What do you really know about menopause?

About a year ago, Christine Staley, a 49-year-old New York-based marketing executive, unexpectedly started gaining weight.

“What am I looking at here?” I’m 48,” Staley asked during an OB-GYN appointment, hinting at the possibility of menopause, to which her provider replied, “We’re a few years old.”

Several months later, Staley began having night sweats. Her provider then ordered a follicle-stimulating hormone test, which confirmed that she was transitioning into menopause.

“Always trust your instincts and ask the doctor to do the test,” Staley said.

Menopause is diagnosed when a person has not had their period for 12 consecutive months. In the United States, the average age of menopause is 51.

The phase leading up to menopause, known as perimenopause, usually affects women in their 40s. During this period, a gradual decline in estrogen levels can lead to classic menopausal symptoms, such as hot flashes, irregular periods, vaginal dryness and night sweats.

Although the transition to menopause is an inevitable stage of life for many people, there is not much awareness or education about it. According to a recent Kaiser Health Foundation survey, only 35% of women between the ages of 40 and 65 have been told what to expect during menopause by a healthcare professional.

“I don’t feel like I got a lot of good advice and information from my doctors,” Staley said.

What does perimenopause look like?

Perimenopause is often more complicated than expected. Maria Carola, a 51-year-old public relations consultant living in New York, said she didn’t realize perimenopause could “go on forever for years.” After noticing that her periods were becoming more irregular, she began to experience intense fluctuations in body temperature, insomnia and mood swings.

During perimenopause, women may experience hot flashes, anxiety, heart palpitations, night sweats, acne and irregular periods, according to Shaghayegh M. DeNoble, MD, FACOG, founder of Advanced Gynecology at Wayne, New Jersey.

DeNoble said menopause is “a bit like puberty,” when many changes are happening in the body at the same time.

For some people, symptoms may be worse during perimenopause than actual menopause due to unpredictable hormonal fluctuations, she explained.

Like puberty, perimenopause comes at different times for everyone. While most people enter perimenopause in their late 40s, some may experience the transition as early as their mid-30s. Many factors, such as genetics, autoimmune diseases, smoking, and a lower body mass index (BMI) could contribute to earlier menopause.

Kecia Johnson, 38, a Los Angeles-based global health influencer, told Verywell she started experiencing perimenopause symptoms in her mid-30s. “I didn’t understand where it came from,” Johnson said. In August 2020, she was diagnosed with colorectal cancer and was told she would go into menopause immediately after treatment.

Certain types of cancer surgeries and treatments, such as chemotherapy, radiation therapy, and oophorectomy, can damage the ovaries and cause early menopause.

About 15% of people may experience vaginal atrophy or genitourinary syndrome of menopause during perimenopause. This is a condition in which the vaginal wall becomes thin, dry and inflamed due to low levels of estrogen, and it can lead to painful intercourse and frequent urinary tract infections (UTIs).

Vaginal atrophy is more common after menopause, affecting around 50-70% of people. But some researchers say this condition is underdiagnosed because patients might be too embarrassed to discuss their symptoms with a healthcare provider.

Why is menopause misunderstood?

Many health care providers aren’t ready to talk about menopause either. A 2018 survey of family medicine, internal medicine, and obstetrics and gynecology trainees found that only 6.8% of respondents felt prepared to manage menopause, while 20% hadn’t even received a course. on menopause.

“They’re not going to teach menopause because they just don’t have a place in the curriculum for it,” said Stephanie Faubion, MD, MBA, medical director for the North American Menopause Society (NAMS).

Healthcare providers can choose to take continuing education courses to prepare for menopause management, and NAMS offers a credentialing exam.

DeNoble, who is a member of NAMS, said her residency OB-GYN training focused much more on reproductive care. “Not that many OB-GYNs are experienced,” she said. “I did a lot of education after my training to learn more about menopause.”

Talking about menopause with other people can also bring a sense of relief. As public figures like Naomi Watts, Stacy London and Michelle Obama open up about their experiences with menopause, more and more people are sharing what they’ve learned from their own challenges.

“Menopause has such a bad rap and now that I’m in perimenopause, it’s been kind of a reality that I’m ‘so old,'” Carola said. “I think it’s a reflective time in a woman’s life anyway – it’s filled with all sorts of milestones and changes. And it’s important to stay positive and remember that your body helps you. has carried so far and that you have many years to enjoy.