Even before you bid your 30s adieu, you might start noticing that things with your body aren’t quite the same as they used to be. Why? Hormones that have been steady since puberty begin to drop, laying the groundwork for an end to ovulation and some pretty major side effects. Welcome to the beginning of menopause. Here’s what to expect — and what you can do to feel your best each step of the way.
In Your 30s and 40s
“Perimenopause, or the years before your period fully stops, can start as early as 35, but most women will experience it in their mid-40s,” says Toni Mueller, M.D., a gynecologist with Complete Women Care in southern California. This transition to menopause usually lasts about seven years, and for some women can stretch on as long as 14 years. During this time, the levels of the hormones estrogen, progesterone and testosterone start falling, which kicks off a wide range of symptoms. “A big one is that your cycles will get irregular, maybe becoming more infrequent, but heavier,” says Dr. Mueller. “You also could start having hot flashes and night sweats.”
Other potential side effects: less muscle mass, more belly fat, lower energy levels and libido, more intense mood swings before your period and trouble concentrating. “Estrogen is also what keeps your vaginal flora in harmony, so now is when you can start to have less lubrication and more painful intercourse,” says Dr. Mueller. Other vaginal changes include a higher risk for yeast infections and a thinning of your external genital tissue, which can cause irritation and pain during sex.
In Your 50s
For most women, this is the decade you say goodbye to periods forever, which can bring on a lot of emotional and physical changes. Some can be positive, especially if you’ve suffered through painful periods in the past — those PMS symptoms and cramps are also gone forever. But other changes can be tough to deal with. “The biggest concern here is a decrease in estrogen, which is felt throughout the body,” says Dr. Mueller. “For example, hot flashes can be intense and are more prominent.” Most women who experience hot flashes have them for about seven years, although they can continue for more than a decade (the earlier hot flashes start, the longer they tend to last).
The shift in your hormone levels also affects your bone strength and heart health. “Estrogen is protective for bones, so now you have to start worrying about osteoporosis,” says Dr. Mueller. “And estrogen helps keep LDL cholesterol down and HDL cholesterol high, so without it you have a higher risk for heart disease, strokes and heart attacks.” Half of postmenopausal women will also have vulvovaginal issues, such as dryness, burning and irritation, and a majority of those women will experience a negative impact on their sex life because of these symptoms.
In Your 60s and Beyond
You may not experience the more upsetting symptoms of menopause anymore, like hot flashes, but you aren’t out of the woods yet. “Women in this decade still have significant vaginal dryness, which means it can be too painful to have intercourse,” says Dr. Mueller. “And they are also at a higher risk for many cancers as well as heart disease.”
Because you’ve gone through so many physical changes since your 40s, you may also struggle to accept the new you. Research shows that it’s natural to feel a sense of grief at the loss of your younger body or that you’re suddenly trapped in a body you don’t recognize.
There is good news: You don’t have to sit back and accept all of these changes. You have options that can improve your physical and emotional well-being, from prescription meds to at-home remedies. “How women feel through these decades depends on what they do during the transition to menopause,” says Dr. Mueller.
Ask your doctor about hormone replacement therapy (HRT)
While not for everyone, HRT can be an effective way to find relief for some of the big menopause-related symptoms, such as hot flashes and vaginal dryness. “With hormone therapy, you can make a huge difference in your quality of life,” says Dr. Mueller. There are different options (estrogen– or progestin-only prescriptions, or a combination), and your doctor can determine if you’re a good candidate and the right one for you. If you do decide to try HRT, it doesn’t mean you’ll be taking hormones for the rest of your life — your doctor will likely start you on a low dose and have you continue for as short of a time as needed.
Consider using a lubricant
In addition to your normal self-care routine of reducing stress, prioritizing sleep and eating well — all steps that can help mitigate menopause symptoms — there are also helpful at-home treatments for vaginal issues like painful sex, dryness, burning and itching. Try using a lubricant during sex and applying a vaginal moisturizer or prescription topical estrogen cream or gel to relieve some discomfort.
Make time for exercise
Last but definitely not least: Prioritize your physical health. Strength training a few times a week and getting your heart rate up regularly can help you avoid the muscle loss and weight gain associated with aging. Exercise can also reduce your risk for heart disease and some forms of cancer. The more you take care of yourself, the happier you’ll feel with your body and the easier it will be to adjust to all of these changes.