Note: This article primarily discusses the experiences of cisgender women. Transgender, nonbinary, and gender-expansive people may also experience menopause-related symptoms and face distinct barriers to accessing care and other health disparities.
If you’re a woman between the ages of 40 and 60, you’ve probably had at least one conversation about perimenopause or menopause.
Menopause is an experience virtually all women share. Despite affecting half the population, menopause has often been overlooked, misunderstood, or treated as something to be endured.
Today, women are talking openly about perimenopause and menopause. Health care providers are developing a deeper understanding of how hormonal changes affect physical health, emotional well-being, sleep, sexual health, and long-term disease risk. As a result, women have access to more treatment options and resources than ever before.
Health care providers are also becoming more sensitive to the unique needs of women who experience the sudden onset of menopause resulting from conditions affecting the ovaries or uterus, chemotherapy, radiation, or surgery to treat certain cancers or proactively reduce cancer risk.
As a Menopause Society Certified Practitioner, I am committed to helping women navigate perimenopause and menopause with confidence. With the right support, information, and treatment options, this transition can be an opportunity to assess your changing health needs and reprioritize your physical and emotional well-being.
Recognizing the signs
Menopause is reached after twelve consecutive months without a menstrual period. The transition leading up to that point is called perimenopause, when menstrual cycles may change as hormone levels fluctuate.
For most women, perimenopause starts in their 40s or 50s, but younger women can also experience it.
The typical perimenopause-menopause transition lasts about 4 – 8 years. During this time, levels of hormones like estrogen, progesterone, and testosterone (yes, women have testosterone) naturally decline. Some women experience only mild symptoms, while others find that these changes significantly affect their quality of life. Both experiences are normal.
Irregular periods are one of the first signs of perimenopause, but other symptoms may include:
- Hot flashes
- Fatigue
- Hair and skin changes
- Joint pain and stiffness
- Weight gain
If you are struggling with any of these changes, talk to your health care provider. Help is available, and you don’t have to suffer in silence.
Focusing on sexual and urinary health
Hormonal shifts can also affect sexual and urinary health. Decreased sex drive, vaginal dryness, urinary incontinence, increased urgency, and more frequent urinary tract infections can make the idea of sexual activity unappealing.
These changes are common, treatable, and nothing to be embarrassed about.
If they are causing you to withdraw from sexual activity, talk with your partner about what’s going on. Vaginal moisturizers and lubricants can make sex less painful. You can also reinforce closeness and intimacy by connecting in other meaningful ways.
Pelvic floor therapy, hormone therapy (HT), non-hormonal therapies, and lifestyle changes can help relieve these symptoms. For many women, HT is a safe and effective option, but treatment decisions should always be personalized based on individual symptoms and health history in consultation with a health care provider.
Getting a good night’s sleep
Perimenopause and menopause can also affect sleep patterns. Symptoms like night sweats, insomnia, and increased urinary frequency can make it difficult to get the recommended 7 – 9 hours of sleep.
Being well-rested is essential to overall health. Poor sleep can contribute to fatigue, irritability, and “brain fog,” affecting focus, memory, and the ability to multitask.
Keeping a consistent bedtime routine, sleeping in a cool, dark room, and reducing caffeine, sugar, and fluid intake before bedtime can reduce these symptoms. If sleep disturbances persist, your health care provider can help determine whether treatment of underlying menopausal symptoms, medication, or other interventions may be appropriate.
Taking care of your emotional well-being
In addition to physical changes, perimenopause and menopause can also trigger emotional changes, including increased feelings of depression and anxiety. Women who could comfortably manage high levels of stress may, at times, find themselves overwhelmed by even small tasks.
For many women, this stage of life coincides with other responsibilities and transitions, such as caring for aging parents, supporting children, advancing careers, or planning for retirement. Hormonal changes combined with these demands can make emotional well-being especially important.
If you don’t feel like yourself, consult your health care provider. Talk therapy, meditation, mindfulness, and medication can help restore your sense of calm and balance.
Protecting your cardiometabolic health
Hormonal shifts can also affect your heart, bones, muscles, and metabolic function. As a result, menopause increases your risk for developing all of the following:
- Type 2 diabetes
- High blood pressure
- High cholesterol
- Osteoporosis
While these changes may sound concerning, menopause can also serve as an important reminder to focus on preventive health and build habits that support healthy aging.
Annual visits with your health care provider can help you stay on top of these changes. In addition to taking your blood pressure at every visit, your health care provider can order bloodwork to monitor your cholesterol and blood sugar levels. Lifestyle changes and medications can usually help manage these conditions.
Declining hormone levels can also lead to changes in bone and muscle health. Strength training and getting enough protein, calcium, and vitamin D can help you maintain muscle and reduce your risk of osteoporosis and fractures.
Embracing a midlife mindset
Perimenopause and menopause are natural parts of life. But just like puberty, no two people have the same experience.
If these changes are disrupting your quality of life, you’re not alone. In addition to guidance from your health care provider and support from friends and loved ones, resources may be available through your health plan.
Independence Blue Cross members have access to a variety of programs to support their well-being through midlife and beyond. This can include nutrition counseling, access to behavioral health support in as quickly as 1 to 2 days from providers in the Connect to CareSM network, digital self-management tools for mental well-being from Spring Health, and support for pelvic health issues from Sword Health. Check your member benefits booklet to learn which programs are available to you.
While perimenopause and menopause can bring uncertainty, they can also be an opportunity to take stock of your health, advocate for your needs, and invest in your future well-being. With the right support, treatment, and information, this stage of life can be approached with strength, confidence, and resilience.
Spring Health is an independent company.
Sword Health is an independent company.
