Menopause is a complex and often frustrating era in a woman’s life. But understanding what to expect when entering this natural milestone can help.

Skagit Regional Health provider Donna Lee, ARNP, offers expert advice to help women navigate their menopause journey.

Understanding the perimenopause to menopause timeline
From a technical perspective, menopause is defined as going one full year without having a menstrual period. Some women go 10, even 11 months and then get their period — at which time the clock starts over. The average age for entering menopause in the United States is currently 51.

Prior to menopause, however, women can start going through perimenopause starting as early as age 40. Perimenopause initiates when menstrual periods become more irregular.

“Women could start to have periods that are further apart, or a little bit longer in length, or they skip an entire month. This can go on for several years,” states Lee.

Effective tactics to mitigate symptoms
Symptoms that may accompany perimenopause include an occasional hot flash, irregular periods and vaginal dryness. Lee wants to clarify that such symptoms don’t necessarily indicate an immediate impending transition into menopause.

“A couple of hot flashes does not mean a woman will be in menopause within the next two or three months. It's just a symptom of the perimenopausal period,” she notes.

One way to mitigate premenopausal and menopausal symptoms is to maintain healthy habits, such as exercising regularly, eating a healthy diet and abstaining from tobacco use. Additionally, tactics such as keeping a cool temperature in the bedroom at night and avoiding alcohol use before bed help to stave off hot flashes. For vaginal dryness, Lee assures there are over-the-counter remedies available.

Getting real about hormone therapy
Lee routinely gets asked about hormone therapy and its effectiveness. She explains that hormone therapy can be very helpful for some. Those who have had a prior history of breast cancer, stroke, heart attack or blood clots are not good candidates for hormone therapy.

According to Lee, the ideal woman for hormone therapy would be someone who is less than 10 years away from their final period. “They are in the first 10 years of menopause and they don't have high blood pressure or uncontrolled cholesterol. And, they're suffering from symptoms such as hot flashes that are causing sleep disturbance or vaginal dryness. Especially if they're at high risk for osteoporosis, those women would be good candidates for hormone therapy.”

The menopausal and postmenopausal care continuum
Many women presume that once they’ve entered menopause, they don’t need to continue with Pap tests or pelvic exams. Lee explains that women should continue with Pap tests until age 65 - and possibly even longer - if there has been an abnormal result. She also recommends a yearly pelvic exam.

“We want to look at the tissue. Women may need some vaginal estrogen. We also check for any lesions and the possibility of vulvar cancers. We talk about incontinence and pelvic floor health. We also look at the potential for pelvic floor prolapse, which we can treat with exercise and surgery in appropriate cases.”

Wondering about menopause? Talk with your primary care provider about seeing a women’s health specialist at Skagit Regional Health.