Menopause symptoms: treatment and video visits

Menopause is when your periods stop for good and you can no longer get pregnant. It happens when the ovaries stop making estrogen, and it is confirmed after 12 months without a period. According to MedlinePlus, it most often happens between ages 45 and 55; according to the American College of Obstetricians and Gynecologists (ACOG), the average age is 51.

The years before are called perimenopause, or the menopausal transition. It usually starts in your 40s (ACOG notes that estrogen levels can start to fluctuate in your 30s and 40s), can last several years, and is when hormone changes cause the most symptoms. Periods become irregular, but until you have gone 12 months without one, you can still get pregnant. If you don’t want a pregnancy at this stage, the CDC describes how effective each method is, and the doctor helps you choose: see birth control online.

Video doctor visits 24/7 — book online and choose your time right away.

A menopause evaluation is a doctor visit, with no membership. A refill of a medicine you already use is a follow-up visit. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. See all prices.

Not everyone has the same symptoms. Night sweats can have other causes too: read night sweats. And if your hands or underarms sweat heavily without hot flashes, read about excessive sweating. The most common menopause symptoms are:

• Irregular periods or periods that change
• Hot flashes: a sudden warm feeling in your face, neck and chest
• Night sweats
• Trouble sleeping and tiredness
• Vaginal dryness and pain during sex
• Mood changes, irritability or anxiety
• Leaking urine or other urinary problems

Changes to your routine. MedlinePlus recommends dressing in layers (useful in Puerto Rico’s heat), avoiding alcohol and caffeine, exercising, lowering stress and keeping good sleep habits. For what the evidence says about habits and hormones, read hormone balance; it does not replace an evaluation of your symptoms.

Non-hormonal options. Some non-hormonal medicines help with hot flashes; in 2023 the FDA approved fezolinetant, a non-hormonal pill for moderate to severe hot flashes; it requires liver blood tests before you start and during the first months, per the FDA. For vaginal dryness, ACOG mentions vaginal moisturizers every 2 to 3 days and lubricants during sex, and cognitive behavioral therapy helps with sleep; see also insomnia. According to the NEI, the hormone changes of menopause can make it harder for your body to make tears: if your eyes burn, see dry eyes.

Hormone therapy (HRT). It uses estrogen, or estrogen plus progestin if you have a uterus, to protect the lining of the uterus. According to ACOG, systemic estrogen (pills, patches, gels or sprays) is the most effective treatment for hot flashes and night sweats, and local estrogen (a vaginal ring, tablet or cream) relieves vaginal dryness. According to MedlinePlus, the lowest dose that works is used, and ACOG advises reviewing every year whether to continue.

Who should not use hormone therapy. According to ACOG, systemic hormone therapy usually is not recommended if you have unexplained vaginal bleeding or have ever had breast or endometrial cancer, a stroke, a heart attack, blood clots or liver disease, and it is not for pregnancy. ACOG also notes a small risk of blood clots and stroke that rises with age, and that patches, sprays and rings may carry less risk than pills. That is why the doctor reviews your risks before considering it; if appropriate, she prescribes it.

If your mood symptoms are severe or you have thoughts of harming yourself, call or text 988 or Línea PAS at 1-800-981-0023. For mood changes that are not a crisis, the doctor can evaluate you by video: see mental health care.

Any vaginal bleeding after 12 months without a period, or bleeding between periods, needs to be checked. MedlinePlus advises contacting a provider. By video, the doctor listens and we refer you for an in-person evaluation with gynecology. If the bleeding is very heavy or you feel dizzy or faint, go to the emergency room or call 911.

A few days away can help you build habits, such as better sleep and more movement; they do not treat menopause. If that interests you, THI, which runs this service, also runs a wellness retreat in Puerto Rico: see the midlife wellness retreat guide.