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  • Unlike puberty and pregnancy, no one formally prepares women for the physical and emotional realities of perimenopause and menopause—which can result in confusion, shame, lack of treatment, and greater risk of health complications.
  • The majority of doctors are unprepared to talk to patients about this hormonal transition. Midi exists to fill this gap and expand access to great care.
  • Women should be prepared with the knowledge that their menopause transition could start earlier than expected, and that it may cause not only hot flashes, but also insomnia, depression, brain fog, lower productivity, weight and body composition changes, and more. Simply awareness can help you feel more prepared, and proactive.
  • The headline: You don’t have to white-knuckle this transition. Menopause symptoms can be treated and improved with lifestyle changes, supplements, herbal remedies, hormone therapy, and other prescription medication. Midi supports all of these, and works with you to come up with tailored solutions.

With any significant bodily change or transition, knowledge is power. Just think about some of the major hormonal events in your life: puberty, pregnancy, post-partum. Ahead of these, you probably got some sort of “talk” from your doctor—along with lots of additional first-hand intel from your mom, sister, and girlfriends. Their input gave you a sense of what to expect and how to troubleshoot different scenarios. Now imagine you’d been forced to wing it. How much more stressful and confusing would that have been? Yet that’s exactly what happens for so many women as they approach menopause.

Most of us don’t start hearing or talking about menopause until it’s well underway—if at all. Fear and stigma can keep women tight-lipped, amongst themselves, and our medical providers aren’t filling the gap (more on this in a minute). The net result: A silence that hurts women’s health.

At Midi, we believe that the more you know about what to expect though the menopause transition, the less alone you’ll feel—and the more empowered you’ll be to get care when you need it. Because you’re probably not getting the “talk” from anyone else, we’ve covered seven must-know truths about this hormonally turbulent time below.

1. Menopause is natural and normal—but that doesn’t mean it’s easy.

Despite being natural and inevitable, menopause isn’t a walk in the park for most women. Roughly 80 percent of us will have symptoms that may impact every meaningful area of our lives, from work to family relationships to sexuality. Yet many women tough it out with no treatment. According to a recent survey, 73 percent of women ages 40 to 65 said they were not treating their menopause symptoms—even though a variety of effective options exist (see #8 for lots of good news).

One likely reason is the lack of good care available. Of the 60 percent of women who seek medical attention for their menopause symptoms, a staggering three quarters are left untreated, according to a review of health insurance claims by Yale University. That may be due to inadequate education and training for doctors, with only 20 percent of OB/GYN residents saying they received formal training in menopause medicine, according to one survey. Per another, most doctors only receive around 1 to 2 hours of menopause training in total. Those with expertise are often overwhelmed (think: long waiting lists and short appointments).

Needless to say, many women fall through the cracks or have to be their own fierce advocates. Which is exactly why Midi exists—to expand access to expert, comprehensive care for women at midlife so they never have to go it alone.  

2. Hormone changes start earlier than you might think.

Perimenopause is the transition period when your ovaries make less and less estrogen until you hit menopause—the official end of your reproductive years. An unpredictable, erratic menstrual cycle is often the first sign. On average, perimenopause starts in your mid 40s and lasts four years, but it may kick off as early as your 30s or as late as your 50s.

Premature menopause (before age 40) and early menopause (before age 45) can be triggered by a variety of factors, including surgery that removes your ovaries, chemotherapy and/or radiation, smoking, a family history of early menopause, and certain diseases and infections. Women who experience menopause ahead of the curve would benefit from extra healthcare support: Research suggests they are at an increased risk of overall mortality, cardiovascular disease, neurological and psychiatric diseases, osteoporosis, and more, because their bodies lose the benefits of estrogen earlier.

3. Think of the menopause transition as puberty in reverse.

The menopause transition, or perimenopause, is sometimes referred to as puberty in reverse, which makes sense since the hormonal shifts in these stages mirror each other. During puberty, estrogen and progesterone levels start low and gradually climb, spiking and dipping unevenly along the way before stabilizing (which can contribute to that classic adolescent angst). During perimenopause, estrogen and progesterone levels start high and gradually taper off, with similar fluctuations that can trigger symptoms like hot flashes and mood changes, until they reach their lowest levels at menopause, which officially starts when a woman has gone 12 months without a period.

4. Symptoms vary widely, and go way beyond just hot flashes.

Every woman experiences perimenopause and menopause differently. Your combination of symptoms, their timing, and severity may be nothing like a friend’s. Hot flashes are a classic sign of estrogen fluctuation and depletion—but they’re far from the only one. Because estrogen interacts with nearly every system and organ in your body, shifting levels of this hormone can come with an array of downstream effects. The most common menopause symptoms include vasomotor symptoms (or VMS, which refers to hot flashes, night sweats, and heart palpitations), poor sleep, genitourinary symptoms (vaginal dryness, urinary problems, decreased libido), psychological symptoms (more on these below), skin changes, and bone loss. Some women experience more surprising symptoms, too, such as depression, anxiety, tingling extremities, dental problems—even a bizarre, but not uncommon one called burning mouth syndrome (which feels exactly like it sounds).

5. Brace yourself for a mind-body experience.

Mentally, you may not feel a much like yourself during the menopause transition, and that’s normal—fluctuating and declining hormones affect the mind on both a cognitive and emotional level. Estrogen promotes activity in an area of the brain associated with learning and memory formation called the hippocampus, and it also supports the activity of “feel good” brain chemicals such as serotonin, which is responsible for mood stabilization. So any time there is markedly less estrogen, these processes can suffer.

Case in point: Poor concentration and difficulty remembering details such as names, appointments, and common words affects around 60 percent of menopausal women. As many as 70 percent of women deal with emotional fluctuations, from feeling a little weepy to full-blown rage—all of which, unsurprisingly, can complicate work and home life. And anxiety affects as many as 51 percent.

6. Gutting it out? Not recommended.

Powering through your menopause symptoms without treatment shouldn’t be viewed as a badge of honor. It can drive further health problems and cost you a lot of money. Insomnia, for example, is a common consequence of untreated hot flashes and night sweats (VMS)  that’s been associated with lower quality of life along with increased risk of coronary heart disease, osteoporosis, and cognitive decline. Women with untreated VMS also use significantly more healthcare resources—accounting for 82 percent more outpatient doctor visits than symptom-free women, according to one study. In fact, research shows that women with VMS have 57 percent more productivity loss days, or days of work missed for medical reasons, than symptom-free women—and this could equate to income lost, or even put your job at risk, if you don’t have sufficient paid sick leave.

7. Fortunately, treatment can be incredibly effective.

This wouldn’t be a very productive “talk” without some solutions—and happily, there are many. Keep in mind, not all of these treatments will be right for you, so it’s important to work with a Midi clinician or another collaborative specialist who can customize your approach.

  • Lifestyle changes: The menopause transition can feel like a runaway train, but you’ve got more control than you think, starting with small, everyday choices you make around diet and exercise.  For instance, ramping up your physical activity can be a game-changer and has been shown to improve hot flashes, sleep problems, musculoskeletal pain, and symptoms of anxiety and depression. Incorporating more whole and minimally processed foods into your meals (the basics—fruits, veggies, nuts, whole grains, lean meats, fish) may help, too, by keeping blood sugar levels in check.  
  • Supplements and botanicals: There’s solid evidence showing that several vitamins, minerals, and botanicals may help to calm menopausal symptoms. Black cohosh, soy, vitamin E, St. John’s Wort, ashwagandha, and curcumin are all worth considering.
  • Prescription medication: When individualized to your needs, age, and family history, hormone replacement therapy (HRT) is the most effective treatment for the VMS and genitourinary symptoms of menopause, and also helps prevent bone loss and fractures. Moreover, most women can safely take HRT, according to the North American Menopause Society. For women who aren’t candidates, though, a variety of non-hormonal medications may help. Low doses of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and gabapentin may all greatly improve hot flashes.
  • Wellness therapies: Natural therapies and supplements can bring real relief, too. In one study, cognitive behavioral therapy (CBT)—a form of therapy that involves challenging negative thought patterns—effectively improved hot flashes, depression, and other menopause symptoms. Research also indicates that hypnosis may reduce hot flashes and improve sleep quality and sexual function; while weekly acpuncture sessions may reduce hot flashes, mood swings, sleep disturbances, and skin and hair problems associated with menopause.

Bottom line: There are solutions to whatever menopause throws at you. Weathering this transition with your sanity and health intact is completely possible! A skilled clinician can help you pinpoint your most effective combination of treatments, factoring in your symptoms, health history, genetics, and lifestyle. But whether you use Midi or another provider with experience treating menopause, get support. Persist until you feel better. And as you navigate this journey, give the “talk” yourself to other women whenever they need to hear it.

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