Menopause: What No One Told You

For many women, menopause arrives with surprisingly little preparation.

You may have heard about hot flushes.

But what about changing periods? Sleep problems? Mood changes? Vaginal dryness? Changes in sexual comfort? Or the feeling that your body suddenly doesn't behave the way it used to?

The years leading up to menopause are called perimenopause. During this transition, hormone levels fluctuate and menstrual cycles can change.

Menopause itself is reached after 12 consecutive months without a menstrual period, when there is no other cause for the absence of periods.

The average age of menopause is around 51, although timing varies.

Your periods may change first

One of the earliest signs of perimenopause is often a change in the menstrual cycle.

Your periods may become:

• More frequent
• Less frequent
• Lighter
• Heavier
• Longer
• Shorter

Some months you may ovulate and other months you may not.

These changes can be normal during perimenopause, but that does not mean every type of bleeding should simply be ignored.

Hot flushes are only part of the story

Menopause and perimenopause can involve:

• Hot flushes
• Night sweats
• Sleep difficulties
• Vaginal dryness
• Changes in sexual comfort
• Mood changes
• Difficulty concentrating
• Changes in menstrual bleeding

Not every woman experiences all of these symptoms.

And symptoms can vary considerably from one person to another.

What can actually help?

Treatment depends on your symptoms, health history, age, menopause stage and personal preferences.

Lifestyle measures may help with overall health and symptom management.

For troublesome symptoms, your gynecologist can discuss options including non-hormonal treatments and, when appropriate, menopausal hormone therapy.

Hormone therapy is not automatically right or wrong for everyone. Its benefits and risks depend on the individual.

If you have a uterus, systemic estrogen therapy generally needs to be combined with a progestogen to protect the uterine lining.

This is why menopause treatment should be individualized rather than copied from a friend, relative or social-media post.

Don't ignore bleeding after menopause

This is one of the most important things to remember.

Once menopause has occurred, vaginal bleeding or spotting is not considered a normal menstrual change and should be evaluated.

There can be many causes, including benign conditions, but abnormal bleeding can sometimes be a sign of a more serious problem.

Do not assume that a small amount of spotting is harmless simply because it happened only once.

Menopause is also a health transition

The menopause transition is an opportunity to look at your overall health.

Depending on your age and individual risk factors, your doctor may discuss:

• Blood pressure
• Blood sugar and metabolic health
• Bone health
• Cardiovascular risk
• Breast and cervical screening as appropriate
• Sleep
• Mental health
• Sexual and vaginal health

You do not need to tolerate symptoms silently.

A better way to think about menopause

Menopause is not a disease.

But troublesome symptoms deserve care.

And abnormal bleeding deserves evaluation.

The goal isn't to turn menopause into another medical problem to worry about.

It is to understand your changing body and get appropriate help when you need it.