KEY TAKEAWAYS:
• Menopause is universal but individual: Symptoms and timing can vary from person to person.
• Symptoms often start in perimenopause: Changes typically begin before menstrual periods stop completely.
• 75% experience hot flashes: This is the most common symptom, but brain fog and mood changes are equally valid experiences.
• Treatment options exist: Lifestyle changes, hormone therapy and non-hormonal medications are available for relief.
• Early conversation helps: Start discussions with your healthcare provider when symptoms begin.
SUMMARY:
Menopause is a natural transition that typically occurs between ages 45-56, when hormone levels shift and menstrual periods stop. While every menopause experience is different, common symptoms include hot flashes, sleep disruption, brain fog, mood changes and physical exhaustion. Recognizing and understanding these symptoms can be empowering to seek care and explore treatment options with your healthcare provider.
Brain fog, weight gain, anxiety, mood changes — the signs of menopause are real and deserve attention.
The good news? More women are talking about menopause than ever before. What was once a quiet, private struggle is now an open conversation.
“Too often, women don’t talk to their healthcare provider about how they are feeling, leaving them to suffer. There are things you can do to lessen the symptoms of menopause, but you need to know what to expect,” said Ngozi Osuagwu, MD, Medical Director of the Women’s Health Center at OhioHealth Doctors Hospital. Dr.Osuagwu, author of the book Sincerely, Your Gynecologist, sat down with us to help us better understand menopause.
What is menopause?
Sometime between the ages of 45 and 56, a woman’s body begins to change. This natural transition starts in aphase called perimenopause. During this time, ovarian function declines and hormone levels fluctuate. As a result, menstrual cycles may become irregular and lighter, and many of the common symptoms will begin.
Menopause is reached after 12 consecutive months without a menstrual period when estrogen levels stabilize at a lower level. While some symptoms may improve over time, research shows that hot flashes and night sweats can last for years — with many women experiencing symptoms for more than seven years, and some for even longer.
The common signs and symptoms of menopause
Some of the most common symptoms include:
- Hot flashes and night sweats
- Physical exhaustion
- Sleep issues
- Brain fog
- Depression, anxiety or mood changes
- Weight gain
“This is a time of transition for many women. Their parents are getting older, and their children may be leaving home, so emotional changes may already be happening,” Dr. Osuagwu said.
She also emphasized, “About 75% of women experience hot flashes. Brain fog is real. Many women feel both during menopause, so do not think you are imagining it.”
Other medical concerns during menopause
With declining estrogen levels, the risk for certain chronic conditions increases, including heart disease, diabetes, high cholesterol and osteoporosis. In fact, after menopause, a woman’s risk of heart disease rises to equal or even surpasses that of men, making prevention especially important during this stage of life.
Some women also develop genitourinary syndrome of menopause (GSM), which can include:
- Frequent urination
- Burning with urination
- Recurrent urinary tract infections
- Vaginal dryness
- Pain with intercourse
While hot flashes may improve over time, GSM symptoms often worsen if left untreated. The good news is that effective treatments are available.
Treatments for menopause
There is no one-size-fits-all approach to menopause care. Every woman’s experience is different, and treatment decisions should be based on how symptoms affect daily life.
Hormone therapy remains the most effective treatment for hot flashes and can also help with other symptoms.
For women who cannot or choose not to use hormones, several non-hormonal options are available:
- Elinzanetant (Lynkuet) — a newer FDA-approved, non-hormonal medication for moderate-to-severe hot flashes and night sweats. It works on the brain’s temperature regulation pathways and may also improve sleep. It is taken once daily, typically at bedtime. Common side effects include sleepiness, fatigue and headache.
- Fezolinetant (Veozah) — another non-hormonal option that targets the brain’s temperature control center. Liver function testing is required before and during treatment.
- Low-dose paroxetine (Brisdelle) — an FDA-approved medication that can help reduce hot flashes.
- Other medications — such as gabapentin, venlafaxine and oxybutynin may also be helpful.
- Cognitive behavioral therapy — can support sleep, mood and coping with symptoms.
- Antidepressants or antianxiety medications — may be appropriate for mood-related symptoms.
For symptoms related to GSM, treatment options include:
- Low-dose vaginal estrogen
- Vaginal DHEA (prasterone)
- Oral ospemifene
- Vaginal moisturizers and lubricants
Lifestyle medicine: the foundation of care
As a Menopause Society Certified Practitioner (MSCP) and Diplomate of the American Board of Lifestyle Medicine (DipABLM), Dr. Osuagwu emphasizes that menopause care goes beyond medications.
“Whether you use hormonal or non-hormonal treatments, lifestyle interventions must be part of the plan. This is how we support not just symptom relief, but long-term health.”
The six pillars of lifestyle medicine include:
- Nutrition – a balanced, whole-food, plant-forward diet
- Physical activity – regular movement to support weight, mood and bone health
- Sleep – prioritizing consistent, restorative sleep
- Stress management – using techniques such as mindfulness, prayer or relaxation
- Social connection – maintaining meaningful relationships and support systems
- Avoidance of risky substances – limiting alcohol and avoiding tobacco
These daily habits can significantly improve both symptoms and overall well-being.
When to talk to your doctor
You do not have to wait until symptoms become severe to talk to your doctor. Start the conversation early so you and your healthcare professional can track changes and find the right approach together.
It is also important to discuss changes in your menstrual cycle. While irregular bleeding can be part of menopause, bleeding that lasts longer than eight days or occurs more frequently than every 21 days should be evaluated. Abnormal uterine bleeding can sometimes signal more serious conditions and should not be ignored.
Menopause is a natural part of aging, but suffering through it is not. More women are speaking up, asking questions and seeking care- and that is a powerful shift. You do not have to suffer in silence. There is help. With the right combination of medical care and health lifestyle choices, you can move through this phase informed, supported and well.
You deserve a provider that advocates for you. Find one here.
Frequently Asked Questions:
Q: At what age does menopause typically start?
A: Perimenopause typically begins between ages 45-56. Timing can vary significantly based on genetics, lifestyle and medical history.
Q: How long do menopause symptoms last?
A: Symptoms can begin during perimenopause and may continue for up to seven years after menopause.
Q: Are there non-hormonal treatment options for menopause symptoms?
A: Yes, several FDA-approved non-hormonal treatments are now available for hot flashes, including elinzanetant, fezolinetant and low-dose paroxetine.
Q: Can lifestyle changes really help with menopause symptoms?
A: Yes. Regular exercise, consistent sleep schedules, stress management techniques and balanced nutrition can significantly impact symptom severity and well-being.
