Ask an Expert: What Can I Expect During Menopause?
PHOTO ILLUSTRATION: NICK BEECHER
Yamnia I. Cortés
Yamnia I. Cortés, an associate professor at the University of Iowa College of Nursing, leads a team of researchers who study midlife women’s cardiovascular health, particularly during the menopause transition. As the principal investigator of the Cortés MenoLab, she has been featured on PBS and Oprah Daily and receives numerous questions from women navigating the challenges of menopause. Here are a few of the most common concerns.
When does menopause usually start, and how long does it last?
In the United States, menopause typically occurs around age 52 and is defined as 12 consecutive months without a menstrual period. Perimenopause, which can last 4–10 years, is the transition period when menstrual cycles become irregular, and women may experience symptoms commonly associated with menopause, like hot flashes and night sweats. However, the age at menopause and duration of perimenopause can vary significantly based on factors such as race and ethnicity, education level, body weight, smoking status, and chronic health conditions.
I’ve noticed weight gain—does menopause have something to do with it?
Weight and body mass index increase gradually during the menopause transition, but menopause itself does not cause a sudden increase. Hormonal changes—especially declining estrogen—can slow metabolism, reduce muscle mass, and shift fat storage to the abdomen. Other factors such as aging, genetics, sleep issues, and lifestyle also play a role.
What are some common symptoms?
Common symptoms include hot flashes, night sweats, depressive symptoms, sleep problems, brain fog or difficulty concentrating, vaginal dryness, recurring urinary tract infections, joint pain, and thinning hair and nails. However, women may experience numerous other symptoms, with the frequency and severity varying widely from person to person.
Is hormone therapy safe, and is it right for me?
Menopause hormone therapy (MHT) should be individualized—considering age, time since menopause, health history, and personal preferences. It is typically used at the lowest effective dose for the shortest duration needed to manage symptoms. MHT can be safe and effective for many people, especially when started near the onset of menopause (typically within 10 years of the final menstrual period). MHT recently has been FDA-approved for vasomotor symptoms (hot flashes and night sweats), genitourinary syndrome of menopause (a condition characterized by vaginal dryness, painful intercourse, and urinary symptoms), prevention of bone loss and osteoporosis, and premature ovarian insufficiency or early menopause (under age 40), where MHT is recommended until the average age of natural menopause.
Are there nonhormonal ways to manage menopause symptoms?
Yes, there are several nonhormonal options:
- Nonhormonal medications. Some antidepressants may help relieve hot flashes, but the only one currently approved is paroxetine. Fezolinetant, which works by targeting the part of the brain that regulates body temperature, was approved in 2023.
- Cognitive behavioral therapy. It may reduce the impact of vasomotor symptoms and improve sleep and mood.
- Healthy lifestyle. A balanced diet, regular exercise, and stress-reducing practices such as mindfulness, yoga, or tai chi may help improve mood, sleep, focus, and overall health. Cooling wearables (including light pajamas and cooling pillows), staying hydrated, and limiting caffeine may also improve vasomotor symptoms and sleep.