Menopause: complete guide to symptoms, treatments and tips for living it better

Menopause is a natural stage in every woman's life, but it often comes with symptoms that can significantly affect quality of life. Understanding what happens in the body, knowing the menopause symptoms and knowing what treatment options exist is key to living this transition with wellbeing. In this complete guide, the gynaecology team at Clínica Eupnea Palamós-Girona walks you through it step by step: from perimenopause to postmenopause, with evidence-based information and practical advice.

What menopause is exactly

Menopause is the moment when the ovaries stop producing eggs and sex hormones (oestrogen and progesterone) drop permanently. Technically, it's diagnosed retrospectively: 12 consecutive months without menstruation with no other explanation.

The average age of onset is between 45 and 55 years, with an average of 51. When it appears before age 40 it's called premature menopause, a situation requiring specific medical evaluation to rule out causes and consider preventive treatments.

The 3 stages: perimenopause, menopause and postmenopause

• Perimenopause: the transition phase, lasting 4 to 10 years before menopause itself. Hormone levels fluctuate, periods become irregular and first symptoms appear.
• Menopause: the specific moment of the last menstruation. Confirmed after 12 months without a period.
• Postmenopause: all years after menopause. Vasomotor symptoms usually decrease over time, but cardiovascular and osteoporosis risks rise.

Most common menopause symptoms

Symptoms vary widely between women in intensity and duration. The most common are:

• Hot flashes: sudden sensation of intense heat lasting seconds to minutes, often with sweating and flushing
• Night sweats that can fragment sleep
• Sleep alterations: insomnia, frequent awakenings, non-restorative sleep
• Mood changes: irritability, anxiety, low mood
• Vaginal dryness and discomfort during intercourse
• Decreased libido
• Weight gain, especially abdominal
• Hair loss and skin changes
• Brain fog: difficulty concentrating or remembering
• Joint and muscle pain

Approximately 75% of women experience vasomotor symptoms during the menopausal transition, and 25-30% have them with enough intensity to affect their quality of life.

Diagnosis and medical evaluation

Menopause diagnosis is essentially clinical, based on age and menstrual history. Hormonal lab work (FSH, oestradiol) can be useful in cases of premature menopause or diagnostic doubt, but isn't routinely needed in a 50-year-old woman without periods.

At the initial consultation we evaluate:

• Menstrual history and symptom evolution
• Family history (osteoporosis, breast cancer, cardiovascular disease)
• Bone densitometry per risk
• Screening mammography
• Gynaecological cytology if applicable
• Lipid and metabolic profile
• Vitamin D and calcium

Treatment: hormonal and non-hormonal options

Hormone replacement therapy (HRT) remains the most effective option to control moderate-severe vasomotor symptoms and vaginal dryness. When started in women under 60 or within 10 years of menopause, benefits usually outweigh risks in selected candidates.

Available options:

• Oestrogens alone (in women who've had a hysterectomy)
• Oestrogens + progesterone (uterus present)
• Oral, transdermal (patches, gels) or vaginal routes
• Tibolone (synthetic steroid)

Non-hormonal alternatives:

• Selective serotonin reuptake inhibitors (SSRIs) like paroxetine
• Gabapentin for nocturnal hot flashes
• Local vaginal treatments (moisturisers, laser)
• Phytotherapy with limited evidence (soy isoflavones, black cohosh)
• Cognitive-behavioural therapy for psychological symptoms

The decision must be personalised, weighing benefits, individual risks and patient preferences.

Lifestyle that improves menopause

Lifestyle is the foundation of wellbeing in this stage. Evidence-based recommendations:

• Mediterranean diet rich in vegetables, legumes, fish and healthy fats
• Regular exercise: combine aerobic, strength and flexibility (minimum 150 min/week)
• Strength training: key for bone and muscle health
• Reduce alcohol (worsens hot flashes and sleep)
• Quit smoking (brings menopause forward and worsens symptoms)
• Sleep hygiene: regular schedule, cool bedroom, no screens
• Stress management: mindfulness, yoga, breathing
• Vitamin D and calcium supplementation per indication
• Maintain social life and meaningful activities

Long-term health care

The drop in oestrogens raises the risk of:

• Osteoporosis: up to 20% bone loss in the first 5 years; densitometries needed and, if appropriate, specific treatment
• Cardiovascular disease: control of blood pressure, cholesterol, glucose and weight
• Genitourinary atrophy: treatable with vaginal moisturisers or local oestrogens without systemic effects
• Cognitive decline: mitigated by physical and social activity

So beyond symptom control, menopause is an opportunity for comprehensive health review and proactive prevention.

Common myths about menopause

Menopause is surrounded by misconceptions that can cause unnecessary worry. Let's dispel the most common ones:

• 'Menopause means the end of sexual life': false. With vaginal moisturisers, local oestrogens or HRT, sexuality continues fully.
• 'Hormone therapy causes cancer': in selected women under 60, risk is minimal and benefits often outweigh it.
• 'You can't avoid weight gain': with adequate diet and exercise (especially strength), weight is fully manageable.
• 'Symptoms must be endured': there are effective treatments for each symptom — no need to suffer in silence.
• 'Hot flashes are inevitable': 25% of women have none, and many milder cases respond well to lifestyle changes alone.

Information is the best tool against myths. Don't hesitate to ask your gynaecologist anything you're unsure about — every doubt has a clear, evidence-based answer.

When to see a gynaecologist or endocrinologist

• Hot flashes or symptoms affecting quality of life
• Bleeding after established menopause (always requires evaluation)
• Very irregular cycles with heavy bleeding
• Persistent vaginal or urinary symptoms
• Very low mood or marked anxiety
• Unexplained weight loss or changes
• Family history of breast or ovarian cancer or early osteoporosis
• To assess if hormonal treatment is right for you