Understanding Menopause: Symptoms, Risks, and Treatment Options
Written By Adama Diarra, DO, FACP
Menopause is a natural phase in life that signifies the end of a woman’s menstrual cycles. In the absence of factors that may adversely affect the ovaries—such as surgery to remove the ovaries, pelvic radiation, certain chemotherapy treatments, infections, or autoimmune diseases—menopause typically occurs between the ages of 45 and 55. It is officially diagnosed after 12 consecutive months without a menstrual period, marking the end of fertility. While menopause is a normal biological process, it can bring about a range of physical and emotional symptoms, as well as long-term health changes.
In this newsletter, we’ll explore what menopause is, how it affects women, what factors can make symptoms more intense, and how it can be treated with both lifestyle changes and medications.
What is Menopause?
Menopause occurs when the ovaries stop producing eggs and the levels of hormones like estrogen and progesterone decrease. These hormones are crucial for regulating menstruation and reproduction. As hormone levels fluctuate and eventually decline, the body goes through several changes.
Menopause happens in three stages:
Perimenopause: Perimenopause is the transitional phase leading up to menopause, when hormone levels start to fluctuate, causing irregular periods and early menopausal symptoms. It can begin several years before menopause. Many women notice subtle changes in their bodies during this time, though pinpointing the right diagnosis can be challenging. In my experience, the key to accurate diagnosis is listening carefully. Often, if you simply allow the patient to speak, they will provide the insights needed to understand what's happening.
Menopause: Menopause is officially diagnosed when a woman has gone 12 consecutive months without a period, marking the end of menstruation and fertility. Unfortunately, it often takes over a year of follow-up, especially in women experiencing disabling symptoms like hot flashes or mental health changes, before we can make a formal diagnosis based on current guidelines. While hormone testing can be helpful, I’ve found that hormone levels are often unreliable for diagnosing menopause. This is because hormone levels, particularly estrogen and follicle-stimulating hormone (FSH), can fluctuate significantly during perimenopause, making it difficult to get a clear picture from a single test. These fluctuations mean that hormone levels are not always a definitive indicator of menopause, and the diagnosis is often based more on symptom patterns and the length of time since the last period.
Postmenopause: The stage after menopause, when symptoms may ease for some women, but the risk for certain health conditions, like osteoporosis, increases due to the continued low levels of estrogen.
When Does Menopause Occur?
The average age for menopause is 51, but it can happen anytime between 45 and 55. In some cases, menopause may occur earlier due to medical treatments like chemotherapy, surgery to remove the ovaries, or other health conditions, such as autoimmune disorders.
How Does Menopause Affect Women?
Menopause affects every woman differently, but there are common symptoms associated with the hormonal changes that occur. These symptoms can range from mild to severe and may include:
Hot flashes: Sudden feelings of warmth, often in the upper body, which can lead to sweating.
Night sweats: Hot flashes that occur during sleep, often disturbing rest.
Mood changes: Anxiety, irritability, or feelings of sadness can arise as hormone levels fluctuate.
Vaginal dryness: Thinning of the vaginal tissues can lead to discomfort during intercourse.
Decreased libido: Many women report a reduced interest in sex.
Sleep disturbances: Difficulty falling asleep or staying asleep is common.
Memory problems or difficulty concentrating: Some women experience what is known as “brain fog.”
The intensity and duration of these symptoms can vary from woman to woman.
Risk Factors That Can Worsen Symptoms
Certain factors can influence how severe menopause symptoms are. These include:
Smoking: Women who smoke tend to experience menopause earlier and have more intense symptoms, such as hot flashes.
Body weight: Women who are overweight may experience more frequent or severe hot flashes because adipose tissue (fat cells) can independently make estrogen.
Stress: High stress levels can exacerbate symptoms like anxiety, mood swings, and sleep disturbances.
Family history: If your mother or sisters had severe menopause symptoms, you may experience something similar.
Health conditions: Conditions like autoimmune diseases or thyroid disorders can worsen symptoms of menopause.
Potential Health Complications of Untreated Menopause
While menopause itself is not a disease, leaving its symptoms or related conditions untreated can lead to long-term health issues, including:
Osteoporosis: The decrease in estrogen can lead to bone density loss, making bones more fragile and increasing the risk of fractures.
Cardiovascular disease: Low estrogen levels may raise the risk of heart disease, particularly in postmenopausal women.
Weight gain: Hormonal changes can lead to an increase in abdominal fat, raising the risk for diabetes and metabolic syndrome.
Urinary incontinence: The tissues of the bladder and urethra lose elasticity, leading to leakage during physical activities such as laughing or coughing.
Mental health challenges: Untreated menopause symptoms, especially sleep disturbances and mood changes, can contribute to depression and anxiety.
Diagnosis and Early Detection
Early detection of menopausal symptoms through routine medical visits is crucial. An annual exam provides an opportunity for your doctor to discuss symptoms, review your medical history, and assess any changes in your body’s hormone levels. Blood tests may be performed to check hormone levels and rule out other conditions that could be contributing to symptoms.
Overview of Treatment Options for Menopause
Every woman’s experience with menopause is unique, and so are her treatment needs. The goal of treatment is to manage symptoms and reduce the risk of long-term health issues. Treatment approaches include lifestyle changes, hormone replacement therapy (HRT), and non-hormonal medications.
1. Lifestyle Interventions
Exercise: Regular physical activity helps to reduce weight gain, strengthen bones, and improve mood. Weight-bearing exercises like walking, jogging, and resistance training are particularly beneficial for bone health.
Diet: A balanced diet rich in calcium, vitamin D, and phytoestrogens (plant-based estrogens found in foods like soy) can help support bone health and reduce hot flashes.
Stress management: Practices such as yoga, meditation, and deep breathing exercises can help manage stress and alleviate symptoms like anxiety and sleep disturbances.
Smoking cessation: Quitting smoking can reduce the severity of hot flashes and other symptoms, while also lowering the risk of osteoporosis and heart disease.
2. Medications for Menopause
Hormone-Based Treatments
Hormone Replacement Therapy (HRT):
Hormone Replacement Therapy (HRT) is used to relieve symptoms of menopause—such as hot flashes, night sweats, mood swings, and vaginal dryness—by replacing hormones your body is no longer making at the same levels, especially estrogen. For some women, progesterone is also added, especially if they still have their uterus, to help protect against risks like uterine cancer.
HRT can be delivered in several ways. Each method has its pros and cons, and what works best depends on your body, symptoms, lifestyle, and health history.
🌿 Common Ways HRT Is Delivered
Pills (Oral Tablets)
Taken daily by mouth.
Pros: Easy to use, widely available, can relieve full-body symptoms
Cons: May increase the risk of blood clots or stroke in some women, especially smokers or those over age 60
Patches
Worn on the skin (usually lower abdomen or buttocks), changed weekly or biweekly.
Pros: Steady hormone delivery, bypasses the digestive system, lower clot risk than pills
Cons: Can irritate the skin, may fall off with sweat or water exposure
Gels or Creams
Applied to the skin daily (arms, legs, or shoulders).
Pros: Easy to apply, absorbed directly through the skin, customizable dosing
Cons: Must avoid skin-to-skin contact with others until it’s fully absorbed; can rub off on clothes
Vaginal Creams, Tablets, or Rings
Inserted into the vagina to treat local symptoms.
Pros: Targets vaginal dryness, discomfort, or urinary symptoms with minimal absorption into the rest of the body
Cons: Not effective for hot flashes or full-body symptoms; needs regular insertion
Pellets (Subcutaneous Implants)
Tiny pellets inserted under the skin (usually hip or buttock) that release hormones slowly over 3–6 months.
Pros: Long-lasting, low-maintenance once inserted
Cons: Requires a minor procedure, less flexible dosing, may be harder to adjust if side effects occur
Non-Hormonal Treatments
For women who cannot or prefer not to take hormone therapy, there are several non-hormonal options that may help relieve hot flashes and other symptoms.
Fezolinetant
A neurokinin 3 receptor antagonist, recently FDA-approved for treating moderate to severe hot flashes in menopause. It works by calming down the brain pathways that trigger hot flashes.
Pros:
Specifically designed to target hot flashes
Non-hormonal and well-tolerated
Does not affect estrogen or progesterone levels
Cons:
May take a few weeks to see results
Long-term safety data is still emerging
Not yet widely covered by all insurance plans. So may cost you an arm and a leg.
Elinzanetant (formerly Elizanetant)
A dual neurokinin 1 and 3 receptor antagonist being studied for hot flashes and sleep disturbances during menopause. Still under investigation, but early trials are promising.
Pros:
Potential to reduce both hot flashes and disrupted sleep
Targets central pathways involved in thermoregulation and mood
Cons:
Not FDA-approved yet (as of 2025)
Still in clinical trials — not available for prescription
Long-term effects and safety are unknown
SSRIs (Selective Serotonin Reuptake Inhibitors)
Certain antidepressants, like paroxetine and escitalopram, have been shown to help reduce hot flashes and improve mood.
Pros:
FDA-approved non-hormonal option for hot flashes
May also help with anxiety, mood swings, or depression
Good option for women who already struggle with mood symptoms
Cons:
Can cause side effects like nausea, weight changes, or sexual dysfunction
May take 1–2 weeks to begin working
Gabapentin
Originally used for seizures and nerve pain, gabapentin can also help reduce hot flash frequency, especially at night.
Pros:
Can help with sleep and nighttime hot flashes
Non-hormonal and generic
Cons:
Can cause drowsiness, dizziness, or brain fog
Works best for nighttime symptoms
Clonidine
A blood pressure medication that can also reduce hot flashes in some women by stabilizing blood vessel response.
Pros:
Helpful for women with high blood pressure and hot flashes
Oral or patch options available
Cons:
Can cause dry mouth, dizziness, or fatigue
Less effective than other non-hormonal options
Personalized Care for Every Woman
Menopause is not a one-size-fits-all experience. Each woman’s journey is unique, and treatment should be tailored to her individual symptoms, health history, risk factors, and personal preferences. In my practice, that process begins with something simple but powerful: listening.
I start by inviting patients to share their story in their own words—without interruption. My initial questions are open-ended to create space for a full, honest conversation. Once I understand the broader picture, I follow up with more specific questions to fill in the clinical details. From there, we review treatment options together. I explain the potential benefits and risks of each, drawing from trusted, peer-reviewed research and data on reported side effects. This collaborative, evidence-based approach allows us to choose a plan that is both medically sound and personally aligned with your goals.
Conclusion
Menopause is a natural stage of life—but that doesn’t mean its symptoms or health implications should be dismissed. For many women, symptoms like hot flashes, mood changes, or sleep disturbances can significantly affect quality of life. Additionally, menopause marks a time when long-term health risks—such as osteoporosis and heart disease—may begin to rise.
With early recognition, personalized care, and thoughtful follow-up, women can reduce discomfort, improve daily functioning, and prevent complications later in life. If you’re experiencing symptoms or entering this phase of life, don’t hesitate to consult your healthcare provider. Addressing menopause proactively can help you move through this transition with strength, confidence, and lasting wellness.
References
American College of Obstetricians and Gynecologists. "Practice Bulletin No. 141: Management of Menopausal Symptoms."
Kaunitz, A.M., Manson, J.E. "Management of Menopausal Symptoms." New England Journal of Medicine, 2015.
Lederman, S., Ottery, F. D., Cano, A., Santoro, N., Shapiro, M., Stute, P., Thurston, R. C., English, M., Franklin, C., Lee, M., & Neal-Perry, G. (2023). Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): A phase 3 randomised controlled study. The Lancet, 401(10382), 1091–1102. https://doi.org/10.1016/S0140-6736(23)00085-5
North American Menopause Society (NAMS). "Menopause Practice: A Clinician’s Guide.”
Pinkerton, J. V., Simon, J. A., Joffe, H., Maki, P. M., Nappi, R. E., Panay, N., Soares, C. N., Thurston, R. C., Caetano, C., Haberland, C., Haseli Mashhadi, N., Krahn, U., Mellinger, U., Parke, S., Seitz, C., & Zuurman, L. (2024). Elinzanetant for the treatment of vasomotor symptoms associated with menopause: OASIS 1 and 2 randomized clinical trials. JAMA, 331(3), 234–245. https://doi.org/10.1001/jama.2024.12345
Shifren, J.L., Gass, M.L.S. "The North American Menopause Society Recommendations for Clinical Care of Midlife Women."
