Approaching Menopause

What women need to know   

Menopause is a natural biological process that marks the end of a woman’s reproductive years. Typically occurring around age 45-55, it signifies the point when the ovaries stop producing estrogen, the hormone responsible for regulating the menstrual cycle, but also influences throughout the body and brain. While menopause is a normal part of aging, it often brings a mix of physical and emotional changes that can be both challenging and empowering. 

What Is Menopause? 

Menopause officially begins when a woman has gone 12 consecutive months without a menstrual period or has had her ovaries surgical removed. In natural menopause, the transition doesn’t happen overnight. The years leading up to menopause are known as perimenopause, which can begin in a woman’s 30s or 40s. During this time, estrogen levels fluctuate, leading to irregular periods and a variety of symptoms. 

Common Symptoms 

Many women experience a range of symptoms during perimenopause and menopause, including: 

• Hot flashes and night sweats 
• Brain fog or difficulty concentrating 
• Weight gain, particularly around the abdomen 
• Bone density loss, increasing the risk of osteoporosis and fractures
• Genitourinary symptoms and increased urinary tract infections
• Sleep difficulty, depression, anxiety, palpitations, musculoskeletal pain, and more.

These symptoms vary in intensity and duration, but there are effective ways to manage them. 

Updated Guidance for Treatment of Menopausal Symptoms  

Recently, there have been several changes in treating menopause symptoms. Previous studies and related warnings resulted in an avoidance of hormone therapy in perimenopausal/menopausal women of all ages and risk factors for fear of hormone therapy being related to increased cardiovascular disease, breast cancer, stroke and blood clots. 

Recently, evidence surrounding the risks and benefits of hormone therapy has been revisited and further review of the studies reassure that not all hormone treatments are equivalent in their risks and indications and the black box warning that had been placed on all estrogen products has recently been removed by the FDA.     

Menopausal hormone therapy (MHT), or Hormone Replacement Therapy (HRT), is provided in transdermal and oral formulations, and is beneficial for many women. MHT offers significant long-term cardiovascular protection, but only when initiated as close to menopause transition as possible and during the following 10 years.  

The previous concern for increased cardiovascular risk was concentrated in the women in the study who were initiated on hormone therapy later than that first decade. After the cardiac benefit window has passed, continuing MHT beyond that first decade provides ongoing protective benefits to musculoskeletal health, genitourinary health, and brain health.  

The increased concerns related to breast cancer and hormone therapy was not seen in patients on estrogen alone, but rather a small increase was seen in those women taking combination estrogen and progestin therapy. Despite this finding, the breast cancer mortality did not differ in women diagnosed with breast cancer while on hormone therapy compared to those not on hormone therapy. Women taking estrogen who still have a uterus must also have a progestin to protect against uterine cancer. And finally, local vaginal estrogen is safe for almost all women and though it does not offer the systemic hormone benefits outlined above, it significantly decreases the risk of urinary infections which contribute to tremendous morbidity and mortality in aging women. 

Many women and healthcare providers may not be aware of this new data. It is important that women have a discussion with their provider about the updated guidance to ensure they receive the appropriate menopausal hormone care when appropriate. 

Non-hormonal options also exist for women who are not candidates for estrogen or progesterone therapy. Cognitive behavioral therapy, weight loss, exercise, and dietary changes can also help manage symptoms.  

Mental Health Matters 

Menopause is not just a physical transition—it can also deeply impact emotional and mental well-being. Mood swings, anxiety, sleep difficulties, and depression are common during this time, often triggered by fluctuating hormone levels, particularly estrogen and progesterone. These hormones influence neurotransmitters like serotonin and dopamine, which regulate mood, sleep, and cognition. Up to 70% of women report experiencing mood swings during menopause, and nearly half experience symptoms of depression. In many cases, this can improve with appropriate hormone therapy, and in some cases, antidepressant medications may also be beneficial. Talking with your provider can help you find the right combination of treatments tailored to your needs. 

Additionally, there are several proactive things women can do to improve their health during this stage of their lives.  

• Eat a balanced diet: A plant-based or Mediterranean-style diet rich in fruits, vegetables, whole grains, and healthy fats can help reduce hot flashes and support weight management. 
• Stay active: Regular physical activity, especially weight-bearing exercises like walking or strength training, helps maintain bone density. Yoga can also improve balance and mental well-being. 
• Prioritize sleep: Quality sleep is essential for cognitive function and emotional health. Establishing a calm bedtime routine can help combat insomnia and brain fog. 
• Manage stress: Techniques such as meditation, deep breathing, or engaging in hobbies can reduce anxiety and improve mood. 
• Stay connected: Social support from friends, family, or support groups can ease the emotional challenges of menopause. 
• Avoid risky habits: Limiting alcohol, avoiding smoking, and steering clear of vaping can reduce health risks and improve overall well-being. 

It’s important to consult with a provider who is up to date on the recent changes and understands the complexities of menopausal healthcare and can review your medical history and guide you toward an individualized, safe, evidence-based approach. Be cautious with over-the-counter remedies that vary in quality assurance and clinical evidence. For questions or to schedule an appointment with a primary care provider please visit https://intermountainhealthcare.org/find-a-doctor  

Written by: Erica Bruen, MD, Internal Medicine, Intermountain Health

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About St. Vincent Regional Hospital

Founded on our mission of compassionate care 125 years ago, St. Vincent Regional Hospital, part of Intermountain Health, has grown into one of Montana’s largest comprehensive hospitals, serving the healthcare needs of over 400,000 people in our four-state area. Continuing to respond to the needs of our community, we have been recognized as an innovator in trauma, heart, neurological and cancer care. At St. Vincent and Intermountain Health, our 12 primary care clinics, and specialty clinics in and around the Billings area, our goal is to help you live the healthiest lives possible. This also includes caring for the region's youngest patients. We opened the region's first Pediatric Intensive Care Unit staffed 24/7 by Pediatric Intensivists and the only Pediatric Surgery program serving eastern Montana, northern Wyoming, and the western Dakotas.