Perimenopause and menopause: myths, reality and how to cope


In this article:

  • Menopause is a natural life transition for women that involves multiple stages and symptoms.

  • Many symptoms can begin in the perimenopause stage, which can start as early as 40 and as late 60 years of age.

  • Swedish gynecologist Heather L. Kipa-Joseph, D.O. breaks down common myths about menopause.

Menopause is a part of life that many women dread. While it can have its challenges, Swedish gynecologist Heather L. Kipa-Joseph, D.O. says menopause is often misunderstood and can cause women to experience unnecessary anxiety or frustration due to a lack of education and resources.

“Historically, we haven’t done a great job addressing this with our patients,” says Dr. Kipa-Joseph. “It’s just been a stage of life we begrudgingly accept. Many women think they just have to suffer through and, eventually, they’ll get past it. But, ladies, it doesn’t have to be that way.”

The first step to changing your outlook is to better understand menopause and the changes within your body. Dr. Kipa-Joseph says she likes to start the conversation with her patients early, in hopes of giving them time to get used to the idea and mentally prepare themselves for the changes to come. For her, that conversation happens when her patients are around 37 to 40 years old – about the time perimenopause kicks in.

Stages of menopause

You might be asking, “Perimenopause? There are stages of menopause?”. The answer is yes, says Dr. Kipa-Joseph, but they’re not always as clear-cut and predictable as we’d like them to be.

Perimenopause is the stage before menopause. During this time, the woman still has active periods and can still become pregnant – but her body begins to slowly reduce its estrogen and progesterone production. This can happen within a span of a year, or more gradually, over several years. Hot flashes, night sweats and other symptoms of menopause may begin at the end of this stage.

Menopause, as defined by the North American Menopause Society (NAMS), is “the final menstrual period and is confirmed when a woman has missed her period for 12 consecutive months (with no other obvious causes).” In this stage, she is no longer producing estrogen and progesterone, marking the end of her body’s fertility.

Post-menopause includes the years following menopause. For about 85% of women, the menopausal symptoms will diminish completely.

Perimenopause and menopause: myth or reality?

It’s no secret that menopause has gotten a bad rap over time. But Dr. Kipa-Joseph says it’s important to remember that not everything you read is true, and not all symptoms are universal. She explained some of the most common myths and misconceptions about perimenopause, menopause and how to cope.

Myth: Perimenopause lasts around a year.

Women often think of the perimenopause stage as lasting about a year. But each woman’s body transitions at its own pace. In fact, the National Institutes of Health reports that perimenopause usually lasts an average of four years. Whether it’s one year or four, you don’t have to suffer through it. If you’re experiencing symptoms, talk with your doctor about options for relief.

Myth: All women start menopause at the same time.

While the average age of menopause is 51, some women start earlier and others later. The age range usually spans between 40 to 58 and can be affected by genetics, lifestyle factors and even smoking. In fact, smokers tend to enter menopause an average of two years earlier, according to the NAMS.

Myth: All women get hot flashes.

Every woman’s journey through perimenopause and menopause is unique, so naturally, the symptoms they experience, as well as the duration and severity of them, will vary. About 85% of women experience some combination of menopausal symptoms, says Dr. Kipa-Joseph. These symptoms can include hot flashes, night sweats, irregular or inconsistent periods, sleep disturbances such as difficulty falling asleep or staying asleep, mood instability, low libido and vaginal dryness, which can lead to painful sex.

The remaining 15%, however, often report no physical changes during this time except for the loss of menstrual periods.

Myth: You should just power through it.

Many women wait to talk with their health care provider until their symptoms are unbearable, says Dr. Kipa-Joseph. “As your health care provider, we don’t want that. If you are experiencing discomfort, please give us a call. We can help find solutions and strategies that make this transition easier.”

Common symptoms patients seek relief for include hot flashes, insomnia, interrupted sleep and difficulty with or painful sex.

Myth: Hormone replacement therapy isn’t worth the risk.

Hormone replacement therapy (HRT) has been a controversial topic for more than a decade due to associated risks, such as breast cancer, heart attack and blood clots. In most cases, however, the benefits of HRT far outweigh the potential risks. In fact, the NAMS, American Society for Reproductive Medicine and other reputable groups continue to support HRT as the most effective treatment for menopausal symptoms such as hot flashes and vaginal dryness.

Dr. Kipa-Joseph, who has treated women with a range of therapies from non-hormonal to hormonal and even natural remedies, says treatment should be individualized. “When talking with my patients about their options, it’s imperative to consider their age, symptoms, medical and genetic history.”

Reality: Brain fog is real.

“Often, one of the most surprising symptoms patients experience is brain fog,” says Dr. Kipa-Joseph. “They come to me complaining of forgetfulness, difficulty remembering things and often just feeling a little out of it. This is normal, and for most women, just a temporary side effect as their bodies adjust to the decreased estrogen.”

Reality: Menopause isn’t a life sentence.

Many women begrudgingly think of menopause as a forever fixture in their lives. Thankfully, this is only a transitional phase for most women, with symptoms subsiding once menopause is complete. 

But you don’t have to struggle through this phase, either, says Dr. Kipa-Joseph. There are resources, tools and even support groups to help you.

“The most important thing for me, when talking to my patients, is to help them better understand menopause and to arm them with the knowledge and tools they can use to not just ‘get through’ this time, but to thrive during it,” says Dr. Kipa-Joseph.


Learn more and find a provider

Whether you need gynecologic care, are starting your journey through menopause or facing another issue related to women’s health, Swedish is here for you every step of the way. Our staff of leading physicians, surgeons and health care professionals provides virtually every medical specialty and subspecialty that a woman requires at every stage of her life.

Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. You can use our provider directory to find a physician, caregiver or advanced care practitioner.

Related resources

Hormones for hot flashes: should you consider them?

5 tips to reduce “meno-fog”

Women’s Wellness & specialty GYN services, First Hill. Meets specialized care 

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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