Menopause Signs: What to Expect and How to Cope

If you haven’t had a period for at least 12 months, it's possible that you’ve gone through menopause. Menopause is when your ovaries produce less estrogen and progesterone, meaning you'll no longer get your period (and can't get pregnant).

Most women go through menopause after turning 40 and before reaching 58, according to The North American Menopause Society. For women in the United States, the average age of menopause is 52, though it's likely you'll start having symptoms long before that because the hormonal changes of menopause happen gradually over a number of years, rather than overnight.

Most women start noticing early signs of menopause about four years before they are menopausal, according to the U.S. Office of Women’s Health. Those years leading up to menopause are called perimenopause.

Signs of menopause

Changes in your period

This may be one of the first things you notice. And, when it comes to changes in your menstrual cycle during (or just before) menopause, pretty much anything goes. Your period may not be as regular as it was. The flow can be heavier or lighter than has been typical for you. You also may miss a period or two — or three. But remember that missed periods aren't considered true menopause until you've gone 12 straight months without having a period or spotting.

• Tip: Check with your doctor to be sure the changes in your period don't have a different cause, like pregnancy (it's possible) or a health problem that may need treatment.

Vaginal changes

As your estrogen levels decrease, your vaginal tissue may become thinner, drier and less flexible. You may notice this as a burning or itching sensation. It can also make sex uncomfortable, or even cause small cuts or tears.

• Tip: Try over-the-counter lubricants, and talk to your doctor about medicines to treat vaginal dryness. Lubricants don’t contain hormones so you can apply these as often as needed — every time you have sex, if need be. You also might consider trying a vaginal moisturizer, which can be applied every couple days, according to the American College of Obstetricians and Gynecologists.

Mood swings and irritability

No one can explain exactly why, but as you approach menopause, it’s not uncommon to be feeling up one moment and down the next. Or you could be more easily irritated. According to the National Institute on Aging, mood swings could stem from a combination of factors. For instance, you might feel sad because your children are growing up so fast and your parents are aging. Or, you might be stressed by responsibilities at home and at work.

• Tip: Aim to get seven to eight hours of quality sleep each night. Make time for your favorite method of stress relief, whether that's being outdoors or spending time with friends. Consider joining an online or local support group for women going through menopause. You can also check in with your doctor to discuss whether hormone therapy to help with mild mood swings could be an option for you. It's important to note, though, that mood swings are different from depression. If you've ever had depression before and find yourself feeling depressed, anxious or suicidal, seek treatment right away.

Trouble sleeping

As your levels of progesterone and estrogen decline, it can be hard to fall asleep. Some women get up more often in the night to use the bathroom, then find it hard to fall back to sleep.

• Tip: The Office on Women's Health notes the importance of developing good sleep habits. For example, don’t nap or have caffeine after lunch. Do your best to go to bed and wake up at the same time every day, even on the weekends. Limit screen time (even TV) before bed. Good news: improving sleep can also help with mood swings!

Hot flashes and night sweats

You'll know you're having a hot flash if you suddenly feel overheated from your neck up. Your face and neck may get red, and you sweat profusely. (This could be followed by shivers and cold chills.) You could have hot flashes a couple times a day or, if you’re lucky, only a few times each month. Hot flashes that happen mostly at night are called night sweats.

• Tip: Wear layers of clothing, like a sweater or sweatshirt you can take off during a hot flash. Keep a glass of cold water by your bed. Talk to your doctor about hormone therapy to help with hot flashes.

Urinary problems

Many women have bladder problems or urinary tract infections (UTIs) when they’re approaching menopause. Falling estrogen levels can weaken your urethra, which means you may have to rush to the bathroom as soon as you feel the urge to go. Or you may leak urine when you sneeze, cough or laugh.

• Tip: If you suspect you have a UTI, contact your doctor -- You may need to start taking an antibiotic. You can also ask about possible solutions for urine leakage, such as a device to support your bladder or physical therapy. Kegels, which are exercises to strengthen the muscles of your pelvic floor, may help. Also, try to maintain a healthy weight — carrying extra pounds around your abdomen puts more pressure on your urethra and bladder muscles.

Less interest in sex

You may be less interested in having sex with your partner. Or you may not feel like having sex as often. Thinner, drier vaginal tissue could cause pain and discomfort during sex.

• Tip: Start by trying over-the-counter vaginal lubricants. If those don't help, talk to your doctor about trying prescription lubricants or medications. And, of course, always talk to your partner honestly and openly about how you feel and what makes you happy.

Staying healthy through menopause

Having a healthy lifestyle is important during menopause and beyond. The American College of Obstetricians and Gynecologists suggests these factors that are key to this:

1. Eat well. In general, eating a balanced and nutritious diet helps you stay happy and healthy at any stage of life, but calcium and vitamin D are especially important during menopause. These are important for maintaining strong bones, which can weaken as your hormone levels decline. You may also find that it’s easy to gain weight as your body changes, so including lots of fruits and vegetables in your diet can help you maintain your weight.
2. Exercise. Being physically active not only helps you maintain a healthy weight and improves your mood, but weight-bearing exercise, such as walking, also helps prevent bone loss that happens during menopause. It also strengthens your muscles, which can help prevent falls.
3. Get regular checkups. As you get older, it’s important to get regular medical checkups as well as any recommended screenings for cancer and other diseases. Finding problems early is often key to successful treatment.

Hormone therapy benefits & risks

If you're thinking about trying hormone therapy for menopause symptoms, consider this: Although hormone therapy can relieve many symptoms of early menopause and prevent bone loss, it can also increase your risk for certain types of cancers (uterine, breast). There's also a chance it could increase your risk of having a heart attack or stroke, cautions the American College of Obstetricians and Gynecologists.

Discuss the pros and cons of hormone therapy with your doctor. This will help you make the decision that's right for you, based on your family history and comfort level.