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Menopause is the transitional period in a woman's life when her ovaries start producing less of the sex hormones estrogen and progesterone. Menopause is declared when a woman ceases to have a menstrual period for 12 consecutive months, marking the end of her reproductive years. A woman who has her ovaries surgically removed immediately enters menopause.

Understanding Menopause
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Natural menopause is a gradual process that begins with perimenopause, usually in a woman's 40s (though it may occur as early as her 30s). Perimenopause can last up to 10 years, as the menstrual cycle tapers off and menopausal symptoms such as hot flashes, night sweats, and mood swings may begin.

Other physical and psychological changes that may occur throughout perimenopause, menopause, and the postmenopausal years include irregular heartbeat, headaches, insomnia, irritability, depression, and anxiety, along with cognitive symptoms like forgetfulness. Menopause is also associated with problems such as vaginal dryness, painful sexual intercourse, urine leakage, and joint pain.

When does menopause usually start?

Perimenopause typically begins in a woman’s 40s, though some women start to experience symptoms earlier. Menopause itself usually happens in the early 50s. Some women may enter menopause in their 40s; others continue to menstruate until their 60s.

What is the difference between premenopause and perimenopause?

The term “premenopause” technically refers to all the time in a woman’s life before menopause; a woman in her 20s, for instance, is generally considered to be “premenopausal.” “Perimenopause,” on the other hand, refers to a specific period shortly before menopause when hormone levels begin to drop and the body prepares to enter menopause.

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Treating Common Symptoms and Challenges

Eventually, symptoms of menopause like hot flashes and mood swings will likely abate. However, for those who find them difficult to manage, there are treatments and strategies that offer some relief. These typically center on lifestyle changes such as breathing exercises, exercise routines, and the use of cooling devices for hot flashes. In some cases, short term use of nonprescription remedies like black cohosh and isoflavones from soy foods or supplements may help. Hormone therapy and non-hormonal medications are available by prescription for severe and disruptive symptoms.

What’s the best way to treat hot flashes?

Regular exercise, maintaining a cool core body temperature—by drinking ice water or placing a cold washcloth around the neck—and paced breathing (six to eight breaths per minute, for 15 minutes, twice a day at the onset of hot flashes) can be effective strategies for some women who experience hot flashes. 

Do hot flashes ever go away?

Most women eventually stop having hot flashes, but how long they last varies widely. The majority of women will experience hot flashes for less than 10 years.

Menopause and Mental Health
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Many of the most well-known menopause symptoms, such as hot flashes, are physical. But cognitive and psychological symptoms can be equally challenging for women to deal with—not to mention confusing or even frightening. Feeling “foggy” or forgetful, a common symptom of menopause, may cause concerns about the onset of dementia or Alzheimer’s disease; mood swings may lead to relationship difficulties or can increase feelings of frustration or anxiety. Hormone therapy, as well as lifestyle interventions—such as exercise, dietary changes, and relaxation techniques—may help women reduce the mental impact of menopause and feel better as a result.

What should I do about menopause “brain fog”?

Forgetfulness, difficulties multi-tasking, and slowed information processing—collectively known as “brain fog”—are common symptoms of menopause. HRT can help, as evidence suggests that decreased estrogen may be responsible for problems with memory and concentration. A healthy diet and regular exercise may also improve symptoms.

Are menopause and depression related?

Mood swings during menopause are not the same as clinical depression. However, fluctuating hormones, combined with frustrating physical and cognitive symptoms, may put some women at greater risk of depression. Any woman undergoing menopause who feels persistently irritable, sad, or anxious for more than two weeks should talk to her doctor. 

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