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When they’re around 10 or 11, girls attend a class about what to expect in puberty. 

When women are pregnant, there’s “What to Expect When You’re Expecting.”

“There’s no ‘What to Expect When You’re Expecting Menopause,’” says gynecologist Dr. Beth A. Prairie, chief medical officer of West Penn Hospital. “There’s no class. There isn’t actually a really great standard book.” 

But Prairie says there’s a simple definition for what menopause is, and most women go through it with manageable symptoms. The keys are keeping up with your overall health and having a good relationship with your gynecologist who can look for irregularities.

“If we’re fortunate to live long enough, it will happen to all of us. And most women get through it just fine,” she says.

The definition of menopause for women who have a uterus, Prairie says, is 12 months of no menstrual periods after the age of 40 with no other underlying reason. 

In the United States, for non-smokers, the average age of menopause is 52. Perimenopause, or the stage that comes before menopause, is about one to three years before your final menstrual period, and that tends to be when women experience the most symptoms, usually hot flashes.

Perimenopause is divided into early and late stages; in the late stage, women will start skipping more than two months in a row of periods, and in the early stage, women will see changes to their menstrual pattern but not skip more than two months in a row.

Prairie says most women get through perimenopause just fine, even if they have hot flashes. If the hot flashes are interfering with their everyday life, if women are soaking through their clothes, for example, they should seek care, she says. 

But she doesn’t want women to see menopause as a great looming disaster as there are many options available to help women manage their symptoms. Step one is always lifestyle and environmental interventions such as exercise and managing stress. 

“What would I tell you five years before your final menstrual period that you should be doing to help you get through your menopausal transition in the healthiest, easiest way possible? … Work toward achieving and maintaining a healthier weight. Exercise every day like your life depends on it. Go outside. Get off your screen. Spend time with people who love you and make you laugh. Manage your stress. I have devoted my life to women’s health. Women hold the weight of the whole globe on their shoulders. Everybody who has a job is working at least two jobs — their regular job and their home job. It’s a lot without a lot of support. Manage your stress, make sure you’re taking care of yourself.

“We know that women who have healthier lifestyles, are managing high blood pressure, diabetes, healthier weight, exercising regularly, tend to have less bothersome hot flashes.”

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After lifestyle, the next option for managing symptoms is medication, which includes hormone therapy.

Hormone therapy is “the gold standard” but isn’t an option for everyone, Prairie says. “However, it is a good option for most women who have bothersome symptoms.”

It can carry some risks. According to the Mayo Clinic, “For best results, hormone therapy should be tailored to each person and reevaluated every so often to be sure the benefits still outweigh the risks.”

One common misconception Prairie sees is when women under 40 think they’re experiencing menopause because they’re moody or have gained weight. 

“If you’re out there in the lay public and you’re trying to figure out is this perimenopause, keep track of your periods,” she says. “There is no test, no matter how much money you spend, that is as exquisitely sensitive and accurate as your menses.”

Having a good relationship with your gynecologist and having annual checkups is key.

“We are the ones who will pick up on your bleeding pattern when we talk to you. We’re the ones who can help differentiate between what I always refer to as normal, regular, perimenopausal bleeding and abnormal, irregular perimenopausal bleeding.

“It’s a really important time to have a relationship with a gynecologist you trust, who listens to you and who makes you feel heard … The women in the Pittsburgh region are incredibly fortunate. We have a lot of gynecologists in the region. You can find one you can work with.”