Midlife 101

No woman should suffer through symptoms of perimenopause and menopause, doctors say.

“Do not let anyone tell you this is just a part of aging, that there’s nothing you can do,” says Dr. Mindy Goldman, chief clinical officer for Midi Health, a virtual care clinic focused on women in midlife hormonal transition. “Those days should be over.”

They may be nearing their end, as doctors and women push for more attention on the topic.

Generation X and millennial women are less likely to accept there’s nothing that can be done to treat symptoms like hot flashes, mood changes and more, according to Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health and medical director for The Menopause Society.

“They’re crowd-sourcing their solutions,” Faubion says. “They’re not okay being told to grin and bear it.”

It starts with more education on the topic and the treatment options available.

“The women I see don’t always know their symptoms are related to perimenopause,” Faubion says. “You have to know enough to be able to ask that question.”

Perimenopause, menopause defined

Perimenopause is the stage when a woman’s body adjusts to the end of its reproductive years, according to the U.S. Department of Health and Human Services Office on Women’s Health.

The name comes from the Greek word “peri,” meaning “around.” Perimenopause lasts four years on average — though doctors say it can last up to 10 — and usually starts in the mid to late 40s. During this transition, hormone levels fluctuate, causing a variety of symptoms, often unexpectedly.

Menopause occurs after 12 consecutive months without a period and marks the end of fertility. Menopause after age 45 is considered normal.

Faubion says education on perimenopause and menopause should start in the mid-30s, but is largely absent due to a lack of training among practitioners. She cites a 2019 Mayo Clinic study that concludes an investment in evidence-based comprehensive menopause management is needed.

The Menopause Society website offers a provider search tool that includes doctors who are “certified menopause practitioners.” The tool is being updated in the coming months.

“The good news is we’re certifying more and more people in this every year,” Faubion says.

Impact of symptoms

In addition to variations on when perimenopause starts and how long it lasts, symptoms also vary. They include irregular periods that may be shorter or longer, heavier or lighter than usual. Hot flashes, or night sweats, can also occur suddenly and are a top complaint among women. Difficulty sleeping, painful sex and decreased libido also are common. Bone loss and body changes can occur, as well as psychological symptoms like difficulty concentrating, memory lapses, mood changes and irritability.

Less common symptoms may include joint pain, thinning hair, heart palpitations or dry mouth, says Goldman, who is also a professor at the University of California-San Francisco and the director of the Gynecology Center for Cancer Survivors and At-Risk Women.

“It’s a very confusing time for a lot of people,” she stresses.

It also comes at a monetary cost. A 2023 Mayo Clinic study led by Faubion found symptoms related to menopause affect work absenteeism, productivity and lost opportunities for advancement, to the tune of an estimated $1.8 billion in lost work time each year and $26.6 billion when medical expenses are included.

Individualized treatment

Treatment options may also be confusing for women. A Women’s Health Initiative study in 2002 discontinued the portion of the study focused on combined hormone treatment due to risks associated with breast cancer, heart disease, stroke and blood clots. This caused alarm and confusion among doctors and patients, with many women stopping hormone replacement therapy completely.

Further analysis of the study indicated some risks were overestimated for women who initiated hormone therapy early after menopause onset.

“They’ve reanalyzed the data,” Faubion explains. “It’s not like hormone therapy changed. It’s the messaging.”

She and Goldman say hormone therapy can be an appropriate and beneficial treatment, and stress care should be individualized.

“As with any medication, you need to individualize decision-making,” Goldman says, noting the risks and benefits of hormone replacement therapy often depend on age, how far from menopause the patient is and other factors like individual and family history.

“If they are a good candidate, let’s do a trial of hormone replacement therapy and see what we can help,” she says.

Other treatment options may include birth control pills or other hormonal contraception and medications indicated for other conditions that have been shown to help with symptoms. Specific non-hormonal medications to treat hot flashes are available, as well as a variety of other options, such as supplements and therapy.

Both Faubion and Goldman stress there are also treatment options for women who have had breast cancer and women with mutations including those in the BRCA1 and BRCA2 genes that increase risks for breast and other cancers.

Goldman says there is a need to bridge oncology and gynecology when treating cancer survivors, and expanding that care is a priority in her career.

“It’s important to realize there are lots of options,” she says. “No one should be told there’s nothing that can be done.”

Comprehensive care

Faubion and Goldman also note that women may continue to experience symptoms post-menopause, and if so, should also seek care.

“It doesn’t matter what your age is,” Goldman says. “The most important thing is seeking expert care as there is always something that can be done.”

Lifestyle factors like diet and exercise also should be considered, especially since risks for cardiovascular conditions and other diseases also increase at the age women are experiencing menopause, doctors say.

“This is a good time for women to look at everything,” Faubion says. “I think we need to use the menopause transition, including perimenopause, to assess risk factors. How do you look at healthy aging?”