Your menopause journey, on your terms.

In everyday language, “menopause” describes the whole transition from fully working ovaries to ovaries that no longer release eggs. Medically, menopause is a single point in time: twelve months after your final period.

The transition is a continuum with three stages — perimenopause, menopause and postmenopause — and it can take up a third or more of your life.

Perimenopause is the lead-up to menopause, when your hormone levels begin to fluctuate. Periods can become irregular, heavier or lighter, and many people notice hot flashes, night sweats, sleep problems, mood changes and brain fog.

It often starts in the 40s, sometimes earlier, and can last several years. You can still become pregnant during perimenopause.

A hot flash is a sudden wave of heat that spreads through the body, usually across the face, neck and chest, and it can bring flushing and sweating. When they happen at night they are called night sweats. Together they are known as vasomotor symptoms.

Researchers do not fully understand the mechanism, but falling estrogen levels affect the brain’s temperature control, so it may signal that you are too hot when you are not.

Progesterone is a hormone your ovaries make after ovulation. It balances estrogen and keeps the lining of the uterus in check. During perimenopause, relatively more estrogen and less progesterone can cause longer or heavier periods.

If you take estrogen and you still have a uterus, your practitioner will usually add progesterone to protect the lining. It is not usually needed after a hysterectomy.

“Estrogen” is the name for a group of hormones, including estradiol, estrone and estriol. Estradiol is the main one your ovaries make before menopause, and it is the form commonly used in hormone therapy.

As estrogen declines during the transition, hormone levels swing up and down, which is what causes many symptoms.

Early reports from the Women’s Health Initiative, published in 2002, raised serious concerns about hormone therapy, and use dropped sharply afterwards.

Later analyses showed the picture is more nuanced. The balance of benefits and risks depends on your age, how long it has been since menopause, and your own health history. Many current guidelines support hormone therapy as a reasonable option for many healthy people under 60 or within ten years of menopause. Your practitioner will talk it through with you.

The right approach depends on how severe your symptoms are, your health history and your preferences.

• Hormone therapy replaces some of the estrogen your body no longer makes. It comes as pills, patches, gels or creams.
• Local treatments are applied directly to relieve vaginal dryness, discomfort and some urinary symptoms.
• Non-hormonal medicines can help people who cannot or prefer not to take hormones.
• Supplements and lifestyle changes support overall wellbeing, energy and sleep.

Many people manage mild symptoms with lifestyle changes and natural remedies, but that is not enough for everyone. Prescription treatments are an effective option when symptoms are disruptive.

Always check with a healthcare provider before starting a natural remedy. Herbal products can interact with medicines, and the evidence for many of them is limited.

For most people of typical menopausal age, symptoms are enough to guide treatment. Hormone levels swing from day to day during the transition, so a single blood test often says little and is not usually needed.

Your practitioner will let you know if tests are useful for another reason.

That depends on your age, your medical history and your family history. A practitioner will review your health information and explain the benefits and risks of each option before recommending a plan.

As with any medicine, there are risks. Please do not start or stop a treatment without professional advice.

Side effects depend on the treatment. With hormone therapy, the most common ones include breast tenderness, bloating, headaches, nausea or heartburn, leg cramps, spotting and mood changes. They often settle over time.

If a side effect is hard to live with, tell your practitioner. There are usually ways to manage it.

• Everyday habits: regular exercise, a balanced diet, good sleep, and limiting alcohol and caffeine can reduce stress and ease symptoms. If you smoke, quitting helps too.
• Cooling tricks: layered clothing, a fan and a cool bedroom can take the edge off hot flashes.
• Over-the-counter products: vaginal moisturizers and lubricants can ease dryness and discomfort.
• Bone health: enough calcium and vitamin D, plus weight-bearing exercise, support your bones.
• Mind-body practices: yoga, tai chi and meditation may help with stress and mood.

You create an account and complete a health assessment. A licensed practitioner reviews it and can reply through secure messaging, so you can ask questions along the way.

In most cases messaging is enough. Sometimes the practitioner may suggest a phone or video visit, or further tests, to find the right plan. If prescription treatment is appropriate, they will write your prescription and it is sent to your home.

Licensed healthcare practitioners, such as nurse practitioners and physicians, who have training in the treatment of menopause symptoms.

No. A prescription treatment can only be provided after a licensed practitioner has assessed your health and decided it is appropriate for you.

You complete your online assessment when it suits you. If the practitioner would like to speak with you by phone or video, you will be given a way to arrange it.

If treatment is prescribed, it is delivered to your home in discreet packaging. A signature may be required on delivery, so choose an address where someone can receive it.

A practitioner reviews it and replies through secure messaging. If they need more information, or think a call or video visit would help, they will tell you. You can message your care team afterwards if you have questions or want to change something.