How To Know You Are Starting Menopause? What It Is, Symptoms And Treatments

You're feeling hot flashes, irritable and have trouble sleeping, could you be starting menopause?

The transition into menopause, a point in a woman's life when menstrual cycles stop permanently, affects women in unique and different ways, depending on the individual.

While the idea of entering menopause might feel daunting, it doesn't need to be. Dr. Julianne Arena, a double board-certified physician from Harvard University specializing in women's health and sexual wellbeing, told Newsweek that some are often resigned to having a defeatist attitude towards menopause.

"They may say: 'Oh, you're just getting older' and 'It is what it is, just accept it,' but I don't believe that," she said. "There are ways that we can transition into menopause and post-menopause and still feel great and healthy, and live long happy lives."

Arena said some aspects of menopause can have a positive impact, such as for our sexual health, which is key for a smooth transition into menopause.

As women enter menopause, they're "not worried about pregnancy as much or have that fear of an unwanted pregnancy," and with the children now out of the house, there's more time for "the self."

The physician said: "As we enter this phase of our life, there is more time for self-care, as well as intimacy and connection, and self-care is our health care."

When Does Menopause Begin?

Arena explained the technical definition of menopause is a full year without a menstrual cycle and the average age for when menopause begins for women in the U.S. is 51. This average is reflective of the woman's health status and other variables that play a role, from the age their periods began to stress levels, whether they smoke and other factors, according to the physician.

She noted: "There can be many changes that happen 10 to 15 years before our periods stop completely. This period is considered perimenopause, which can begin in our 30s or 40s. Perimenopause is when we start to have hormonal shifts."

Levels of estrogen (the hormone responsible for the development and regulation of the female reproductive system) are always shifting month to month. But the perimenopause period sees progesterone (the hormone responsible for various functions such as maintaining pregnancy and menstrual cycles) start to go on a "slow decline."

This could entail heavier or irregular periods or spotting and "we start to see other issues that can happen with mood" as well as other physical, mental and emotional changes that can happen before actual menopause.

Symptoms of Menopause

As outlined by Arena, some of the "telltale" signs of menopause include the following:

• Hot flashes (a sudden feeling of heat in your whole body or just the upper part, which can be followed by heavy sweating and cold shivers)
• Night sweats (hot flashes that are strong enough to wake you up)
• Vaginal dryness (which can lead to sex being painful or uncomfortable)
• Menstrual cycle changes (irregular periods as well as shorter or longer, lighter or heavier, than usual)
• Shifting sleep pattern (waking up too early or difficulty falling asleep)
• Dry hair
• Changes in libido (sex drive)
• Weight gain
• Skin changes
• Bladder issues (more frequent urgency to urinate)

Arena said: "In the over 20 years I've worked with different women, I never say 'never' when someone asks whether a symptom they're experiencing is because of menopause or perimenopause.

"But bear in mind that symptoms like hot flashes and night sweats can also be simply a result of having high levels of stress and alcohol. Having these symptoms once in a while doesn't mean you're going through menopause. It's when you notice a pattern, a consistency of symptoms, some regularity, that you can assume that things are changing and shifting towards menopause."

The Most Overlooked Symptom of Menopause

There's not a lot of emphasis put on mood changes when it comes to menopause, according to Arena. "Mental and emotional changes that are happening during menopause are really underplayed and underserved."

In many cases, a woman may present these mood shifts and a doctor will just say "you're anxious" or "you're depressed" and "here's your medication," instead of looking at the possibility of menopause.

Women may be more irritable as "fertility is declining, which may be significant for some, not feeling as feminine by losing their child-bearing years," she said.

So, for those experiencing unusual mood changes, it's definitely worth a visit to a doctor to open a conversation. Ask to have "your nutrients and your hormones tested" when you visit the doctor. "Let's test and not guess" and see what's going on, Arena said.

Brain Fog and Menopause

Brain fog is a largely overarching symptom of menopause that can entail multiple variables. Arena said: "Brain fog can be defined in so many different ways," from "lack of clarity" to a "decrease in memory" or situations like "walking into a room and forgetting why I'm here" or "just difficulty with word choice."

She explained: "I often talk about hormone symphony, where all of our hormones need to play well together to make beautiful music. It's about the harmony between estrogen, progesterone and testosterone, but also about glucose and insulin, our gut health, our thyroid gland and cortisol." Cortisol is the body's "fight or flight" stress hormone, while estrogen helps protect our brain.

As we go through menopause, all of these hormones are changing, and that hormonal symphony is disrupted. "Cortisol, that stress hormone, feeds back to our brain and affects our brain function," Arena said.

This affects different parts of our brain, such as the hippocampus (the memory center) and the amygdala (the fear and emotion center). "So, our brain is on fire and that can present itself as brain fog in many different ways," Arena said.

How Does Menopause Affect Sex Life?

Menopause could lead to a drop in libido due to physiological reasons, such as sex being more painful due to vaginal dryness. Or some women going through menopause may be less interested in sex due to changes in their mood and other psychological reasons.

But good sexual health is key for a smooth transition into menopause, Arena said. "I believe we're hardwired for intimacy and connection. When we have sex and we achieve orgasm, that releases oxytocin, which is our bliss hormone."

According to the doctor, studies have shown that "when we're intimate and having sex, we live healthier and longer lives. It's so easy to put it [our sexual health] on the backburner but everything is always a little bit better when we have that intimacy and connection, when our sex lives are active."

There is no quick fix or pill for enhancing your sex life and it requires a multi-layered approach. Improving libido starts with asking ourselves the following questions, as outlined by Arena:

• How do I feel about myself? Do I feel good in my skin?
• What's going on with my vagina? Is sex painful?
• How is my connection with my partner?
• Am I sleeping enough? "Sleep is when we rest, we digest, we heal. So if we're not sleeping, that affects our intimacy and our sex life."

How To Improve Your Orgasm

Arena recommends Cliovana, a non-invasive therapy that can help improve "the frequency and intensity of orgasms," as well as lubrication and pain, while some of Arena's patients have reported seeing an improvement with bladder issues.

What Is Cliovana and How Does It Work?

Arena, a Cliovana specialist, explained Cliovana uses soundwave technology to "improve blood flow and nerve endings to the vaginal area, focusing specifically on the clitoris."

The treatment itself is all external, so nothing is applied within the vagina. The process entails applying gentle suction, soundwave therapy and vibration to the vaginal area, "which all works together to improve blood flow."

The treatment takes less than 10 minutes and is administered twice a week for two weeks. Arena said Cliovana has only been around for three to four years, "so it's really cutting-edge technology for women."

She noted: "There's always been a focus on male intimacy in sexual health. There are 26 FDA-approved medications for male sexual dysfunction. For women, there are two. So male sexual disfunction has always been on the forefront."

Arena, who has worked with women as an OB-GYN for 20 years, said sexual health can be "tricky" to talk about and she realized she needed "to initiate that conversation for many people" and ultimately between their partners.

Cliovana is not just for those going through menopause, but for any woman who wants to improve their sexual health, regardless of age, the doctor said.

What To Eat and Do, Before and During Menopause

In the simplest of terms, "be as healthy as you can," Arena said. That means getting "the pillars of our health aligned, which will help make the transition into menopause a lot easier. It's all about balance."

Nutrition

You need to strive to eat "as clean as possible," Arena said. There's no "perfect" diet for menopause but "eating from the land," as you might see in a Mediterranean diet, is important.

Processed foods, sugar and carbohydrates will disrupt our hormones and our balance, so "the cleaner we can eat, the better."

Arena said research suggests soy can help with the menopausal transition. But "the challenge is that a lot of the soy [in different foods] today isn't clean and is genetically modified. So you need to be careful," she warned.

Limit Alcohol

Excessive alcohol consumption can also make the transition more difficult. Alcohol increases our risk of hot flashes, night sweats, disturbed sleep as well as breast cancer. "Never say never to alcohol," but it needs to be taken in small amounts, Arena advised.

She explained: "You want to make sure that in general, that your body is detoxifying well. So, if your body is in a good healthy state, and your liver is working well, one or two drinks a week is fine."

Physical Activity

"We have to move our bodies," Arena said, and "as we age, we need to do more strength training and less cardio to protect our muscles and our bones."

As women's bodies lose those aforementioned hormones approaching and during menopause, it puts them at risk for bone loss and osteoporosis. "So, strength training is key to help the muscles and the bones," Arena said.

Sleep Hygiene

Arena advised: "We have to optimize our sleep. We get rewarded in our society for having minimal sleep but that takes a toll over time because sleep is foundational."

For more information about menopause, see the websites of the U.S. Office on Women's Health and the U.S. National Institute on Aging.