Hot flashes, night sweats, insomnia, low libido, mood changes — these are all considered symptoms of menopause, or the end of your menstrual cycles, when you haven't had a period in 12 months. On average, menopause happens at age 51 for people with ovaries, according to The North American Menopause Society (NAMS), but these symptoms can start months or years before then (a time called perimenopause).
And they can throw you for a loop, especially if they hit during a time in your life when you're caring for kids or a parent at home, in the prime of your career, and just trying to make it through each day. In other words: Who has time for a hot flash?
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We asked gynecologists who have gone through it to talk about how they personally manage their menopause symptoms. Here are snippets of their best advice — and how you can learn from it, too.
1. Ask About Hormone Therapy
Arianna Sholz-Douglas, MD, ob-gyn, founder of Tula Wellness & Aesthetics in Tucson, Arizona, tells LIVESTRONG.com she started perimenopause in her late 30s.
"I had no idea what was going on," she says. "I had worsening PMS, irritability, hot flashes and insomnia."
The breaking point, however, was when she was having "homicidal thoughts" about her husband: "He didn't do anything, but I really hated him. I thought maybe I had a problem," says Dr. Sholz-Douglas, who's also the author of The Menopause Myth.
She knew she needed help, and after connecting her feelings to perimenopause, she went on hormone therapy at age 43.
"Starting on hormone therapy was a lifesaver," Dr. Sholz-Douglas says. (Hormone therapy replaces estrogen and/or progesterone to treat menopause symptoms, per the Mayo Clinic.) Her hot flashes went away. Her irritability decreased. She could sleep better. "I wasn't 100 percent back to baseline, but I felt more like myself within just a couple weeks," she says.
Spoiler: The rage Dr. Sholz-Douglas felt abated, and she is still married to her (very much alive) husband. "During menopause, your brain chemistry is changing, and it can be a very difficult time if you don't know what's happening," she says.
If you're interested in hormone therapy, here are a few questions to ask your doctor about:
Is it right for my symptoms? HT can help hot flashes, night sweats, vaginal dryness and bone loss, per NAMS.
What are my risks? Ask your doctor about what plan is in place for taking HT. As NAMS points out, hormone therapy is recommended to be taken at the lowest effective dose for the shortest amount of time to minimize any risks.
What type of HT would I take? Talk to your doctor if it's recommended that you take estrogen and progesterone or estrogen only. HT can also be taken systemically (e.g. an oral tablet) or locally (e.g. vaginal cream).
2. Pay Attention to Your Triggers
Though her hot flashes got way better on hormone therapy, Dr. Sholz-Douglas realized that wine still triggered those waves of heat. So, she stopped drinking wine and switched to vodka.
That might not be the case for everyone, but it speaks to the fact that you have to pay attention to your symptoms and make tweaks when necessary.
3. Take Steps to Manage Stress and Anxiety
Sharon Malone, MD, ob-gyn, chief medical officer at Alloy, says she was still taking birth control pills in her mid-40s when she started going through perimenopause. Most of the symptoms were masked because of the hormones from the pills, but during the week-long course of placebo pills, she started to feel irritable.
She stopped oral birth control in her late 40s to see if she was done having a period. Unfortunately, hot flashes and rage flooded in full-time. "I was so completely irritated, I couldn't stand it," she says. Sleep problems took root for the first time in her life, too. Around age 50 or 51, Dr. Malone went on hormone therapy.
Things didn't improve right away, though. Her sleep issues were anxiety-based, the product of a spinning mind that wouldn't shut down at night. (On the other hand, sleep problems due to night sweats tend to quickly improve on hormone therapy, she says.) Here's what Dr. Malone did to work on her anxiety levels to help manage her insomnia:
- Started taking an anti-depressant for her anxiety: Have a conversation with your doctor about whether medication is right for you.
- Kept up an exercise routine: "Walking and going to the gym to do resistance training has been part of my routine as long as I can remember," Dr. Malone says. Regular exercise is not only a stress-reliever, but is associated with more and better quality sleep, according to the National Sleep Foundation.
- Reduced her work stress: "I had a demanding job and children in middle school. It was about this time that I realized something had to give, and so I gave up my obstetrics practice to work at a different pace," Dr. Malone says. "I couldn't continue to burn the candle from both ends, and I'm no different from most women. Once we get to this point in life, you have to make some adjustments," she says.
These changes might not be what you need, but by taking a holistic look at your life, you can figure out what's best for you. "No one has a secret recipe [for how to manage menopause symptoms]. There's a combination of lifestyle changes we all must make when entering the transition," Dr. Malone says.
4. Better Educate Yourself About Menopause
As an ob-gyn, Emily Hu, MD, lead chief medical advisor at Evernow, has experienced various life events right alongside her patients. That's been true when she had two children, and now, as she's settled into her late 40s.
"What I tell my patients is that when you're in your mid- to late-40s, a lot of these symptoms — hot flashes, night sweats, irregular periods — can happen. Too often we think of menopause as being far away, but we should be having this conversation with younger women," she told LIVESTRONG.com.
Here's why that's important when we think about successfully managing menopause symptoms: Many people don't know their symptoms are related to menopause. In a June 2022 study in Women's Health, more than 60 percent of respondents said they weren't informed about menopause, and 70 percent said they only started to learn about menopause after their symptoms started.
Unfortunately, if you don't know what's going on, you can't take steps to manage bothersome symptoms or feel like yourself again.
As Dr. Hu explains, patients often come in saying they know they're not in menopause yet because they're still having periods. "They'll say they're not feeing that great because they're tired all the time, gained a bit of weight, are having hot flashes or are struggling to sleep with night sweats. They're not in menopause yet, but their hormone levels are fluctuating," Dr. Hu says.
Being able to name that what you're experiencing is a hot flash, for example, means you can prepare for it and do something about it. For instance, she says:
- Know your triggers: One common hot flash trigger might be stress (e.g. getting mad at your kids, being late to a meeting), which can deliver a "wave of sweat."
- Try to avoid that trigger: Taking a deep breath, organizing your schedule in a different way, divvying out morning tasks to the other members of your household. You can't avoid all stress, but trying to lessen those moments where your body is flooded with stress hormones is worth a try.
- If the hot flash hits, find cool: Dress in layers and take off a layer, carry a fan with you and blast your face, have a cold beverage nearby to sip.
When to See a Doctor About Menopause Symptoms
If you're in your 40s, initiate the conversation about menopause with your doctor. "There's this umbrella called perimenopause, of which there are at least 30 symptoms," Dr. Malone says, and they can start years before your period stops.
If symptoms are hampering your quality of life, seek out a practitioner who is knowledgeable in menopause. You can find a menopause clinician in your area by using the search tool on the NAMS site.
- National Institute on Aging: “Research explores the impact of menopause on women’s health and aging.”
- The North American Menopause Society: “Menopause 101: A primer for the perimenopausal.”
- National Institute on Aging: “What Is Menopause?”
- Women’s Health: “An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause.”
- The North American Menopause Society: “Hormone Therapy: Benefits & Risks.”
- Mayo Clinic: "Hormone Therapy: Is It Right for You?"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.