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The 7 Most Common Perimenopause / Menopause Health Changes And OB/GYN Tips To Navigate With Ease

The 7 Most Common Perimenopause / Menopause Health Changes And OB/GYN Tips To Navigate With Ease

Perimenopause/Menopause Symptoms

By Barbra Hanna, DO, FACOG, MSCP, 10/14/2023

While menopause is best known for marking the end of a woman's reproductive years, it also brings changes to your body and health that are less frequently discussed. It’s important to learn about these changes since all women experience menopause either naturally, chemically, or surgically. No matter how you experience your menopause, it can bring about various physical, emotional, and psychological changes you may not associate with your hormonal changes.

Education is Empowerment!  Understanding the changes your body is going through is the first step in managing menopause with grace, confidence, and good health.  Read on to learn the 7 most common health changes associated with menopause.  

1. Hot Flashes and Night Sweats

Up to 80% of women experience bothersome hot flashes and night sweats (hot flashes that happen at night) - the hallmark symptoms of the menopause transition. These bothersome flashes are caused by hormonal fluctuations and can disrupt your sleep, mood, memory, and daily activities.  Recent research even indicates those pesky heat waves are not good for your heart health. Think about it this way - if you are hot, bothered, and not sleeping well, you will most likely reach for fatty - carb-heavy comfort foods and skip exercise thus experiencing a growing waistline - increasing your risk of high cholesterol, high blood pressure, and type 2 diabetes.

Prevention tip: Schedule a visit with a menopause specialist to learn about your options to tame the flame with safe and effective science-backed treatments covered by health insurance.

2. Bone Health

Decreased estrogen levels during menopause, especially in the first 10 years after your final menstrual period, increase your risk of osteoporosis.  Osteoporosis is a silent disease that thins your bones, decreasing their density and increasing your risk of fracture.  It is important to have bone density testing when recommended by your physician or healthcare provider.  The Menopause Society recommends all women 65 and over undergo bone density testing. If you are younger than age 65, your physician or health care provider will recommend you have a bone density if you have additional risk factors for osteoporosis.   Some common risk factors for osteoporosis include menopause, family history of osteoporosis, low body weight/being small and thin, prior bone fractures, loss of height, smoking, and having an inactive lifestyle.

Women who choose to begin hormone therapy containing estrogen for bothersome menopause symptoms enjoy the added benefit of stronger bones and the prevention of osteoporosis.  Estrogen is FDA-approved for osteoporosis prevention. However, beginning estrogen after the age of 60 is not recommended by The Menopause Society, so if you are at risk of osteoporosis, the timing of beginning estrogen is imperative.

Prevention tip: Regular exercise that includes resistance training, along with a balanced diet rich in calcium and Vitamin D can help maintain bone health. If you are under age 65 and have osteoporosis risk factors, ask your healthcare provider to order a bone density if they haven’t already!

3. Cardiovascular Health

Estrogen plays a protective role in heart health by relaxing your arteries and promoting good cholesterol in pre-menopausal women. Its decline during menopause increases your risk of heart disease by allowing your arteries to become thicker and stiffer and your LDL (bad cholesterol) to rise.  This increases your risk for high blood pressure, heart attack, and stroke in menopause. While hormone replacement therapy is not medically indicated for the prevention of cardiovascular disease, women who begin it in the early menopause transition may experience better cardiovascular health. Checking your blood pressure regularly and completing recommended lab testing to determine if you have elevated cholesterol is crucial to treating and preventing heart disease.

Prevention Tip: The most effective way to prevent heart disease is by being physically active and maintaining a healthy diet. MyMenopauseRx recommends giving the Mediterranean diet a try.

4. Emotional Health

Hormonal changes in perimenopause and menopause can negatively affect your mood and emotional well-being.  Some women even describe their perimenopause mood changes as “PMS” on steroids!  Unfortunately, it is common to experience mood swings, irritability, or even symptoms of depression in the menopause transition. If you are suffering, you are not alone. Up to 70% of women experience new or worsening mood changes in perimenopause. A history of postpartum depression, PMS, and/or a prior history of anxiety or depression all increase your risk.

This time of life, often referred to as the sandwich generation, is stressful!  You may be caring for aging parents, children, and your significant other, all while running your household and even working. Add to that hormone fluctuations causing you to feel lousy and maybe forgetful,  it’s no surprise you may not feel like yourself. The good news is that hormonal and non-hormonal treatments can help. Despite still having regular periods,  you can still begin hormone therapy in perimenopause. The current medical literature indicates if you are suffering from mood changes in perimenopause, beginning hormone therapy early can be more effective than waiting until you experience your final period.

Prevention Tip: Research has shown that daily exercise has a powerful positive effect on mood. Exercise is natural medicine! Commit to your mental health and exercise daily.

5. Weight gain and metabolic health

Many women find it more challenging to maintain their weight in perimenopause and the years beyond.  Your decreasing estrogen levels deserve some blame.  According to the Obesity Medicine Association, the average weight gain in the menopause transition is 5-7 pounds but anywhere from 3-30 pounds can be experienced. Most of the weight gain seems to appear in your waistline.

What worked for you 10 years ago just will not work for you now.  Declining estrogen levels increase the development of belly fat and visceral fat (the bad fat around your internal organs).  Your hunger hormone, ghrelin also increases with a decrease in estrogen. Factor in your natural decrease in physical activity - let’s be honest, we are not as active as we were 10 years ago, along with your decreased muscle mass and you have a recipe for a slower metabolism and weight gain. Unfortunately, your newfound increase in central weight gain increases your risk of insulin resistance, type 2 diabetes, high blood pressure, and elevated cholesterol.

While users of hormone therapy develop less belly fat, estrogen is not a weight loss treatment. Hormone therapy does treat your bothersome menopause symptoms and helps you feel like yourself again, allowing you to commit to your health and waistline.  Maintaining your weight in the menopause transition and beyond takes your commitment to making healthy choices.

Prevention Tip: Our bodies were designed to be hunters and gatherers - not to sit behind the wheel of a car or a computer screen. To prevent weight gain and its associated metabolic changes, move daily and add dedicated strength training 2-3 days per week to your exercise routine. Muscle burns more calories than fat.  Maintaining your muscle mass is a natural metabolic boost!

6. Vaginal and Bladder Health

Your bladder, urethra, vagina, and labia (vulva) all have estrogen receptors. The decline of estrogen levels in menopause can lead you to experience vaginal dryness, discomfort, painful intercourse, increased UTIs, and urinary frequency or urgency.  This below-the-belt estrogen deficiency syndrome is called “Genitourinary Syndrome of Menopause”. While all of these symptoms sound dreadful, they are treatable!  There are many over-the-counter lubricants and moisturizers available to ease your symptoms but only prescription treatments treat the underlying problem.  FDA-approved estradiol designed specifically for use in the vagina is a safe and effective treatment for most women, even those with a history of breast cancer.  Open communication with your menopause specialist can help address these concerns and explore the best treatment options tailored specifically for you.


Prevention Tip: Seek treatment early when symptoms first appear. The further out from your final menstrual period, the more bothersome your below-the-belt symptoms may become.

7. Skin and Hair health

Menopause and your plummeting estrogen levels bring noticeable changes to your skin and hair.  Decreased estrogen makes your skin prone to thinning, sagging, easy bruising, and wrinkling. Studies have shown women lose 30% of their skin collagen in the first 5 years after menopause and an additional 2% yearly thereafter. The Menopause Society 2022 position statement on hormone therapy states women who use menopausal hormone therapy to treat their bothersome menopause symptoms have less collagen loss and wrinkles.  Estrogen elevates the skin’s levels of hyaluronic acid and collagen production.

You may also notice an increase in facial hair, acne, and hair loss. Perimenopausal acne is common. As your hormones roller coaster and shift, women are more prone to acne and hair growth on your face. Prescription oral and topical treatments are effective and safe for long-term use if needed.

It’s not uncommon to experience thinning and hair loss on your central scalp.  Unfortunately, hair loss is common as women age. Next time you are in a room of senior women, look around. You will see many scalps. This hair loss is called androgenic alopecia or female pattern hair loss.   If you are anxious over unwanted hair loss, the sooner you seek treatment, the more successful you will be at retaining your locks. The menopause specialists at MyMenopauseRx recommend lab testing to ensure you do not have a nutritional deficiency before beginning any over-the-counter or prescription treatment. Safe, effective hormonal and non-hormonal prescription medications are available. The earlier you begin treatment, the better the results!

Prevention tip: Great skin at any age requires you to hydrate, hydrate, hydrate! Drink plenty of water and use SPF daily, wear a hat when outdoors, moisturize often, and use a topical retinol nightly.  You can also apply a small dab of vaginal estradiol cream under your eyes as part of your nightly bedtime routine.

Navigating menopause with grace and confidence is easy when you are well-informed about the changes you can expect. While these changes can be challenging, menopause presents an opportunity for you to prioritize self-care, embrace a healthy lifestyle, and seek support when needed. Remember you are not facing menopause alone!


The content is meant for educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Please seek the advice of your physician with any questions you may have regarding a medical condition.