You’re hot and sweaty. You wake up at night drenched even though you’ve got the air conditioning cranked. Your vagina feels dry even when you crave sex, and it seems like your hair is starting to thin in the front. Could this be menopause?

Maybe. Menopause is the official end of a woman’s fertility, and it usually happens in most North American women around age 51. But the symptoms and bodily changes that signal menopause can start as many as 10 years prior to the official event: the day you mark 12 consecutive months on your calendar without having had a period. Bleed after that point, and the counting begins again.

So, how can you recognize the signs and deal with the symptoms of menopause? First, if possible, find out how old your mother was when she reached menopause. If she had a hysterectomy you’re out of luck, as that’s considered surgical menopause. If you have sisters, note when they reach menopause and you’re likely to do the same. Second, understand that if you smoke, you’re likely to reach menopause two years earlier than non-smokers.

Watch for the typical changes in the hormones estrogen, progesterone and testosterone, which are all responsible for the symptoms you’re likely to experience. Almost all women (80%) experience hot flashes during the day or night. Vaginal dryness can occur, causing irritation and discomfort, especially during intercourse. Insomnia often strikes and is compounded by night sweats. You may notice an increase in fat building up around your middle, and your breasts may appear to be thinner. Your skin may feel drier and itchier.

Menopause isn’t for the cowardly, and dealing with its symptoms is no party. Use this guide to make your way through the changes in your body, mind and spirit to emerge through menopause the woman that you want to be for the next third of your life—you’ve still got a lot of living to do!

Some women are thrilled to say goodbye to menstrual cycles and embrace the bodily changes. Others associate their femininity and sexuality with their fertility and see this as a time of loss. Are you experiencing any of these symptoms? The more symptoms you have, the greater the chance you’re moving through menopause.

• Irregular periods
• Night sweats
• Vaginal dryness
• Hot flashes
• Sleep disturbances
• Mood swings
• Thinning hair
• Skin dryness/changes

Continue to get regular annual check-ups, since the hormonal changes of menopause do affect your body’s systems. Chronic medical conditions including heart disease and some cancers may also appear after menopause. Use this checklist of questions to make sure your next office visit is complete:

• Based on what I’ve shared with you, am I experiencing the start of menopause?
• Am I a candidate for hormone therapy for the symptoms? Why or why not? What are the risks if I decide to take hormone therapy?
• Are over-the-counter hormone replacements the same as the prescription hormone therapy? Do they give me the same risks and potential benefits?
• Am I at high risk for breast cancer? How is menopause changing my breast cancer risk?
• Am I at high risk for heart disease? How is menopause changing my risk?
• Should I be concerned about bone loss? How can I minimize bone loss?
• Is my sex life going to change?
• Is sex going to be less comfortable during and after menopause?
• What can I do to minimize any discomforts?
• I’ve heard that some women leak urine during or after menopause. Will this happen to me? What can I do to prevent it?

Problem ... Hot flashes, night sweats
Solved ... Hormone therapy is one option, but not for women at risk for breast cancer; ask your healthcare provider what your individual risks are for this treatment. If you can’t take hormones, you should also avoid the supplements that contain phytoestrogens (like soy) and black cohosh. Dress in layers and fabrics that move sweat from your body, like cotton. Use fans and cool clothes to reduce the flushed feeling; talk to your healthcare provider about medications that can reduce hot flashes).

Problem ... Mood swings
Solved ... Don’t suffer in silence; let your healthcare provider and your friends and family know about the emotional roller-coaster you’re on. Try to reduce stress and moods through meditation—take at least 20 minutes a day to sit quietly and focus on your inner being/spirit. Prayer is meditation, as is absolute silence; low-dose antidepressants may help as well.

Problem ... Weight gain
Solved ... Eat healthy and get regular exercise every day, particularly exercise that targets fat loss overall like walking, and watch the number of calories you’re eating each day.

Problem ... No interest in sex
Solved ... Using testosterone in women to boost libido is controversial: studies have shown the placebo was as effective as the therapy. Try talking with a sexuality counselor.

Problem ... Sleep
Solved ... Reduce or eliminate caffeine, especially within 6 hours of bedtime, exercise in the mornings rather than evenings, and create a cooler, dark cocoon-like environment to promote deep sleep. Put drops of lavender oil on a sachet or your pillow to promote calm. Ask about prescription medications to help you achieve better sleep.

Problem ... Leaking urine
Solved ... Do pelvic floor exercises to strengthen the muscles that help you start/stop urine; losing weight and vaginal estrogen creams can also help. Talk with your healthcare provider about possible medications.

About the Author: Mary Lou Reed, CNM, MSN, RNC is in clinical practice at East Alabama Medical Center in Opelika, AL.