How Much Do You Really Know About Menopause?

• The average age of menopause is 51, but perimenopause can start as early as one's mid-30s.

• During perimenopause, people may experience symptoms like hot flashes, anxiety, heart palpitations, night sweats, acne, and irregular periods.

• Many medical students don't receive education on menopause while they're in school or in residency programs.

About a year ago, Christine Staley, a 49-year-old marketing director based in New York City, started gaining unexpected weight.

“What am I looking at here? I’m 48 years old,” Staley asked at an OB-GYN appointment, alluding to the possibility of menopause, to which her provider responded, “We’ve got a couple of years.”

Several months later, Staley started having night sweats. Her provider then ordered a follicle-stimulating hormone test, which confirmed that she is transitioning to menopause.

“Always trust your gut and make the doctor run the test,” Staley said.

Related:Is Menopause on the Horizon?

Menopause is diagnosed when someone hasn’t had their period for 12 consecutive months. In the United States, the average age for menopause is 51.

The phase leading up to menopause—known as perimenopause—typically affects women in their 40s. During this period, a gradual decline in estrogen levels can lead to classic menopause symptoms, such as hot flashes, irregular periods, vaginal dryness, and night sweats.

Even though menopause transition is an inevitable stage of life for many people, there’s not much awareness or education about the topic. Only 35% of women ages 40–65 were actually told what to expect in menopause by a healthcare provider, according to a recent survey by the Kaiser Health Foundation.

“I don’t feel like I’ve gotten a lot of good counseling and information from my doctors,” Staley said.

Related:How to Talk to Your Healthcare Provider About Your Menopause Symptoms

What Is Perimenopause Like?

Perimenopause is often more complicated than expected. Maria Carola, a 51-year-old PR consultant living in New York, said she didn’t realize perimenopause could “drag on for years.” After noticing her periods becoming more irregular, she started experiencing intense body temperature fluctuations, insomnia, and mood swings as well.

During perimenopause, women may experience hot flashes, anxiety, heart palpitations, night sweats, acne, and irregular periods, according to Shaghayegh M. DeNoble, MD, FACOG, founder of Advanced Gynecology in Wayne, New Jersey.

DeNoble said menopause is “kind of like puberty,” when a lot of changes are happening to one’s body at once.

Related:Reducing the Symptoms of Perimenopause

For some people, symptoms might be worse during perimenopause than the actual menopause because of the unpredictable hormone fluctuations, she explained.

Like puberty, perimenopause happens at different times for everyone. While most people enter perimenopause in their late 40s, some can experience the transition as early as their mid-30s. Many factors, such as genetics, autoimmune diseases, smoking, and having a lower body mass index (BMI) could contribute to an earlier onset of menopause.

Kecia Johnson, 38, a global health influencer based in Los Angeles, told Verywell that she started experiencing perimenopause symptoms in her mid-30s. “I didn’t understand where it came from,” Johnson said. In August 2020, she received a colorectal cancer diagnosis and she was told that she would go into menopause immediately after treatment.

Some types of surgeries and cancer treatments, such as chemotherapy, radiation therapy, and oophorectomy, can damage the ovaries and cause early menopause.

Related:What Is Medical Menopause?

About 15% of people might experience vaginal atrophy, or genitourinary syndrome of menopause, during perimenopause. This is a condition where the vaginal wall becomes thin, dry, and inflamed from low estrogen levels, and it can lead to painful intercourse and frequent urinary tract infections (UTIs).

Vaginal atrophy is more common after menopause, affecting around 50%–70% of people. But some researchers say this condition is underdiagnosed because patients might be too embarrassed to discuss their symptoms with a healthcare provider.

Menopause tends to be a reflective time in a woman’s life anyway—it’s filled with all sorts of milestones and changes. And it’s important to stay positive and remember that your body has carried you to this point and there are many many years left to enjoy.

Why Is Menopause Poorly Understood?

Many healthcare providers aren’t prepared to talk about menopause, either. A 2018 survey of family medicine, internal medicine, and OB-GYN trainees found that only 6.8% of respondents felt prepared to manage menopause, while 20% hadn’t even received a lecture on menopause.

“They’re not going to teach menopause because they just don’t have room in the curriculum for it,” said Stephanie Faubion, MD, MBA, medical director of the North American Menopause Society (NAMS).

Healthcare providers can choose to take continuing education courses to prepare for menopause management and the NAMS offers a credentialing exam.

DeNoble, who is a member of NAMS, said her OB-GYN training in residency was a lot more focused on reproductive care. “Not that many OB-GYNs are experienced,” she said. “I’ve done a lot of education after my training to learn more about menopause.”

Talking about menopause with other people can also provide a sense of relief. As public figures like Naomi Watts, Stacy London, and Michelle Obama have opened up about their experiences with menopause, more people are sharing what they’ve learned from their own challenges.

“Menopause gets such a bad rap and now that I am in perimenopause it has been a bit of a reality check that I am ‘that old’,” Carola said. “I think it tends to be a reflective time in a woman’s life anyway—it’s filled with all sorts of milestones and changes. And it’s important to stay positive and remember that your body has carried you to this point and there are many many years left to enjoy.”

Read Next:How Long Do Menopause Symptoms Last?

Menopause symptoms may start as early as your mid-30s. It might be challenging to discuss your symptoms with healthcare providers if they’re not trained to discuss and treat menopause. If you’re experiencing vaginal dryness, heart palpitations, anxiety, or joint aches, consider finding a certified menopause practitioner or a member of NAMS on this directory.