When to Seek Care for Signs and Symptoms of Menopause

Hot flashes, sleep problems, mood swings, and weight fluctuations are all common as women near midlife. You may view these symptoms as a rite of passage — or something you just need to push through. 

The National Institute on Aging reports that the average age of menopause is 52. However, being in menopause means that you haven’t had a menstrual cycle for a year or longer. Perimenopause, the period of hormonal changes leading up to menopause, can start as soon as your early 40s. More and more, women are realizing that they don’t have to put up with years of uncomfortable symptoms.

“If you have any symptoms that are bothering you, it’s time to see a health care provider,” says Lisa Baute, MD, a Mass General Brigham obstetrician-gynecologist with a special interest in women’s midlife health. “Menopause is very normal, and women shouldn’t feel hesitant to bring it up with their primary care provider or gynecologist.” 

What are the signs and symptoms of perimenopause and menopause?

Women tend to experience similar symptoms throughout perimenopause and into menopause. One of the most common and disruptive ones is hot flashes. These tend to present as intense heat that feels like it starts inside and blooms outward. Women may sweat profusely, then feel very cold immediately afterward.

“Hot flashes can occur any time, but many women get them overnight,” explains Dr. Baute. “You may wake up sweating and feel like you need to change your clothes or sheets.”

In addition to hot flashes and night sweats, many women experience:

• Brain fog or forgetfulness
• Menstrual cycle changes
• Mood swings
• Muscle aches
• Vaginal dryness
• Weight gain

Which provider should I see for menopause help?

Women who have concerns about menopause should schedule an appointment with their primary care provider or gynecologist. Which provider you should see depends on your provider’s experience and your relationship with them. Some primary care providers are comfortable managing menopause, while others aren’t. All gynecologists have training to treat menopause.

Dr. Baute notes that heavy periods, loss of periods, or frequent periods warrant a trip directly to the gynecologist. Gynecologists are experts in women’s health and hormonal changes. They can help you find the root cause of menstrual changes.

Some gynecologists also have special certifications in midlife women’s care. These specialists have completed training to better understand treating women before, during, and after menopause.

What to expect at your appointment

You may talk with your provider about menopause symptoms during your annual visit, or you may make a special appointment. Your provider will likely ask:

• Do you have symptoms that are disrupting your usual activities?
• How often do you have symptoms?
• Is there anything that worsens or relieves your symptoms?
• What symptoms bother you most?
• When did your symptoms start?

It’s unlikely that you’ll get blood work to evaluate menopause. “There’s no blood test that definitely tells us whether you’ll benefit from treatment or not,” explains Dr. Baute. The range of normal hormone levels before and during menopause is quite wide. Instead, providers consider what symptoms you have and how severe they are when recommending treatments.

Understanding menopause treatments

Treatment varies depending on whether you’re in perimenopause or menopause. During perimenopause, women are still menstruating. Because of this, it’s generally most beneficial for providers to treat symptoms with low-dose or progesterone-based birth control pills. Starting hormone replacement therapy (HRT) during perimenopause can increase bleeding and menstrual irregularities.

If you haven’t had a menstrual cycle for a year or longer, you may be a candidate for HRT. HRT is a medical treatment to replace female hormones. “Estrogen and progesterone are the mainstay if your primary complaint is hot flashes or night sweats,” says Dr. Baute. “These medications effectively treat symptoms while offering an added benefit of helping to maintain bone density.”

Depending on your symptoms and preferences, other menopause treatment options may include:

• Blood pressure medication to reduce hot flashes
• Certain antidepressants that are FDA-approved for hot flashes and night sweats
• Fezolinetant, an FDA-approved medicine that targets the brain to reduce hot flashes
• Gabapentin, a neuromodulator that helps with sleep and night sweats
• Testosterone, especially if low libido (sex drive) is a concern

Healthy habits can also help manage menopause symptoms. These include:

• Dressing in layers to manage hot flashes
• Eating a healthy diet that focuses on fresh foods, lean protein, and complex carbohydrates
• Exercising regularly, incorporating resistance training to maintain bone density
• Practicing sleep hygiene by limiting screen time before bed, minimizing alcohol, and keeping your bedroom cool and dark

Finding menopause relief

Perimenopause and menopause are often filled with discomfort and frustration. But you don’t have to suffer through this phase of life.

“Menopause has been a bit of a hot topic lately,” says Dr. Baute. “I think women are generally getting more comfortable talking about it, and that’s a great thing! There are effective treatments to help manage this life stage, and women shouldn’t be afraid to ask for them.”