8 Surprising Facts About Menopause and Perimenopause

April 24, 2023

menopause graphic

Women’s bodies go through many changes, often involving their monthly menstrual period. But when you experience menopause, the transformation is so significant that it’s called “the change of life.”

Menopause is the permanent stopping of menstruation — clinically defined as a woman not having a period for 12 consecutive months. While the thought of no more PMS, pads and tampons may sound amazing, it’s not that simple.

Melissa Terry, MD
Melissa Terry, MD

The process leading up to menopause (perimenopause) and life after (post-menopause) can be tricky — your mind and body can feel out of your control due to a roller coaster of hormonal changes. “There’s much more to menopause than suddenly stopping menstruation,” says Dr. Melissa Terry, MU Health Care OBGYN. “It’s important for younger women to learn about menopause to prepare mentally and physically before they get to that transition.”

To help with that mental preparation, Dr. Terry shared some facts about perimenopause and menopause that you may not (but should) know:

1. Menopause Can Occur Anytime

The average age of menopause in the United States is 52. But menopause can happen earlier for some people, whether naturally or for medical reasons:

  • Early menopause occurs between ages 40 and 45. About 5% of women go through early menopause naturally.
  • Premature menopause refers to menopause before age 40 — experienced by 1% of women.

Early or premature menopause can happen naturally. But other reasons menopause occurs early include:

  • Cancer treatments, including chemotherapy or radiation to the pelvic area
  • Health conditions such as autoimmune diseases, HIV and AIDS, and chronic fatigue syndrome
  • Smoking, which can cause menopause to occur as much as two years before nonsmokers
  • Surgery, either to remove both ovaries (bilateral oophorectomy) or the uterus (hysterectomy)

Women who go through menopause earlier than average often experience more severe menopause symptoms. Because their bodies stop making estrogen at a younger age, they’re also more likely to have a lifelong higher risk of depression, heart disease and osteoporosis (loss of bone density).

2. The Transition to Menopause Takes Years

The symptoms people typically associate with “going through menopause,” such as hot flashes and moodiness, begin during perimenopause. The transition period before menopause normally takes four years but can last anywhere from two to eight years.

Your hormone levels, especially estrogen, can change randomly during that time. You may experience menopause symptoms that come and go, such as:

  • Brain fog and problems with memory and focus, reported by 60% of women
  • Changing feelings about sex based on discomfort or lack of arousal
  • Hot flashes, or sudden feelings of warmth and sweating, experienced by 75% of women
  • Menstruation changes to both premenstrual symptoms and monthly cycle
  • Mood changes, including depression, anxiety, crying spells and irritability
  • Problems sleeping, often the result of hot flashes, anxiety and incontinence
  • Urinary problems such as incontinence

“Not all women will experience menopausal symptoms the same way,” Dr. Terry says. “Every woman's menopause story is different.”

3. Genetics Play a Role in the Timing of Menopause

If you’re wondering when you may naturally begin the transition to menopause, look no further than your own mother.

“If your mom went through menopause at age 51, for example, you would probably go through menopause right around that same time,” Dr. Terry says. “If you naturally go through menopause at 45, which is earlier than average, your mom may also have gone through it early. While it’s not an exact science, being mentally prepared for the timing is important.”

4. Your Periods May Change During Perimenopause

By the time you near menopause, you might assume your periods will become lighter or less frequent during the transition. But Dr. Terry says that couldn’t be further from reality for many women.

“The first thing women typically notice is changes in the timing of their cycles,” she says. “Periods might start to get closer together. They might get farther apart. They might get heavier or they might ease up. It's very unpredictable, and it's very individual.”

But changes in your cycle, especially at a younger age, do not always indicate perimenopause. “When you start experiencing irregularities with your cycle, that is the perfect time to see a primary care doctor or gynecologist to discuss those changes,” Dr. Terry says. “Other health conditions such as thyroid disorder, obesity or ovarian tumors can cause irregularities with your cycles.”

5. You Can Still Get Pregnant During Perimenopause

Pregnancy — even well past the age of 40 — is another reason you may notice menstrual changes during perimenopause. And it can happen up until the final 12 months that mark menopause.

“If you still have periods, even one period every six months, you can still get pregnant,” Dr. Terry says. “That’s why we recommend reliable contraception use until your doctor confirms that you’re in menopause.”

6. Perimenopause Can Affect Mental Health

Estrogen can act as an antidepressant. So when levels fluctuate and drop, it’s common to notice mental health symptoms.

Between 20% and 40% of women experience depression around menopause. While the symptoms may result from hormonal changes, Dr. Terry adds that it’s also natural to undergo this type of response to such a significant life change.

“When a woman gets to this phase of life, it’s common to grieve the loss of the ability to get pregnant and have a baby,” she says. “That grief can cause a lot of women to experience depression.”

To help ease mental health symptoms during the menopause transition, Dr. Terry recommends reducing stress, prioritizing sleep and engaging in social activities. If you’re still struggling, reach out to your doctor for additional help.

7. Hot Flashes Don’t End With Menopause

Unfortunately, the symptoms of menopause don’t vanish along with your periods — hot flashes can continue for up to 14 years after menopause. Some symptoms, such as brain fog, may improve after menopause. But others get worse.

“There are a whole host of symptoms under the heading of genitourinary syndrome of menopause, such as vaginal dryness and painful intercourse,” Dr. Terry says, “and those get worse the older a woman gets.”

Dr. Terry recommends hormone replacement therapy or vaginal estrogen cream to treat post-menopausal symptoms. “Menopausal hormone therapy isn’t considered a standard practice yet but can have significant health benefits for women when used during the first few years after menopause,” she says. “It can stabilize bone loss, decrease the risk of heart disease and Type 2 diabetes, and protect against other negative health consequences associated with menopause.”

8. You Can Take Steps Now to Minimize Menopause Symptoms Later

You can minimize symptoms during perimenopause with birth control pills or a hormone-containing IUD to stabilize hormones. But you can also relieve many menopausal symptoms with healthy lifestyle choices.

Putting those healthy habits in place before menopause helps avoid severe symptoms and ease the transition. Dr. Terry recommends:

  • Avoid excessive amounts of alcohol: It can trigger menopausal symptoms and increases the risk of poor sleep.
  • Don’t smoke: Smoking during the menopause transition makes you more likely to have severe and frequent hot flashes than women who quit smoking or never smoked.
  • Eat a healthy diet: A body mass index (BMI) under 25 is associated with milder hot flashes and improved brain function.
  • Get regular exercise: Moving daily helps with sleep and decreases the risk of cardiovascular disease.
  • Reduce stress: Get in tune with how your body feels by practicing meditation and other mindfulness techniques.


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