Patient Handout: Menopause Tip Sheet

What to expect before, during and after menopause and what might help relieve symptoms

Menopause is clinically defined as “the point at which a woman has not had a period in 12 consecutive months.”

For many women, the symptoms associated with menopause can be a challenging experience. However, menopause does not happen abruptly. It occurs gradually – often over the course of several years.

What to Expect

The initial stage of menopause is called the menopausal transition, or perimenopause. This is the stage leading up to menopause when a woman’s ovaries begin to produce less estrogen and progesterone. Due to the decline in these hormones, symptoms start to develop. Periods may stop suddenly or may slow down gradually. Ovulation occurs less frequently.

Perimenopause can occur eight to 10 years before menopause. While the average length is four, symptoms typically begin in the last one to two years, when estrogen levels begin to drop more quickly.

Menopause occurs after perimenopause. This stage happens to all women, typically between the ages of 45 and 55 – the average age is 51.

Menopause is officially diagnosed when a woman’s period has ceased for twelve months. Any vaginal bleeding occurring after this is considered abnormal and a doctor should be consulted.

While menopause occurs for the rest of a woman’s life – postmenopause is also a phase. During this stage, menopausal symptoms have begun to decrease, but the risk for other health conditions increases due to the lack of hormones, such as heart disease and osteoporosis. Hormone therapy and lifestyle changes can reduce these risks.

Symptoms associated with menopause include the following:
• Hot flashes
• Night sweats
• Dry skin
• Vaginal dryness with associated discomfort during sex
• Emotional changes
• Urinary urgency
• Difficulty sleeping

Women who are experiencing perimenopause may experience all of the above symptoms, plus:
• Breast tenderness
• Periods that are lighter or heavier than normal
• Worsening of premenstrual syndrome (PMS) symptoms
• Irregular periods

Symptomology is different for each woman – no two women are alike. However, the symptoms do signal that estrogen levels are decreasing.

Natural Supplements vs. Medications

Typically, menopause treatment consists of hormone replacement therapy (HRT). HRT replaces the hormones that are no longer made by the body during menopause.

HRT has several formulations, but it is most commonly prescribed as a pill that is taken once daily. These pills typically contain estrogen and progesterone. Oral medications are effective for many of the symptoms associated with menopause, such as hot flashes and night sweats. Topical preparations, on the other hand, do not treat these symptoms but can treat vaginal dryness.

HRT is considered safe, but for some women, there are risks. Because of the risks associated with HRT, the FDA recommends that the lowest dose should be used, and for the shortest duration that is needed. The most significant risk associated with HRT is the increased risk of stroke and blood clots in the legs.

According to, “Menopausal hormone therapy may be an option for women up to age 59, but usually only within ten years of menopause. Younger women and those close to their final menstrual period are less likely to have the harmful side effects from menopausal hormone therapy.”

Some women opt to use supplements instead of HRT. It is important to note that most of these supplements do not have much research supporting their efficacy, but women continue to use them to treat their symptoms:
• Black cohosh: Primarily used to treat hot flashes, black cohosh can be drunk as a tea, taken as a capsule or a pill, or consumed as a liquid extract.
• Red clover: Containing phytoestrogens, which are similar to estrogen, red clover may treat a myriad of menopause symptoms. Red clover can be taken as a pill or drank in a tea. It should not be consumed with any HRT that contains estrogen.
• Soy: A member of the pea family, soy also contains phytoestrogens. Soy can be found in many supplements and foods such as soy milk and tofu. Soy is not safe to consume for women who are already taking HRT containing estrogen.

Strategies for Coping

Not every woman is interested in taking medication to deal with the symptoms associated with menopause – or can take medication. In these instances – and even with the prescribed medications – specific strategies can be utilized to cope with the symptoms:
• Hypnosis: One study found that this relaxation technique reduced hot flashes by 74%!
• Mind and body practices: Yoga, tai chi, and acupuncture are thought to reduce menopause symptoms – specifically stress, muscle, and joint pain, and sleep problems.
• Consuming cold drinks: During hot flashes, consuming cold beverages, such as ice water, iced tea, or fruit juices containing antioxidants can cool you down. Avoid beverages such as alcohol and coffee, which can have a diuretic effect and worsen hot flashes.
• Exercise: An excellent tactic for reducing irritability in general, exercise may also reduce irritability in menopausal women.


Cleveland Clinic. (2017, January 6). Menopause, perimenopause, and postmenopause. Retrieved from

US Department of Health and Human Services. (2016, December 1). What is menopause? Retrieved from (2018, May 22). Menopause treatment. Retrieved from

WebMD (2018, August 4). Natural treatments for menopause symptoms. Retrieved from

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