Menopause: What to expect

The symptoms of menopause range from hot flushes and difficulties sleeping to vaginal dryness but for most women, they will disappear over time.

Most women reach menopause in their early fifties. As your body goes through various changes, including hot flushes and sleepless nights, it's natural to have some concerns.

Menopause is a time of change. It's when your ovaries stop making estrogen and your periods stop. At first, you'll probably have irregular periods. They may be shorter or longer than usual. You might bleed less or bleed heavier. You might skip some months. Soon, your periods will stop completely. Menopause occurs when a woman has not had a period for 1 year.

Just as when you went through puberty and first started having periods, your body will now go through many changes. Menopause isn't the end of anything (except periods, of course). It's the beginning.

You're in what many people call the prime of life. You might have kids that are old enough to go out on their own. You might have free time you never had before.

The average woman will begin menopause around age 51, though some begin earlier and some later. Men, too, face midlife changes, but the changes for women are more dramatic. Hormone levels drop, causing more intense physical and emotional changes. The best way to cope with the change is to be ready.

Hot flushes

Most menopausal women will experience hot flushes, or hot flashes. A hot flush is a sudden feeling of heat rushing to the upper body and face. Hot flashes can happen at any time, causing you to feel uncomfortably warm and your face to redden. Some women have them infrequently, perhaps a few times a month. Other women have them every day. They may last from a few seconds to a few minutes.

While uncomfortable and sometimes embarrassing, hot flushes are harmless. Try dressing in layers (so you can always shed a few clothes), and keeping the temperature low in your house.

Some research suggests that women who exercise regularly have fewer and less intense hot flushes.

Sleep difficulties

There's always something to keep a woman awake at night. If it's not crying babies or snoring partners, it's menopause.

Hot flushes are called "night sweats" when they happen at night. They can wake you from a deep sleep and leave you exhausted the next day.

You also may suffer from less REM (rapid eye movement) sleep. REM is the stage of sleep when you dream. Without it, you wake up feeling unrested and irritable.

Some menopausal women have trouble falling asleep, or wake up far too early.

Do your best to get enough sleep. Go to bed earlier and take naps. Without good sleep, you'll be irritable, depressed and have trouble concentrating.

Bone loss and osteoporosis

Everyone, men and women, lose bone as they age. It's normal. What's not normal is losing too much too fast and having your bones become brittle and prone to breaking.

During menopause, your rate of bone loss increases. To prevent osteoporosis, keep your bones strong. Be active. Strengthen your bones with weight-bearing exercise. Brisk walking will help. So will running, tennis, aerobics, lifting weights and dancing.

Make sure you get enough calcium. You'll need more now than you did before–about 1,500 mg per day. You can find it in milk, yogurt, cheese, broccoli, soybeans, tofu and ice cream. Many orange juices and cereals are also fortified with calcium. You need vitamin D to absorb calcium. Drink milk fortified with vitamin D and get plenty of sunlight. You could also consider taking calcium or vitamin D supplements.

Heart attacks and stroke

When you're young, the estrogen produced by your ovaries helps protect you from heart attacks and stroke. During menopause, you lose that protection. Heart disease kills more women than any other cause of death. Strengthen your heart with brisk walking, swimming, aerobics, running and other cardiovascular activities.

Quitting smoking, eating a low-fat diet, and reducing alcohol intake will also lower your risk of heart attack and stroke.

Sexual changes

Lower levels of estrogen may affect your sex life. Vaginal tissue may become thinner and dryer, causing discomfort during intercourse and making you more prone to vaginal infections. You might find it takes you longer to get aroused or reach orgasm, or that you have less interest in sex.

You and your partner should talk about your needs and feelings and what you can do. Water-soluble lubricants, sold in drug stores, can moisten the vagina. More time spent on foreplay helps. Try new positions and new techniques.

Until it has been at least a year since your last period, assume you're still fertile. This means you need to take precautions if you don't want to become pregnant.

Emotional changes

Mention women and hormones and people expect a punch line. It's commonly believed that because menopause is a time of hormonal change, it makes women a bit unbalanced. That's not true. It is true that some women might experience mood swings or irritability or depression. These might be caused just as much by lack of sleep or hot flushes as hormone levels.

Menopause can be a time of great change in a woman's life. You might be sad you can no longer have children or your grown children are leaving the nest. You might find yourself caring for aging parents. Like any phase in life, menopause has its stressors.

If you find yourself feeling depressed, reach out for support. Talk to your spouse or siblings, or a close friend or counselor.

Post-menopause

Post-menopause is when most of the symptoms of menopause have faded. Many women are just as relieved now as when they looked back and felt glad to be out of puberty.

Focus on staying active, eating well and enjoying the prime of life.