On the morning of an important presentation at work, she got up early, worked out, went over her notes, showered, dried her hair, applied makeup, and slipped on a silk shirt — then felt her cool facade melt into a pool of panic. Along with her makeup. Her hair fell limp as her shirt soaked up the sweat.
Menopause was making her late for work. Again.
Menopause isn’t just a single moment when periods stop, like flipping a switch. It’s a journey that starts with perimenopause and continues long after that “official” menopause moment.
Let’s break it down.
Perimenopause
Laura Strong, a nurse practitioner at Montage Health, says there are steps you can take to feel like yourself again before, during, and after menopause.
Perimenopause is the transitional phase entering into menopause and can last several years.
It typically starts in the mid 40s (but can begin earlier) and is fueled by fluctuating, and eventually declining, estrogen levels.
You might notice changes in your menstrual cycle, like shorter or longer intervals between periods.
And then come the symptoms:
- Hot flashes
- Night sweats
- Decreased libido
- Vaginal dryness/atrophy
- Sleep issues
- Mood swings
- Fatigue
- Brain fog
- Weight gain
- Decreased bone density
Menopause
You’re considered officially in menopause after you’ve gone 12 full months without a period. It’s technically just one day but symbolizes a big shift: the end of fertility and the beginning of a new chapter.
Postmenopause
After that one-day milestone, you’re considered postmenopausal. This is the rest of the journey. And while some symptoms fade, others (like decreased bone density or vaginal dryness) may linger or intensify without support.
“This is when we focus on protecting long-term health, things like cardiovascular support, bone density, and maintaining quality of life,” says Laura Strong, a nurse practitioner at Montage Health’s obstetrics and gynecology clinic. “How we manage it depends on your symptoms, goals, and health history.”
Managing menopause symptoms
“. . . with the right guidance, women can go through this transition with confidence and come out stronger on the other side.”
— Laura Strong, nurse practitioner, Montage Health
“If symptoms are mild,” Strong says, “we often start with lifestyle changes.”
That includes:
- Dressing in layers and using fans to ease hot flashes
- Walking daily and adding weight-bearing exercises for bone health
- Taking at least 800 IU of vitamin D3 daily to support bone density
- Eating smaller meals, more frequently
- Avoiding big meals before bed
- Cutting down on screen time for better sleep
When symptoms get in the way of life — if you’re skipping social events, struggling at work, or just not feeling like you — medications might be the next step.
“Hormone-replacement therapy can be a game changer for some women, but it’s not for everyone,” Strong says. “Women with a history of breast cancer, stroke, cardiovascular disease, or blood clots may need to avoid hormones and explore over-the-counter or non-hormonal prescription options instead.”
Menopause is also an important time to get up to date on health screenings. Yearly lab work, mammograms, and bone-density scans can offer valuable insight and help catch issues early.
Strong encourages women to have open, honest conversations with their healthcare provider, who can help tailor a personalized plan.
“There’s no one-size-fits-all approach,” Strong says. “But with the right guidance, women can go through this transition with confidence and come out stronger on the other side.”
Explore women’s health
Menopause at a glance
Perimenopause
- The transition phase before menopause
- Can start in your 40s or earlier
- Estrogen levels begin to fluctuate
- Periods become irregular
Menopause
- Officially starts after 12 months without a period
- Just one day, but marks a big hormonal shift
Postmenopause
- Begins the day after menopause and lasts the rest of your life
- Focus turns to bone health, cardiovascular wellness, and long-term well-being
Quick symptom soothers
- Dress in layers and use fans to help manage hot flashes
- Do weight-bearing exercise to support bone health
- Take vitamin D3 (800 IU daily) to help prevent osteoporosis
- Avoid large meals before bedtime
- Practice good sleep habits (including less screen time, especially before bed)
Fast facts
- Perimenopause can generally last four–eight years
- Most women reach menopause between ages 45–55 years
- You can still get pregnant during perimenopause
- Hormone replacement therapy isn't for everyone, and that's OK
