frequently asked menopause questions

What is menopause?

Menopause occurs when the ovaries no longer produce estrogen and progesterone, resulting in physiological changes to the body.  A woman—or person assigned female at birth (AFAB)—enters menopause on the day that marks the 1-year anniversary of one’s last period¹.  For most, menopause will occur naturally, though menopause can be the result of medical interventions such as surgical removal of the ovaries (oophorectomy) chemotherapy or pelvic radiation.  On average, menopause occurs by age 51², though like all things menopause, one’s “anniversary” is individual and can occur years earlier or later.

What is perimenopause?

Perimenopause—also known as the menopause transition—is the period of 5 to 7 years that precedes the milestone of menopause.  Perimenopause is marked by hormonal changes that can manifest in signs or “symptoms” such as hot flashes, night sweats, brain fog, and weight gain, to name a few. Most women (or individuals AFAB) experience perimenopause during their mid 40s, however, it can begin as early as one’s late 30s and as late as one’s early 50s.

The criteria established by the medical community for entry into perimenopause is the onset of irregular or “variable length” menstrual cycles with at least 7-day differences in cycle length (for example, a cycle of 26 days followed by a cycle of 33 days).  Individuals experiencing cycle lengths of 60 days or greater are considered in late stage perimenopause.³ 

What exactly is happening during perimenopause (aka “the menopause transition”)?

The transition or approach to menopause known as perimenopause is marked by the experience of hormonal fluctuations—chiefly, estrogen and progesterone—that result from the ovaries “winding down” and releasing fewer eggs at less regular intervals. While estrogen (namely estradiol) and progesterone are commonly associated with the regulation of the menstrual cycle, both hormones play significant roles in a number of functions across the body including muscle growth and strength, building and remodeling of bone, stabilizing connective tissue, managing blood sugar, regulating appetite, managing moods, enhancing memory function, controlling body temperature, controlling blood pressure, regulating inflammation, and much more. As these hormones shift and ultimately decline, the body experiences a “recalibration” that can produce a number of signs or “symptoms” which for many individuals, may increase as they approach the menopause milestone.

At what age do most women experience perimenopause and menopause?

One universal truth about menopause is that every experience is individual.  Most will enter the menopause transition, or perimenopause, by their mid 40s.  The transition however, can be experienced as early as one’s late 30s and as late as one’s early 50s.  

The average age of menopause onset (or the one year “anniversary” of one’s last period) is 51.

How will I know I am in perimenopause?  Can I take a test to find out?

Taking note of the signs (“symptoms”) and/or monitoring one’s menstrual cycle for changes are the best indicators that one may be in perimenopause (aka, the menopause transition).

While hormonal blood tests certainly exist, the fluctuations in hormones that occur during perimenopause do not allow a test to provide any meaningful data (i.e., estrogen can test high in one moment and normal the next).  Net net: you can save time and money by tracking the signs.

If I am on birth control, will I experience perimenopause or perimenopause symptoms?

Yes.  Hormonal contraception, however, can mitigate the experience of certain symptoms and may make it difficult for you to know if you have reached menopause given its impact on your periods.

What are the most common symptoms?
According to a survey⁴ by Women Living Better, these are the 12 most commonly reported symptoms by women age 35 – 55—though there are over 30 that have been reported by women at large.

1. Heavy Periods
2. Shorter menstrual cycles
3. Disrupted sleep
4. Mood changes
5. Hot flashes + night sweats
6. Sore breasts
7. Headaches
8. Weight Gain
9. Cramps
10. Low libido
11. Vaginal Dryness
12. Brain Fog

If I am in perimenopause, can I still get pregnant?

Yes.  Until you have reached menopause, you can still get pregnant.

Will I suffer from hot flashes?

Up to 80% of women in the US report experiencing vasomotor symptoms, including hot flashes and night sweats during perimenopause or menopause, making it the most commonly experienced symptom. There are several factors that can influence the intensity of hot flashes including being obese, habits such as drinking alcohol or smoking, physical inactivity and stress. Race or culture and certain medications can also play a role.⁵

Can I treat hot flashes?

YES!  There are several ways to manage and mitigate hot flash symptoms, from lifestyle strategies like nutrition and exercise to doctor-prescribed hormones and non-hormonal therapies.  

Is hormone therapy safe?

Hormone therapy is deemed beneficial to women under the age of 60, who are within 10 years of the onset of menopause (“1-year anniversary”) and who have no contra-indications.

The Menopause Society (formerly the North American Menopause Society) states that: “Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture.”  Read the full statement here.

How can I find a physician specializing in menopause and/or hormone therapy?

If you find yourself in need of an ObGyn or a physician who specializes in menopause, the Menopause Society has a searchable registry of health professionals who are certified menopause practitioners here.   

Sources: 

1. McNeil MA, Merriam SB. Menopause. Ann Intern Med. 2021 Jul
2. US Preventive Services Task Force. Mangione CM, Barry MJ, Nicholson WK, Cabana M, Caughey AB, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Stevermer J, Wong JB. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: US Preventive Services Task Force Recommendation Statement. JAMA. 2022 Nov 01
3. Contraception During Perimenopause: Practical Guidance, Int J Womens Health. 202
4. Symptom experience during the late reproductive stage and the menopausal transition: observations from the Women Living Better survey. Coslov, Nina MBA; Richardson, Marcie K. MD, FACOG; Woods, Nancy Fugate PhD, RN, FAAN
5. Menopause, Kimberly Peacock; Karen Carlson; Kari M. Ketvertis, National Library of Medicine, Stat Pearls, 2023 December 21

The above list is far from comprehensive. If you are seeking an answer or a reputable resource for a burning question, comment below and I’ll do my best to address in a timely fashion!