Navigating Menopause: Beyond the Hot Flashes

There’s nothing glamorous about hot flashes. The most telling symptom of menopause and the most common reason people seek treatment for this condition, hot flashes (aka vasomotor symptoms) are sudden feelings of warmth in the upper body, which usually feel most intense over the chest, neck, and face.

But there is no shortage of better (and probably more useful) descriptions offered up by women who’ve felt the heat of hot flashes first-hand:

'It’s like my own personal summer.”

“It feels like being consumed by fire from the inside out.”

“It’s like having a furnace explode in my body.”

The medical term is so infamous, it has spawned an entire industry of self-help products and merch. There are hot flash t-shirts (“Still hot – it just comes in flashes now!”). Hot flash pajamas. Hot flash spray. Hot flash sheets. Hot flash patches. Hot flash tea. Hot flash fans.

Of course, hot flashes are just the beginning of things. There are several other symptoms menopausal people often feel on the regular. Night sweats. Mood swings. Painful intercourse. Low libido. Vaginal dryness. Irregular periods. Heavy bleeding. Sleep disturbances. And the list, literally, goes on.

It goes without saying that perimenopause (the time period that precedes menopause when symptoms first appear) and menopause are naturally-occurring conditions that can be unnaturally disruptive, debilitating, and difficult to navigate.

Thankfully, menopause is having a moment and, hopefully, a moment that will last. Media outlets, social media influencers, and medical practitioners are paying more attention. And many forward-thinking health and wellness companies are developing new products to help educate and ease the minds and bodies of the 2+ million people who reach menopause each year in the US.

Hopefully, this overview will also educate and ease a few minds, and help demystify and destigmatize a natural and unavoidable bodily process that should be respected as a rite of passage worth honoring and understanding.

What is menopause?

Menopause is a natural biological process that marks the end of a person’s menstrual cycles and fertility, and its diagnosis is confirmed after an individual has gone 12 consecutive months without a menstrual cycle. At this stage, ovaries stop producing estrogen and stop releasing eggs. The time period leading up to menopause, when people start experiencing changes in their menstrual cycles, hot flashes, and other symptoms is called perimenopause. As perimenopause marches toward menopause, many people start experiencing more and more menopause symptoms (including irregular periods), but ovulation still occurs and a perimenopausal person can still get pregnant.

How long does perimenopause last? When does menopause begin?

The average duration of perimenopause is around four years, although it can last just a few months or extend as long as a decade. Characterized by irregular menstrual cycles and other symptoms related to hormonal fluctuations, perimenopause usually starts in your 40s. Some people experience symptoms for a few months. Some people have symptoms for several years. Typically, menopause begins in a person’s late 40s or early 50s, but the exact age varies widely.

What are the symptoms of menopause and perimenopause?

Menopause is associated with a variety of symptoms, but the duration and severity of these symptoms vary among people. Additionally, some symptoms will be temporary and resolve on their own while others may persist and require medical attention. Every situation is specific and anyone experiencing bothersome menopausal symptoms should consult her healthcare provider to discuss management options.

In some cases, your provider might recommend a blood test to check your follicle-stimulating hormone (FSH) and estradiol (E2) levels. Although a high FSH can be a sign of perimenopause, a single FSH reading isn’t a reliable indicator since day-to-day hormone levels fluctuate dramatically. Truthfully, it can be difficult to distinguish the hormonally-based symptoms of perimenopause from more general changes due to life transitions – aging, midlife events, children leaving home, career and relationship changes – so it’s unlikely all perimenopausal symptoms are due to hormonal fluctuations alone.

Common symptoms of menopause include:

• Irregular Menstrual Cycles: Declining estrogen levels can make periods more unpredictable, and with less progesterone to regulate growth of the endometrium, the uterine lining may become thicker before it sheds. This can result in heavier periods. Fibroids and endometriosis, both of which are fueled by estrogen, might become more troublesome too.
• Hot Flashes and Night Sweats: An estimated 30-35% of perimenopausal and menopausal people suffer sudden waves of body heat with flushing and sweating that can last 5-10 minutes. These episodes can occur at night while sleeping too.
• Sleep Disturbances: About 40% of perimenopausal people have sleep problems – trouble falling and staying asleep. This can lead to insomnia and fractured sleep problems and, of course, contribute to fatigue and fogginess.
• Vaginal Changes: During late perimenopause, falling estrogen levels can cause vaginal tissue to become thinner, drier, and less elastic, which can lead to itching, irritation, painful sexual intercourse, and an increase in urinary tract infections (UTIs).
• Mood Symptoms: Hormonal fluctuations during perimenopause might contribute to mood changes, including irritability, anxiety, and depression. That said, studies haven’t proven a definitive correlation between hormone levels and new mood symptoms. Of course, the unpredictability of perimenopause can be stressful and provoke irritability on its own. The best predictors of mood symptoms, in general, are life stress, poor overall health, and personal and family history.
• Fatigue: Some people experience increased fatigue and lack of energy during perimenopause.
• Changes in Libido: Some people report lower desire and more difficulty being aroused.
• Memory and Concentration Issues: Perimenopause can affect memory, concentration, and cognitive function.
• Joint and Muscle Pain: Perimenopause can be associated with joint and muscle pain.

Are there ways to treat these symptoms?

The short answer: Yes. There are several useful treatment strategies for managing perimenopause and menopause symptoms, including non-prescription remedies, medical interventions, and lifestyle changes. As always, it’s essential to discuss new, bothersome, or worsening symptoms with a healthcare provider to determine the best approach.

• Hot Flashes: The first rule of thumb is to avoid possible triggers (you’ll know them), like warm air temperatures, hot beverages, and spicy foods. For example, dressing in layers so you can quickly remove layers is always a good idea. Some people find relief with certain medications, like SSRI antidepressants, gabapentin, and clonidine, but there are side effects that need to be considered. For severe hot flashes, estrogen replacement is the only true fix.
• Irregular Periods: Low-dose birth control can be a good choice here. By suppressing ovulation, these meds modulate menstrual flow, regulate periods, and stabilize endometriosis. They also protect against endometrial and ovarian cancer, stave off hot flashes, reduce vaginal dryness, and prevent bone loss.
• Vaginal Dryness: Low-dose contraceptives or vaginal estrogen therapy can help relieve this symptom. But there are other approaches. Vaginal moisturizers can improve moisture and elasticity and lubricants (find a good water-based lube) can make intercourse less painful. Additionally, sexual activity seems to improve vaginal tone and help maintain a healthy acidic environment that can be protective against infections.
• Non-prescription Remedies: Some people find relief using products like soy-based supplements, black cohosh, and herbal remedies, but efficacy varies. Definitely discuss their usage with a care provider.
• Bone Health: Maintaining bone health is a crucial consideration during menopause and calcium and Vitamin D are two supplements often recommended to reduce the risk of osteoporosis.

What lifestyle changes help with symptoms?

Adopting certain lifestyle changes can help manage symptoms of perimenopause and menopause and contribute to overall health and wellbeing. Here are some lifestyle habits that might beneficial:

• Regular exercise: Both aerobic exercises and strength training helps manage weight, boost mood, and improve sleep.
• Healthy Diet: Consuming a well-balanced diet rich in fresh fruits and vegetables, whole grains, healthy oils, and lean proteins is never a bad move.
• Stress Management: Practicing stress-reducing techniques, like meditation, yoga, deep breathing, and mindfulness can have positive impacts on mood and wellbeing.
• Adequate Sleep: Thoughtful sleep hygiene – consistent sleep schedule, comfortable sleep environment (dark and cool), relaxing before bedtime – might help alleviate symptoms.
• Reduce Caffeine and Alcohol: They can contribute to poor sleep and exacerbate hot flashes.
• Stay Hydrated: A good habit for overall health.
• Maintain a Healthy Weight: Good eating habits + regular exercise. A healthy weight can alleviate symptoms and reduce the risk of health conditions.

A reminder: Treatment decisions should be personalized based on your own health history, personal preferences, and subjective symptomology. Regular check-up and check-ins with a provider are essential for monitoring progress and adjusting the plan.

Take control of your own menopausal journey

Perimenopause and menopause are natural biological processes that all women face, usually beginning in their forties, that cause numerous symptoms related to declining supplies of estrogen and progesterone. Hot flashes tend to get the most buzz, but other symptoms (vaginal dryness, mood changes, sleep disturbances) can be just as disruptive and discomforting. Thankfully, there are many ways to manage these symptoms and many more lifestyle adjustments that can lighten the emotional and physical load of perimenopause and menopause as well. And while several important studies have demonstrated an association between menopausal symptoms and lower quality of life, many menopausal women report positive aspects associated with this life stage as well. So, we leave you with a few good reasons to have hope:

No more periods or menstrual symptoms. Sex without worrying about pregnancy. Disappearing body hair. Shrinking uterine fibroids. A renewed zest for life. More confidence. Increased bonding with other women.

If you are experiencing symptoms of perimenopause or menopause, sign up for a Tia membership and schedule an appointment with the clinic nearest you. Tia's clinics are located in New York, Arizona, Los Angeles, and San Francisco. Let Tia’s team of sexual and reproductive health experts address your concerns with the highest quality, most comfortable gynecological care around.