Perimenopause and Menopause: What to Expect (video)

Menopause usually happens when women are in their late 40s or early 50s; the average age of menopause in the United States is 51. Technically, a woman is considered to have completed menopause when she has not had a menstrual period for more than 12 months.

The period of time leading up to menopause is known as perimenopause. During this time, which typically begins in the late 30s or early 40s and can span 10 years or more, women begin noticing changes in their menstrual cycle. For example, their monthly periods may become heavier or lighter than usual. They may also become somewhat irregular.

“During perimenopause, a woman’s periods become closer together for a while, maybe happening every 21 days instead of the usual 28 days,” says Dr. Kelly. “And then they may begin missing periods, and eventually stop having them.”

For some women, the end of their menstrual cycle may be the only noticeable symptom of menopause. For other women, symptoms can be quite severe. As the body’s estrogen levels sharply decrease, hot and/or cold flashes, night sweats, insomnia, mood changes and weight gain can result. Vaginal dryness may cause pain during sex.

Estrogen is also thought to play a role in heart health. During perimenopause and menopause, women may develop heart palpitations and an increased risk of heart disease and stroke.

“Bone loss is another unwanted effect associated with menopause,” says Dr. Kelly. “Over the course of the 30 years or so that a woman may live beyond menopause, she may develop osteoporosis, a thinning and inflexibility of the bones which can lead to fracture and disability.”

Fortunately, treatments can help address many symptoms of menopause. One of the most common is hormone replacement therapy (HRT), which replaces the estrogen and progesterone hormones that a woman naturally produces during her reproductive years. Available by prescription, HRT products are typically made from the urine of a pregnant mare and comes in several forms, including pills, skin patches, vaginal creams and vaginal rings.

In addition to relieving unpleasant symptoms, HRT can help protect bones from osteoporosis. However, it may also increase the risk of breast cancer and other diseases.

Another type of hormone replacement therapy uses bioidentical hormones. These products are made from plant sources to look more like natural hormones.

“For example, estradiol is the main type of estrogen a woman produces,” says Dr. Kelly. “Bioidentical estradiol is going to look like the chemical structure of your estradiol and be absorbed in a way that your natural estradiol would be into your system.”

Bioidentical hormone replacement therapy can help keep your bones strong, help prevent heart disease and dementia, and help with vaginal issues and other symptoms. Because bioidentical hormones bind to the body’s receptors more naturally than traditional HRT, women tend to feel better on it. Bioidentical therapy also may have fewer risks than regular HRT.

Lifestyle also can have an impact on menopause symptoms. Research shows that women who maintain a healthy weight tend to have fewer hot flashes and night sweats; minimizing alcohol and caffeine and getting regular exercise also may help. A cool pad placed beneath the bedsheets can help with night sweat discomfort.

“Whether you’re a woman in your late 30s and starting to have symptoms, or into your 50s or beyond, it’s important to talk to your gynecologist about what you may be experiencing,” says Dr. Kelly. “We can help you figure out an individualized plan, whether it be hormone therapy or something else, to help you through this transition.”