenopause

Typically starting in the mid to late 40s, this is the time when menstrual cycles may become irregular or erratic as the fertility hormones estrogen and progesterone start to decline. Premenopausal side effects may include vaginal dryness, night sweats and hot flashes

Stage 2: Menopause

This happens when you have not had a period for 12 consecutive months, during which time the body is transitioning: the ovaries’ supply of mature eggs diminishes and can cause irregular ovulation and periods. Simultaneously, the production of hormones estrogen and progesterone declines. Most symptoms of menopause are triggered by estrogen levels dropping substantially. After a full year of no periods, postmenopause has begun. 

While the National Institutes of Health reports that there is no general agreement among medical experts about any one or few specific drivers of menopause onset, studies show a variety of many factors can affect the timing. Researchers have found these to include age at menarche (a woman’s first period), mother’s age at menopause, gestational age (the time between conception and birth), number of pregnancies and births, regularity of menstrual cycles, polyunsaturated fats consumed, serum lead levels, education and socioeconomic status, general health and lifetime disease occurrences, diet, prescription medications, and use of alcohol, tobacco and drugs. A blood test for menopause that ascertains levels of FSH – follicle stimulating hormone – can also confirm menopause.

Stage 3: Postmenopause

Postmenopause begins after 12 months with no menstruation and lasts for the rest of your life. For many women, symptoms experienced at the height of menopause diminish. However, the occurrence of what is known as postmenopausal syndrome can result in their continuation. 

Scientific research finds it difficult to separate health issues during postmenopause from those of the general aging process, but have found primary health concerns to include: osteoporosis, cardiovascular disease, cancer, sexual decline, cognitive decline, psychiatric symptoms, vasomotor symptoms (issues with temperature regulation that can cause hot flashes and night sweats due to gonadal hormone changes), and urogenital atrophy (recurring urinary tract infections, vaginal dryness and sexual dysfunction).
 

The impact of menopause on your health

Physical changes

Women experience the effects of menopausal transition in several ways, mainly because of complex hormonal changes. Metabolism can slow, which means the body uses energy differently and fat cells change, often leading to weight gain and changes in body composition and/or physical shape. This is a result of decreasing hormones, in particular estrogen. 

Changes can also occur in heart and bone health. Research points to estrogen being a protective hormone for women against cardiovascular disease (CVD). When estrogen production declines during menopause, CVD risk increases. Postmenopausal women also face what experts now refer to as a serious health issue: osteoporosis – rapid bone loss that significantly increases the risk of fractures. Again, this is related to estrogen deficiency, but also from excessive glucocorticoid, steroid hormones made by the adrenal glands cortex that play an important role in how fat, glucose and protein is metabolized and stored in the body. Glucocorticoid can cause demineralization of bone making it weak, and it’s why most women are advised to undergo a bone density test, typically at age 65.

Pregnancy and menopause

Natural pregnancy is not possible after menopause occurs, as the ovaries stop making and releasing eggs. This is also the case when women have both their ovaries and/or uterus removed at any age, which causes immediate menopause.

During perimenopause (stage 1), pregnancy is still possible, even though the likelihood is lower due decreased fertility (along with typically decreased coital frequency). Pregnancies that do occur during perimenopause are at higher risk for chromosomal deficiencies, miscarriage and maternal complications. It is important to discuss sexual habits, pregnancy risk and continuing contraception with your healthcare provider. 

You may not feel old in your mid-30s, but pregnancy after age 35 is considered a “geriatric pregnancy” because advanced maternal age increases health risks to both mom and baby. These risks include miscarriage, gestational diabetes, high blood pressure while pregnant, preeclampsia, stillbirth, cesarean section, premature birth weight, having twins and genetic disorders such as Down Syndrome.

Menopause and mental health

Shifts in hormone balance due to plummeting estrogen and progesterone are to blame for mood swings suffered by many women throughout perimenopause, menopause or both. Experts at Harvard Medical School say estradiol is the major culprit as the most potent form of estrogen. Hormone replacement therapy (HRT) is the main treatment to balance out hormones back to more normal levels. 

While instances of psychiatric symptoms including anxiety and depression are higher in menopausal women, a clear correlation has not yet been scientifically proven. However, while your body is enduring many physical changes during perimenopause and menopause, it’s important to understand that your mood swings and irritability are normal and to place importance on taking care of your mental health.
 

How to manage symptoms of menopause

Managing menopause naturally

There are several natural menopause relief lifestyle approaches to consider, including the following:

• Exercising regularly: Working out — especially cardio — can help protect against cardiovascular disease. Research shows Pilates is a good workout choice for postmenopausal women as it helps combat anxiety, depression and fatigue.
• Mindfulness and meditation: Numerous studies show that menopausal women report being better able to manage their overall symptoms and experience improved sleep and mental well-being by practicing yoga, Tai Chi, mindfulness, meditation and breathwork.
• Eat a nutritious balanced diet: A balanced diet that includes lots of fruits and vegetables has been shown to help in preventing cardiovascular disease. Research shows that menopause supplements including calcium and vitamin D can help maintain bone strength and decrease the risk of breakage, especially hip fractures. Limiting processed foods and refined sugar has been shown to help decrease depression in menopause.
• Consider taking science-backed supplements: More research is needed, but preliminary studies show that the following ingredients in menopause supplements may help reduce symptoms. Consult with your doctor to see if they are right for you:
  • Black cohosh: helps reduce instances of hot flashes.
  • Red clover: may relieve flushing episodes and hot flashes.
  • Evening primrose oil: has the potential to reduce night sweats. 
  • DHEA: dehydroepiandrosterone (DHEA), produced naturally by the body to aid in the production of other hormones, may help with vaginal dryness and painful sex after menopause, osteoporosis and overall wellness through menopause and general aging.

How your primary care doctor can help you manage menopause

To get the best care and start feeling better, be open with your physician about your menopause-related concerns. Share your health history, your current sexual activity and any specific menopause-related symptoms you’re experiencing. Discuss any health problems or medication side effects that may be affecting your reproductive health h, and be open to medication changes and new treatments. The key is to be honest and transparent with your doctor so he or she can guide you to your goal.

Be completely honest with your doctor 

Sometimes, it’s tempting to be less than truthful with our doctors when it comes to fraught topics like sexual activity, reproductive health and weight. It’s understandable to feel embarrassed or even ashamed if you’re struggling with issues related to sex or sexual health. Like menstruation and many other matters related to women's health, menopause can be a sensitive topic that is difficult to talk about.

Your doctor has seen it all: You won’t be their first patient to struggle with these issues. You can also communicate to your doctor that you are anxious or embarrassed about these topics and that you could use reassurance.

Make a list of your questions and concerns

It’s easy to forget important questions at the doctor, especially if your appointment is short or rushed. A simple solution is to write out your questions and concerns ahead of time. You could even keep a list on your phone or a pocket notebook and add to it whenever you think of something else you want to bring up.

If you are planning to make (or have already made) major lifestyle changes, it’s recommended that you check with your doctor to ensure these changes are safe and appropriate for you. Good general questions to ask include:

• What steps do you recommend for managing my symptoms?
• Should I be tested for any menopause-related diseases?
• Do you have patients who successfully reversed their perimenopause or menopause symptoms? 
• Is there a hormonal or other medication I should try?
• Are there menopause books, podcasts, or literature I should check out?
• What lifestyle changes do you recommend?

Bring your spouse or trusted friend

Not everyone knows that you are allowed to bring someone with you when you go to the doctor. Having a confidante by your side can make you feel more secure and help you remember what you want to talk about with your doctor. It also shows your doctor that you have a strong support system and research has shown that strong social and emotional support are associated with better health.

Take notes

Doctor’s appointments can be overwhelming. In order to remember your doctor’s recommendations, it can be helpful to take notes during your appointment. If you bring someone with you, you can ask them ahead of time to take notes for you. You should also get a visit summary from your doctor after each appointment. If you are not sure how to access this summary, ask your doctor or a member of their front desk staff.
 

Conclusion

Menopause is an inevitable part of a woman’s life. Every woman will experience it – whether naturally when the ovaries shut down and menstruation stops, or after removal of the ovaries or uterus. The keys to surviving menopause are knowing the signs and symptoms, being educated on how to manage your unique menopause experience, and partnering with your doctor to help you get through menopause in the healthiest and most emotionally balanced way possible.

Wondering what doctor to see for menopause? Find an MDVIP-affiliated physician to help manage your menopause.
 

FAQ About Menopause

Can you get pregnant during menopause?

Pregnancy is possible during perimenopause – the first stage of menopause – when your ovaries start releasing fewer eggs and menstruation becomes irregular. Once you have gone 12 months without a period, you have entered stage 3, postmenopause, when the ovaries have completely shut down and natural pregnancy is no longer possible.

Can you get pregnant after menopause?

When menstruation completely ceases and you have gone a whole year without a period, this indicates your ovaries have stopped releasing eggs and you can no longer get pregnant naturally.

What is a menopause stage indicator?

Like a home pregnancy test, a menopause stage indicator is a home menopause test to help you track whether you are experiencing perimenopause, menopause or postmenopause, by testing your urine for 10 days to monitor changing follicle-stimulating hormone (FSH) levels, which play a key role in the functioning of a woman’s ovaries.

Do men go through menopause?

“Male menopause” is not a complete myth, but it is not comparable to the severe reproductive hormone decline women experience in menopause. Over a period of many years as a man ages, levels of testosterone and other hormones naturally decline about 1% per year in a process called late-onset hypogonadism. Most men over 40 stay within the normal range, with only 10-25% having levels deemed low with a blood test, typically due to being overweight with a body mass index (BMI) over 30.

Does menopause make you tired?

Due to drastic hormonal changes, fatigue is a common symptom of menopause. One study shows that 85% of women suffer fatigue and stress during menopause. Hormone replacement therapy (HRT) or complementary therapies such as yoga, mindfulness and meditation may help.

What signals the end of menopause?

When you’ve experienced 12 consecutive months without a period, you are through menopause and are now in postmenopause, where you will remain for the rest of your life. Typically, menopause symptoms gradually decrease but can sometimes continue to varying degrees. If so, consult with your doctor for possible continuation of menopause treatments.