Menopause: what to expect from this natural stage of life

(6-minute read)

Written by: Dr. Luísa Santos

Introduction: a natural phase that deserves more information

For a long time, menopause was a little-discussed topic. Many women went through this phase with little information and feeling that the symptoms were inevitable—something that simply had to be endured.

Today we know that this view is outdated.

Menopause is a natural stage in a woman's life that marks the end of reproductive function. However, the hormonal changes that occur during this phase can influence various body systems, affecting metabolism, sleep, mood, bone health, and even how the body responds to stress. In Portugal, the average age for menopause is between 48 and 51, although the first signs can appear several years earlier, during a period called perimenopause.

With adequate information, healthy lifestyle habits, and professional guidance, many women can navigate this phase with quality of life and well-being. Even more importantly: understanding what is happening in the body helps reduce anxiety and make informed decisions about health.

What happens in the body during menopause

Menopause is clinically defined as 12 consecutive months without menstruation, in the absence of other medical causes.

However, changes begin before that. During perimenopause, the ovaries gradually start to reduce their activity, leading to fluctuations and a progressive decrease in the production of two fundamental types of hormones:

• estrogens
• progesterone
  

These hormones play an important role in various body systems, including:

• body temperature regulation
• energy metabolism
• cardiovascular health
• maintenance of bone and muscle mass
• cognitive function
• sleep quality
• emotional well-being

As hormone levels decrease and fluctuate, the body needs to adapt. This adaptation process explains many of the symptoms that can arise during this phase.

📌 Did you know?

It is estimated that 60 to 80% of women experience menopause-related symptoms, with hot flashes being one of the most common.

Most common symptoms of menopause

Each woman experiences this phase differently. Some have few symptoms, while others may feel more intense changes. Additionally, symptoms can appear gradually or in different combinations.

1. Vasomotor symptoms

Hot flashes and night sweats are among the most characteristic signs of menopause. These episodes result from changes in the brain's temperature regulation center associated with decreased estrogen.

📌 Did you know?

Moderate to severe vasomotor symptoms can last between 7 and 11 years, although the duration varies greatly among women.

2. Sleep changes

Sleep disturbances are also common during this phase. Some women report:

• difficulty falling asleep
• night awakenings
• non-restorative sleep

Night sweats can contribute to these changes, creating a cycle of fatigue and lower energy during the day.

3. Cognitive changes

Some women report mild cognitive changes, such as:

• difficulty concentrating
• memory lapses
• a feeling of “brain fog”
  

These changes are usually temporary and can be associated with various factors, including hormonal changes, sleep deprivation, and high stress levels.

📌 Myth vs. Truth

Myth: menopause causes permanent memory loss.

Truth: cognitive changes associated with menopause are generally mild and transient.

4. Emotional changes

During menopause, some women may experience:

• irritability
• anxiety
• mood swings
• increased emotional sensitivity
  

These changes result from the interaction between hormonal, psychological, and contextual factors.

5. Genitourinary symptoms

With decreasing estrogen, genitourinary syndrome of menopause (GSM) can occur. This condition can include:

• vaginal dryness
• discomfort during sexual intercourse
• vaginal irritation or burning
• urinary symptoms, such as urgency or recurrent urinary tract infections
  

Unlike hot flashes, these symptoms tend to worsen over time if left untreated.

📌 Myth vs. Truth

Myth: vaginal dryness is something women simply have to accept with age.

Truth: there are several effective treatment options that can significantly improve these symptoms.

What changes after 40

Many of the changes associated with menopause begin gradually, even before the last menstruation.

Among the most common changes are:

• gradual loss of muscle mass
• increase in abdominal fat
• slightly slower metabolism
• greater sensitivity to stress
• changes in sleep
• more irregular menstrual cycles
  

These changes result from a combination of natural aging, hormonal changes, and lifestyle. For this reason, strategies such as a balanced diet, regular physical activity, and good sleep quality become particularly important in this phase of life.

Strategies that can help improve well-being

Although menopause is inevitable, there are several strategies that can help reduce the impact of symptoms and improve quality of life.

1. Balanced diet

A varied diet rich in nutrients can support metabolic and cardiovascular health. It is advisable to prioritize a Mediterranean diet:

• vegetables
• fruit
• legumes
• whole grains
• fatty fish
• nuts
  

Adequate protein intake is also important to preserve muscle and bone mass.

2. Regular physical activity

Physical exercise plays a fundamental role in this phase. Its benefits include:

• preservation of muscle mass
• bone health protection
• mood improvement
• reduction of cardiovascular risk
  

International recommendations suggest at least 150 minutes of moderate physical activity per week, including strength exercises.

3. Sleep and stress management

Maintaining consistent sleep routines and adopting stress management strategies can help improve well-being. Practices such as:

• walks
• yoga
• meditation
• breathing exercises
  

can contribute to improving emotional balance.

📌 Did you know?

Sleeping less than 7 hours a night is associated with a higher risk of metabolic changes and increased stress sensitivity.

What is not menopause

Not all symptoms that appear after age 40 are related to menopause. Some situations may have other medical causes and should be evaluated. These include:

• persistent intense fatigue
• unexplained weight loss
• vaginal bleeding after menopause
• persistent pelvic pain
• severe depressive symptoms
  

Therefore, it is important not to automatically assume that all symptoms are part of menopause. Evaluation by a healthcare professional can help clarify the origin of changes and define the best approach.

Available treatments

The treatment of menopausal symptoms should be individualized, taking into account:

• intensity of symptoms
• age
• general state of health
• the woman's preferences
  

Available options include:

1. Hormone therapy in Menopause

Hormone therapy with estrogens is considered the most effective treatment for hot flashes and night sweats, when there are no medical contraindications. When properly indicated, in women under 60 or in the first years after menopause, it generally presents a favorable benefit-risk ratio.

2. Non-hormonal options

For women who cannot or do not wish to use hormones, there are therapeutic alternatives, including certain medications and behavioral approaches. Additionally, some supplements are frequently used, although scientific evidence varies. The choice of the best strategy should always be made with the guidance of a healthcare professional.

When to seek help?

Although menopause is a natural phase of life, there are situations where it is advisable to seek medical evaluation. You should seek professional advice if you experience:

• vaginal bleeding after menopause
• very intense hot flashes that interfere with daily life
• persistent vaginal pain
• significant depressive symptoms
• recurrent urinary tract infections

Medical evaluation allows for identifying the best approach for each case and excluding other conditions.

The role of the pharmacy in this phase of life

The pharmacy can be an important support point for many women during this phase. The pharmacist can help to:

• clarify doubts about menopause
• advise on products for vaginal dryness or hot flashes
• guide on nutritional supplements when appropriate
• recommend medical evaluation when necessary
  

Having access to clear and evidence-based information can help make safer decisions about health.

A series to better understand this phase of life

This article is the first in a series dedicated to menopause, where we will explore in more depth some of the most important topics of this phase of life.

In the next articles, we will address:

• Sleep and menopause: why it's so common to sleep worse during this phase and what can help
• Nutrition in menopause: how diet can support metabolism and energy
• Physical exercise: why movement is essential to protect muscles, bones, and cardiovascular health
• Stress and mental health: how hormonal changes can influence the nervous system
• Menopause and professional life: impact on work, concentration, and energy management

The goal of this series is to provide clear and evidence-based information to help women better understand their bodies and make informed decisions.

Conclusion

Menopause is a natural phase of life and does not have to be lived with suffering or resignation. With adequate information, healthy lifestyle habits, and professional guidance, many women can navigate this stage with balance, energy, and quality of life. More than the end of a phase, menopause can represent the beginning of a new chapter – a phase of maturity, self-awareness, and redefinition of priorities.

References:

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2 - “The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-794. doi: 10.1097/GME.0000000000002028. PMID: 35797481.

3 - National Institute for Health and Care Excellence (NICE). Menopause: diagnosis and management. NICE guideline NG23. 2015 (updated 2019). Available at: https://www.nice.org.uk/guidance/ng23;

4 - International Menopause Society. 2020 Global Consensus Recommendations. Available at https://www.imsociety.org/statements/position-papers-and-consensus-statements/;

5 - Avis NE, Stellato R, Crawford S, Bromberger J, Ganz P, Cain V, Kagawa-Singer M. Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Soc Sci Med. 2001 Feb;52(3):345-56. doi: 10.1016/s0277-9536(00)00147-7. PMID: 11330770;

6 - Thurston RC et al., 2021 — Menopausal Vasomotor Symptoms and Risk of Incident Cardiovascular Disease Events in SWAN https://www.ahajournals.org/doi/10.1161/JAHA.120.017416;

7 - Susanna Savukoski, Hannele Mäkelä, Juha Auvinen, Jari Jokelainen, Katri Puukka, Tapani Ebeling, Eila Suvanto, Maarit Niinimäki, Climacteric Status at the Age of 46: Impact on Metabolic Outcomes in Population-Based Study, The Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 7, July 2019, Pages 2701–2711, https://doi.org/10.1210/jc.2018-02025