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Navigating menopause

Menopause, the time of life during which a woman stops having her period, is a normal and inevitable change, but it can take a while to get through it—several years for most women. As you navigate this midlife transition, here’s what you can expect along the way.

STAGE 1—Perimenopause

Perimenopause refers to the six or more years leading up to your final period, plus the 12 months afterwards. Perimenopause is what most people refer to when they talk of “going through” or “being in” menopause. Women usually go through perimenopause between ages 45 and 55, but some may start as early as their 30s.

During this time, your ovaries slow hormone production. Hormone levels—especially estrogen—decline gradually and erratically. You may experience changes like irregular or skipped periods, hot flashes, night sweats, difficulty sleeping and vaginal dryness.

Treatment tactics: Not all midlife changes are a result of perimenopause. See your doctor to evaluate any menstrual abnormalities and other symptoms. Blood and urine tests to measure hormone levels can determine whether you’re nearing menopause. Perimenopause is a natural process that doesn’t require treatment, but if changes become severe or difficult to manage, discuss symptom relief with your healthcare provider.

Treatments can include low-dose oral contraceptives, hormone therapy (HT), antidepressants, estrogen creams and vaginal lubricants. Self-care measures that help you stay cool, avoid hot-flash triggers and manage stress can also help you cope. Because it’s still possible to conceive, take steps to avoid pregnancy if a baby isn’t in your plans. Consume at least 1,000 mg of calcium and 400 IU to 800 IU of vitamin D daily. Talk to your doctor about your risk for osteoporosis and heart disease.

STAGE 2—Menopause

Menopause marks the end of menstrual periods. Most women reach menopause between ages 40 and 58, with an average age of 51. Not until you’ve stopped menstruating for one full year will you know you’ve reached menopause.

Treatment tactics: Symptoms like hot flashes and sleep difficulty begin to ease as your body adjusts to lower and less erratic hormone levels. If you’ve been taking HT, re-evaluate whether you need to continue. Treatments should continue to focus on reducing bothersome symptoms and maintaining bone and heart health. Bump up your calcium intake to at least 1,500 mg.

STAGE 3—Postmenopause

This stage refers to the rest of your life—all the years after you’ve reached menopause. At this point, you no longer need to prevent pregnancy.

Treatment tactics: Your goal is to remain healthy and productive for decades to come. Eat a healthy diet, avoid excess weight gain, exercise regularly and include strength training in your routine. Discuss with your doctor when to schedule a bone density scan and whether you should take daily aspirin therapy, fish-oil capsules or bone-building medications.