FAQ: Women have managed menopause naturally for centuries. Does this really need to be treated?
Menopause begins when the ovaries stop producing sufficient estrogen to support menstrual cycles, often in a person's mid-40s to mid-50s. The simplest way to identify menopause is when you haven't had a period in 12 months or more, or if your ovaries were removed.
For those who suppress periods with hormonal methods, the onset of menopause may not be so obvious.
Perimenopause begins years before your last menstrual period. People in their 40s and early 50s with ovaries may begin to notice irregular periods along with issues like night sweats, disrupted sleep and mood, changes to the vagina and sex drive, exaggerated migraines, joint pain, and brain fog.
Some people will get hot flashes, which start closer to your last period.
Thirty-five symptoms have been linked to menopause, and the list will grow as researchers learn more about midlife changes to female organs. However, menopause isn't necessarily responsible for every new symptom in your 40s and 50s. Sorting out what's going on can require a thoughtful conversation with an experienced physician.
Major menopause symptoms like hot flashes can persist for several years before subsiding. While hot flashes are more uncomfortable for some than others, it's important to note they are associated with a higher risk of future heart disease and stroke. Low estrogen levels also lead to more rapid loss of bone and muscle mass, which are critical for health in later decades.
The Menopause Society recommends hormonal treatment for hot flashes and other menopause symptoms in people aged 60 and younger, with numerous caveats that should be discussed with an experienced clinician. Yet while estrogen seems to offer preventive benefits for not only the heart but also bones and muscles, there currently isn't an official recommendation to use hormonal therapy for prevention alone.
Expert menopause therapy is part of routine care provided at Sequoia Project Internal Medicine, where we follow along closely as the science develops.