7 Things You’d Be Shocked People Don’t Know About Menopause

The average age of menopause is 52 in the United States.When it comes to women’s health, there are many topics that aren’t discussed as often as they should be — or discussed without shame. Menopause is, unfortunately, one of the topics, even though an estimated 1.3 million Americans enter menopause each year.The secrecy leads to false information and fear, in addition to unnecessary discomfort for those going through the change. Many people don’t even know what menopause is, other than hot flashes (which can be part of it).“The definition of menopause is one full year without a period in the absence of something else to explain it, like pregnancy,” said Dr. Mary Jane Minkin, a gynaecologist at Yale Medicine in Connecticut.And, we only know it’s our last period when looking back in time, added Dr. Karen E. Adams, a clinical professor in the department of obstetrics and gynaecology at Stanford University School of Medicine in California and the director of Stanford’s menopause and healthy aging program.“When you have your last period, you don’t know that’s your last period until a year later, and you say, ‘Well, I guess that was it,’” Adams added.The average age of menopause in the United States is 52 (and 51 is the average age throughout the world), said Dr. Ella Speichinger, an OB-GYN at University of Missouri Health Care.Menopause is just one day — “it’s the day that you have gone 12 months without a period,” Adams added. After that, you’re in post-menopause, which is the phase of life you remain in until you die.There are signs and symptoms associated with this time in life, along with the segments before it. Below, doctors share what they want everyone to know about perimenopause, menopause and post-menopause.1. The symptoms you likely associate with menopause start during perimenopause, which generally happens in your 40s.“The buildup to that last period is the perimenopause timeframe, and perimenopause, on average, lasts four to seven years, but it can be one to 10 years,” Adams said.Meaning with menopause at an average age of 52, perimenopause will start for many people in their mid-40s or even early 40s.“It’s not necessarily when you’re 55 or 60 that you need to be thinking about this. It could be in your mid-30s that you need to be thinking about it and putting the pieces in place to have that transition go smoothly and go well,” Adams said. (More on that below.)While there’s a misconception that symptoms such as hot flashes and night sweats happen once you reach menopausal age, that’s not the case.“Perimenopause often is the most symptomatic time, and people aren’t even really aware of it yet. It’s not even on their radar screen,” she added. People tend to notice changes to their menstrual cycle, like skipped periods or varying cycle lengths, for example, in addition to hot flashes, night sweats, trouble sleeping, joint pain and brain fog.“Those are all kind of nonspecific symptoms,” Adams said. You could easily mistake the symptoms of perimenopause for any number of issues that have similar signs. “It could be your thyroid. It could be that you have major depression, and you need to get that treated. It could be you’re developing rheumatoid arthritis ... it could be long COVID,” Adams said. Or, it could be perimenopause.“There’s a lot of different things it could be, but when you have them all together, it’s definitely important that people think, ‘Wow, this could be perimenopause,’” she said. If you notice these symptoms, it’s important to talk to your doctor to figure out what’s going on, whether it’s perimenopause or not.2. More than half of people experience PMI during perimenopause, which is kind of like PMS.“About 65 to 70% of people get a thing called perimenopausal mood instability, or what we call PMI, and that’s more common than PMS [premenstrual syndrome], but people have never heard of it, right?” Adams said.“We all know what PMS is. We talk about it. We know what it is. PMI is more common than PMS, but nobody’s ever heard of it,” she added.With PMS, you can generally anticipate when the mood swings, fatigue and cravings will happen, but the same can’t be said for PMI.“It’s completely unpredictable because hormone cycling becomes unpredictable in perimenopause, so people wake up every day and they don’t know how they’re going to feel,” Adams explained, “they don’t know if they’re going to be irritable or angry or anxious, or if they’re going to feel normal.”This is a major sign that you may be in perimenopause, Adams said. “If something like that’s going on, see a provider and think about treatments that might stabilise that mood stuff,” she added.3. A doctor can’t look at you and say exactly when you’ll go through menopause, but it can be genetic (although it isn’t always).You probably want to know when exactly you’ll start perimenopause and menopause, but the answer isn’t cut and dry. However, there are a few things you can turn to for guidance. You can talk to your mom or older sister about when they went through menopause.“That’s helpful, certainly helpful, things tend to run in families,” Minkin noted. Meaning, if your mom and older sister both went through menopause in their early 50s, it’s reasonable to think that’s when you’d go through menopause, too. But it’s not absolute, Minkin said. It could happen earlier or later for you, too.It’s also possible for certain medical procedures and surgical treatments to put you in menopause, Adams said. This includes things like some cancer treatments or the removal of the ovaries, Adams said.4. Menopause causes loss of bone density, but there are things you can do to prepare for that.During menopause, folks experience bone density loss because of the decreased oestrogen production in the body.“A lot of what causes morbidity and mortality in elderly women is bone issues, primarily osteoporosis, so falling and breaking a hip when you’re 80 or 85 is an absolute disaster because one in four of those women will die, and another one in four will be permanently disabled,” Adams said.The best thing to do to avoid this is to work on prevention methods earlier, like in your 20s and 30s, to help build up your bone density, Adams noted.“You can build more bone density by doing more weight-bearing exercise, paying attention to calcium and vitamin D, things like that,” Adams said, “and then you can actually go into perimenopause and menopause with more bone because you can actually build up your bone density in those years.”Strength training is an important way to build your bone density so you are more prepared for perimenopause and menopause.5. The symptoms of menopause are treatable via  hormone therapy, but mixed messages created panic among American women.It’s estimated that only 5% of women take hormone therapy in the United States. This is the result of lots of mixed messaging about the treatment.In 2002, the Women’s Health Initiative released a flawed study that linked estrogen replacement therapy to an increase in breast cancer, “which is ... absolute bullshit, the study didn’t even say that but that was the interpretation, unfortunately, that came out,” Minkin said.As a result, American women in droves stopped taking oestrogen replacement therapy, and medical residences stopped teaching about menopause because there was no more oestrogen therapy, Minkin said.“Hormone therapy promotes heart health, promotes bone health and manages the symptoms. So that’s another important message, which is there’s a very, very effective, good treatment for all these symptoms and a lot of the diseases of aging, and many people are not taking advantage of it,” Adams said.To be clear, there are risks to any medication, Tylenol and ibuprofen included. This goes for hormone therapy, too, which is associated with a higher risk of blood clots and can raise cancer risk in those with certain types of cancer history. While certain groups of people should not take the medication, it is overall safe, experts say.“The risk of menopausal hormone therapy equates to the same relative risk ... of having more than one drink a day of alcohol,” Speichinger said.“So me, personally, when I counsel patients about this, I say that there’s still risk with hormone therapy, but there’s actual true benefit with hormone therapy, and alcohol cannot boast the same benefits,” Speichinger said.Minkin added that there are various forms of hormone therapy available, in addition to other treatments, and they don’t all carry the same risks. It’s important to talk to your doctor about what’s best for you.6. To help you manage and understand your perimenopause, menopause and post-menopause symptoms, it’s important to find a doctor who understands. “If somebody’s looking for a provider, [try] checking on the Menopause Society website because people who are interested in it are registered there,” Speichinger said.“Anybody who’s listed there is somebody who knows about menopause, likes to talk about menopause and can probably help you,” Minkin said.For many people, perimenopause, menopause and post-menopause are isolating times because of the stigma attached to them and the unwritten code of silence surrounding them. But it doesn’t need to be and shouldn’t be.7. Many aspects of menopause are pretty intimidating, but there is a real thing called “menopausal zest.”“The transition time is hard, and people have to manage that, but there is a real thing called menopausal zest,” Adams said, “and once people are through the transition, and they are stable on the other side, they are happier.”In fact, post-menopausal folks say they’re happier in their relationships, happier at work and more joyful, overall, Adams added.“That is, I think, also a very important message that menopause is not the end of something. For many people, it’s a new beginning. It’s a window or a door opening and people reinvent themselves,” she said.Medications and treatments from your doctor can help you get to this point quicker, too, which is yet another reminder not to force yourself to suffer in silence.“Menopause is inevitable if you live long enough, but suffering is not inevitable, and you don’t have to suffer through it,” Adams said. “In fact, it can be quite liberating.” Related...How Do You Know When Menopause Is Actually Over?More Menopause Symptoms May Predict This 1 Change To Your Memory Later In LifeMost UK Women Start Menopause at This Age, So Preparing Early Can Help