Perimenopause, Menopause & Beyond

Not just any change

‘When will menopause happen’ and ‘how bad will it be’ are questions we get a LOT as women go through their 40s. While we can’t say exactly what it will be like for YOU, we can give you an idea of what to expect and provide you with options for managing disruptive symptoms—if you have them.

  • The basics

  • Are we having fun yet?
  • Management options
  • What to expect at your visit
  • Are we having fun yet?

    Menopause is technically defined as the absence of spontaneous menstrual cycles for 12 months. When it occurs naturally (as opposed to as a result from surgery or illness), it is usually around age 50 or 51—but can range from as early as age 45 to as late as 55.

    Perimenopause—what most people think of as ‘the change’ or transition—can start as early as eight to 10 years before your period actually stops (doesn’t seem fair, we know). During this time, your ovaries gradually produce less estrogen until one to two years before menopause, when the drop in estrogen is more sudden. This is the time when many women experience the most severe symptoms of menopause. Hormone levels can swing more widely during this time, causing (sometimes dramatic) fluctuations in mood and energy, along with hot flashes, night sweats, vaginal dryness and vulvar changes, difficulty concentrating, changes in libido and headaches. Ready for this? Until your period actually stops all together you can still get pregnant—so birth control continues to be important. And, even once your period is completely gone (yes! Yes! YES!) other symptoms can continue as your hormone production continues to decline.

    Once your ovaries stop releasing eggs and producing most of their estrogen—sometimes it takes years—you may begin to notice additional effects of menopause, such as changes in skin tone and texture, where you carry weight and the ability to manage your weight—as well as changes in your bone mass and strength. If you experience bleeding after your periods have stopped for a year, call us right away so we can evaluate this abnormal bleeding.

    OK. So that is a lot of information and some of it doesn’t sound that fun. But, remember, for the majority of women, symptoms of this transition are mild and manageable and there is a percentage of women who will experience no symptoms whatsoever. And, for the women who experience symptoms that are dramatic and impact their quality of life, there are treatments and therapies that are known to help.

  • Management options

    If you’re bothered by symptoms before or after menopause, the management options you discuss with your provider will depend on the type and severity of symptoms you experience; your health and risk factors for heart disease, stroke and breast cancer; and how much time has passed since you started menopause. The types of things you’ll discuss include:

    Lifestyle modifications, such as consistent exercise, healthy eating and weight management to promote energy and a sense of wellbeing. Limiting caffeine, alcohol and stopping smoking can also help with hot flashes.

    Non-hormonal medications to address specific symptoms—such as bisphosphonates to treat osteoporosis, anti-depressants to help with mood or mild hot flashes, lubricants for vaginal dryness or over-the-counter sleep aids to help with sleep problems.

    Systemic estrogen only or combined estrogen-progestin hormone therapy in the form of a pill or patch.

    Topical hormone therapy to treat vaginal dryness and painful sex.

    Complementary approaches and the science behind them.

  • What to expect at your visit

    A lot of women bring up questions and changes they believe are related to perimenopause and menopause at their women’s wellness visit—which is great! We are happy to address your questions and get as far as we can at this visit. Be sure to bring as much information as you can about your menstrual cycle and symptoms. Try tracking everything using a calendar or menstrual period app for several months to see how often it happens, what your bleeding is like and how you experience other menstrual symptoms. Your clinician will use this information to assess where you are in the transition to menopause. Of course, they will want to know about other symptoms, too—like hot flashes, trouble sleeping, pain with sex, etc. We’ll get as far as we can in discussing how to address your symptoms and we may we need to schedule a follow up visit to either finalize your plan or check to see how it’s working or both.

    If you’re not due for a wellness visit and you’re having symptoms of perimenopause or menopause that are disrupting your life, schedule an office visit to discuss them. Most of our nurse practitioners, nurse midwives and physicians are able to help. We also have several clinicians with additional training and certification in menopause management. Hormone testing usually isn’t needed to begin therapies to help with symptoms.

Is this normal?

Answers you want, questions you may not want to ask
Nora Tallman, CNM, MSN - Nurse-Midwife in Portland, OR Nora Tallman, CNM, MSN
Nurse-Midwife
Obstetrics and Gynecology
Check Accepted
Insurance

If you’re pregnant and want to begin care at WHA–or need to schedule an appointment during your pregnancy, call us! Find a provider and location here.

Please have your insurance information handy before you begin scheduling.

This will allow our teams to check whether your plan may require a referral for the care you need or to prepare benefits information to share with you at your visit. If you do not enter insurance information when scheduling, you may be asked to pay a $200-$500 deposit before receiving service.