After years of navigating perimenopause and its formidable symptoms, it may seem like a milestone to reach menopause – clinically defined as 12 months without a menstrual period.

“Some women expect it to be like the flip of a switch,” said Natalie Saunders, MD, associate professor of obstetrics and gynecology at Michigan Medicine. “‘I’m in menopause, so the hot flashes, insomnia, brain fog and other symptoms should stop, right?’” 

Transitioning from perimenopause to menopause doesn’t mean symptoms resolve overnight. As your body adjusts to a permanently lower level of hormones, menopause symptoms can actually become the most prevalent.

Common symptoms patients experience during menopause and post-menopause (clinically defined as the period after menopause that lasts through the end of life) include:

• Hot flashes and night sweats
• Insomnia
• Weight changes
• Vaginal dryness/pain during sex
• Changes in sex drive 
• Depression
• Dry skin
• Hair loss
• Urinary incontinence

“I was at my wit’s end,” one woman in her late 50s said. “I had itching and burning in intimate areas for years that was affecting my life, especially my sleep. I tried a few over-the-counter creams, but they didn’t help. Then I started having incontinence, which made my symptoms worse. "

About half of patients in menopause experience what is called genitourinary syndrome of menopause, a cluster of symptoms.

“The loss of estrogen can leave tissue surrounding the vagina, vulva, bladder and urethra more fragile, and can cause a number of symptoms affecting everyday life,” said Shubham Kalwani, DO, assistant professor in the U-M Department of Family Medicine and Department of Obstetrics and Gynecology. “These symptoms range from mild to more severe, depending on each patient.”

Genitourinary syndrome of menopause may cause:

• Vaginal dryness, irritation, itching and burning
• Urinary urgency, frequency, burning, incontinence and recurrent infections
• Decreased vaginal lubrication, reduced sexual arousal, pain with intercourse and difficulty achieving orgasm

Most of these symptoms, Kalwani added, can be treated with over-the-counter lubricants and creams, as well as vaginal hormonal treatments. Less commonly, an oral medication, such as Selective Estrogen Receptor Modulators (SERMs), can be used.

“If you’re having these symptoms, even just a few, it’s important to address them with your doctor,” Kalwani noted. “Many patients are hesitant to discuss this due to the intimate nature, but these symptoms are part of a medical condition that can be improved with correct treatment.”

In an effort to elevate awareness about menopause and encourage support, Kalwani and Saunders hosted a “Navigating Menopause Together” webinar as part of U-M’s Connecting the Dots Virtual Conference. View the seminar and menopause resources at the Connecting the Dots web page. 

Keep Medical Appointments

Those experiencing menopause/post-menopause should continue to have their heart and bone health monitored by their clinician. 

“Some women will continue to receive treatment to manage their symptoms,” Saunders said. “Others may be able to alter their medications as symptoms abate or halt altogether. This stage of menopause, like perimenopause, is different for each patient.”

Appropriate exercise and nutrition to bolster heart and bone health, she added, should become a staple in patients’ lives. 

‘Menopause Mind’ No More?

As the roller coaster of hormones stabilizes during the menopausal/post-menopausal stage, some women find that their mood improves, depression lifts and brain fog dissipates. For others, however, it will be important to continue treatments to combat depression and other symptoms with medication, cognitive talk therapy and targeted exercise.  

Find Community and Support

Medical textbooks describe menopause as a natural end to women’s reproductive capability. A cycle that began in girlhood and progressed through childbearing years now, like aging itself, reaches a biological conclusion. 

Even though menopause is a normal part of aging, Kalwani said that, because it affects an intimate part of women’s lives, it also can be isolating. 

“The more we treat menopause as a normal biological process, the more open women become to discuss their experiences,” she said. “There is comfort in knowing you’re not alone in feeling unlike yourself, in asking for help from your doctor, in seeking more information about a process you don’t entirely understand.” 

Patients can benefit from community and camaraderie in menopause support groups, which are available at local and national levels. To find a group that fits your needs, connect with the Menopause Society. 

For more information about perimenopause, menopause and post-menopause, view the U-M Menopause Awareness web page.