What to expect through the stages of menopause

This paid piece is sponsored by Sanford Health.

Let’s talk about a woman’s natural transition away from her reproductive years.

This is the extended period in life that takes place over the course of several years in three stages: perimenopause, menopause and postmenopause.

Perimenopause, or the menopausal transition, marks the end of reproductive years and signals the natural transition into menopause. This typically occurs in most women during their 40s.

Symptoms that begin during this time include irregular periods, hot flashes, sleep troubles, decreasing fertility, painful intercourse, mood changes and vaginal or bladder problems.

Menopause is when a woman permanently stops having menstrual periods, signaling the end of her ability to have children. During this time, hormone levels start to change.

Read: 5 things women should know about menopause

Fast-forward to the last of the three: postmenopause.

According to Dr. Alla Zamulko, an internal medicine specialist at Sanford Health, postmenopause is when a woman hasn’t experienced a menstrual period in 12 months or a full calendar year.

“Menopausal symptoms really can occur at various ages ranging, on average, from 45 to 55 years old,” Zamulko said.

The average age of a woman beginning menopause in the United States is 51.

Common symptoms during postmenopause

It’s common to associate the postmenopausal stage with hot flashes and night sweats similar to those which begin during menopause.

Zamulko said these can vary with each woman but can range significantly from mild to severe.

Other physical symptoms include fatigue, headaches, dry skin, urinary tract infections, vaginal dryness, pain with intercourse, changes with hair texture and muscle aches.

“These symptoms can be found in different illnesses, and we can’t disregard them thinking it’s just menopause,” Zamulko said.

“It’s important to sort out with your physician where these symptoms are coming from, for example, diabetes, thyroid abnormalities, gastrointestinal issues and so on.”

Emotional symptoms may include mental fog, insomnia, irritability, tearfulness, anxiety, depressive symptoms and mood swings.

Listen: Integrative care for women in midlife

With this drop in estrogen levels and symptoms, women can see an increased risk for various symptoms, diseases and cancers.

Keeping up with routine care

If any of those symptoms become too disruptive, patients are encouraged to call their health care provider and not wait for that wellness exam or routine screening.

“It’s important to follow age-appropriate screenings, including the mammogram for breast cancer, colonoscopy and hyperlipidemia (high cholesterol),” she said. “Changes in women’s life can lead to osteoporosis and osteopenia, which is why a bone density screening, or DEXA scan, is also important during this time.”

At her routine wellness visit, a woman and her physician will review health status, necessary screening tests and labs, and check her body thoroughly for any symptoms that need to be addressed.

Typically, the DEXA scan starts at age 65, but depending on the patient’s status and other health conditions, the physician will evaluate calcium and vitamin D levels among others to determine if the scan is needed sooner to diagnose and provide appropriate treatment.

To find the best treatment for symptoms and individual health, women should discuss options with their doctor. Some options include:

• Hormone therapy prescribes a combination of the female hormones estrogen and progesterone. It commonly is taken in pill form; however, estrogen also can be given by using skin patches and vaginal creams.
• Estrogen therapy is a prescription for estrogen, which the body no longer makes after menopause. This type of therapy often is prescribed for women who have had a hysterectomy.
• Estrogen alternatives, such as ospemifene, can be used to improve the symptoms of vaginal atrophy without affecting uterine cancer risk.
• Nonhormonal treatments include other medications and alternative therapies such as homeopathy and herbal treatments. Before receiving alternative therapy, women should talk to their doctor about potency, safety, purity and effectiveness concerns.

Sanford Health offers advanced urogynecology treatments, including the Mona Lisa. Reach out to your primary care provider, or find an internal medicine provider to schedule an appointment and learn more about your options.

Welcoming the postmenopausal stage

“We all go through different phases in life,” Zamulko explained. “Hormone levels begin to change during those early adolescent years into adulthood, through pregnancy and beyond.

“Now we turn the page and enter another chapter, and it’s one that millions of women go through, so they should know they’re not alone, even with that common fear of aging.”

She encourages women to listen and feel heard, knowing that their concerns are validated and they have the necessary resources and reassurance that this is an expected stage in life.

During this chapter, a well-balanced diet, regular activity and adequate sleep are all still important parts of maintaining a healthy lifestyle.

“If your symptoms are bothersome, things will get better,” Zamulko said. “Some of my happiest patients well into their 70s and 80s don’t have hot flashes, take care of their grandchildren and great-grandchildren, play bingo and are still very active.”

This new chapter in life can be fulfilling and happy, she added. If not, she said patients shouldn’t suffer from disruptive symptoms in silence and should reach out to a provider for support and guidance.

“Every journey is different for each woman.”

Learn more

• Find an internal medicine provider at Sanford Health
• Is there a link between menopause and genetics?
• Take the quiz: How much do you know about menopause?