Meet Laura Abrignani, RN, NP, MSN, MSCP
Laura is a Nurse Practitioner with over 25 years of experience in women’s health and the founder of Coastal Well Woman, a wellness center specializing in menopausal care. As a Menopause Society Certified Practitioner, she’s dedicated to providing compassionate, evidence-based support to women at every stage of life. In collaboration with Guava, she helped author this article to guide women through the menopausal transition.
Menopause Symptoms
1. Are hot flashes the only symptom of menopause?
No, there are over 34 symptoms of menopause! Hot flashes are just one of the many common symptoms.
Estrogen receptors are found throughout the entire female body, including the central nervous system (CNS), heart, lungs, liver, breasts, urinary and GI tracts, bones/joints, lymphatic system, and skin. So while most women are aware of the commonly known “vasomotor symptoms” that occur in the CNS, such as hot flashes, night sweats, sleep disturbance, and mood changes, there may also be other short and long-term health effects, some of which could be detrimental to optimized wellness as you age.
Some examples of other menopause symptoms include reduced reduced skin and tissue elasticity, which can cause vaginal atrophy and dryness, affecting intimacy due to pain and increased risk of genitourinary (GU) infections.
Women may also experience heart palpitations, joint pain, challenges maintaining weight, brain fog, and more. Menopause also has longer-term effects on bone health, brain health, and heart health, meaning it should be a part of a broader conversation with your provider around health and wellness.
2. Does menopause cause weight gain?
Menopause can cause weight changes due to fluctuations and deficiencies in estrogen.
While estrogen is freely flowing throughout our bodies in our younger, reproductive years, body fat is more evenly distributed between the hips, breasts, buttocks, and thighs. This is different than in menopause, where there’s a shift to more centralized belly fat, which can lead to “menopause belly.”
While weight gain during menopause is not necessarily inevitable, it may be harder to maintain previous routines and expect the same results without weight gain.
You may face new challenges in managing weight, and it can require some pivoting to get results. It’s important to remember that you’re aging in tandem with menopause, which also affects metabolism. It may take a little more work or revising current routines to something that is more effective for that specific time in our lives.
3. Does menopause only affect your reproductive system?
No, estrogen receptors exist throughout the entire female body, so the effects of fluctuating and declining female reproductive hormones can affect multiple body organs and systems.
4. Should I just tough it out since menopause is a natural process?
Menopause is a natural biological process, but it is important to understand that menopause goes far beyond hot flashes. It can cause sleep disturbances, mood changes, joint pain, fatigue, weight challenges, long-term health implications that could affect the heart, bone, skin, GI and GU systems, and more. Because of this, menopause encompasses biological, psychological, and social implications.
5. How long do menopause symptoms last?
Menopause-related symptoms tend to last anywhere from two to eight years, but this is a highly variable timeline. Menopause is a time of transition with various stages, symptoms, and experiences that are as unique and individualized as the patient going through them.
Menopause Stages
6. What are the stages of menopause?
The three stages of menopause are perimenopause, menopause, and postmenopause.
Perimenopause:
Perimenopause is the time before natural menopause. In some instances, this can last up to 10 years.
Perimenopause is a time of hormonal fluctuations and irregularity. This causes the commonly known symptoms and signs of perimenopause, like sleep disturbances, hot flashes, mood swings, menstrual cycle irregularities, and more.
Perimenopause may also produce some lesser-known symptoms such as heart palpitations, joint pain, brain fog, skin dryness, and loss of elasticity, and others, which can be anywhere from mild to severe. These are the symptoms that typically lead women to consider treatment or relief, but it’s important to keep in mind how unique each woman’s experience may be.
Menopause
Menopause is the specific day when a woman has not had a period for one consecutive year–everything beyond this point is considered postmenopause. At this stage, periods are over, but the physical symptoms of estradiol (E2) deficiency, such as hot flashes, and emotional symptoms of menopause may disrupt sleep, lower energy, or affect mood. This may go on for approximately another 3 to 5+ years after periods have stopped.
Postmenopause
Once menstruation has stopped and symptoms have subsided, a woman is considered post-menopausal. Due to modern longevity and lifespan, women can expect to live up to 40% of their lives in postmenopause. This, unfortunately, increases their risk for osteoporosis, heart disease, and other conditions, as they lose the protective benefits of estrogen.
Other health considerations to keep in mind at this age, in addition to the transition through menopause, are normal aging, changes in metabolism, overall health status, and comorbidities.
7. When does menopause start?
The average age in the U.S. is currently 52. That being said, typically, menopause ranges from the ages of 45-58.
Perimenopause may precede menopause by 10 years, so some women experience changes and symptoms as early as 35-38 and well into their 60s.
Some women may experience early menopause (before the age of 40) or primary ovarian insufficiency. These women need specialized attention due to early loss of estrogen and the long-term health complications associated with this condition.
8. Does menopause happen overnight?
Menopause is a transition from your reproductive years to closing that chapter. It’s a process! While menopause itself is technically just one day, the entire journey, including perimenopause to menopause, can span 7-14+ years.
9. If you have an easy time with periods, will you have an easy menopause?
Each woman's experience with menopause will be different, and just because life was easy at one point, it may not be an indicator of the menopause transition experience.
Education is key for women to know what to expect during menopause and to understand their options for treatment. It’s also important for providers to look at the whole person to assess for applicable lifestyle modifications during this time.
Menopause is as unique as each woman, as is her experience through the reproductive years. In some cases, your mother’s experience might provide a loose barometer of what you might experience, but the experience will still be unique.
10. Can you get pregnant during menopause?
If you’re still having periods, you can still get pregnant–even if your periods are irregular. While the risk of pregnancy during menopause is dramatically decreased, you should still consider a reliable contraceptive if you’re still having periods and do not want a pregnancy.
Hormonal contraception can be especially beneficial during perimenopause, a stage frequently accompanied by irregular and/or heavy menstrual cycles that may affect your daily quality of life. Hormonal contraception helps regulate menstrual cycles, manage symptoms, and provides dependable pregnancy prevention for those who need it. Types of hormonal contraception used in perimenopause include oral contraceptives, intrauterine devices (IUDs), patches, rings, and injectables.
11. Does hysterectomy cause menopause?
In short, sometimes. A hysterectomy, or the surgical removal of the uterus, doesn’t immediately cause menopause if the ovaries are left intact. However, some research suggests it may lead to an earlier onset of menopause, possibly due to reduced blood flow to the ovaries, which can affect their function over time.
When a hysterectomy includes removal of the ovaries—a procedure called an oophorectomy—it does cause immediate menopause, known as surgical menopause. That’s because the ovaries produce key reproductive hormones like estrogen, progesterone, and testosterone. Their removal triggers a sudden and significant drop in these hormones, often leading to more intense menopausal symptoms than those experienced in natural menopause.
Losing these hormones can significantly affect a woman’s health and quality of life. Women who’ve gone through surgical menopause frequently receive estrogen therapy, or hormone replacement therapy, during their post-operative recovery to avoid the immediate onset of menopausal symptoms, which in some cases can be severe and somewhat shocking.
Estrogen replacement therapy in women with a history of early bilateral salpingo-oophorectomy (BSO), or removal of both ovaries and the fallopian tubes, has been associated with several positive health outcomes. Studies have found a reduction in bone disorders, mood changes, cognitive dysfunction, coronary heart disease, and all-cause mortality, as well as improved sexual health.
Women can also have a hysterectomy and keep their ovaries. This may delay menopause and allow them to go through natural menopause years later. Interestingly enough, studies have indicated that women who undergo hysterectomy without removal of ovaries may move into menopause earlier than previously believed, with some studies showing menopause to occur within a year of surgery. This is believed to be due to the lack of blood supply to the ovaries after the removal of the uterus.
Hormone Therapy
12. Is hormone therapy dangerous for all women?
The Menopause Society states that hormone therapy is safe and effective when started within 10 years of menopause or before age 60, provided the dosage, timing, and patient selection are appropriate.
Hormone therapy (HT) has a complicated history. To examine its health implications, the Women’s Health Initiative conducted a large US trial with over 27,000 women from 1993 to 1998. The group’s mean age was 63 but ranged from 50 to 79 years old. In the study, they learned that age, type of HT used, and patient selection were key to safe, effective, and “optimized” outcomes.
Interestingly, the younger cohort of women had more favorable health outcomes than the older cohort after being treated with a particular hormone type, called CEE, or conjugated equine oestrogens.
Subsequent randomized controlled trials have continued to demonstrate a favorable safety profile of HT when started early in menopause. HT is the most effective treatment for the relief of vasomotor symptoms (VMS), and also reduces bone loss, fracture risk, and can treat the genitourinary syndrome of menopause (GSM).
13. What’s the difference between hormone therapy (HT) and hormone replacement therapy (HRT)?
Hormone therapy (HT) refers to any medical treatment involving the replacement of hormones to address hormone imbalances or deficiencies. HT is a broader term than HRT since it can apply to menopause or other situations like gender-affirming care or cancer treatment.
Hormone replacement therapy (HRT), on the other hand, is a subcategory of hormone therapy that has traditionally described a treatment for the natural symptoms of menopause. It works by replacing hormones like estrogen and progesterone as their production decreases throughout the menopausal transition. HRT has recently also been referred to as menopause hormone therapy (MHT) for more specificity.
Author’s Note
Let’s just say that if I had known I could’ve taken something in my younger years to help prevent osteoporosis, but no one ever brought it up or shared that information with me, I’d be more than a little upset—particularly now that I deal with brittle bones and high risk of fractures. We do women a disservice when we dismiss their concerns and fail to take the time to understand their experiences, goals, and risks. We should be offering potential solutions that support their wellness, not just for today, but for the long run.
