The years before, during and after menopause can be stressful, but various treatments can help.  Menopause is defined as the end  of menstruation. Prior to the onset of menopause, levels of the hormones estrogen and progesterone decline. This causes menstrual periods to become sporadic and irregular. A woman may occasionally miss a period for one or more months. Length of the cycle may change and menstrual flow may become lighter or heavier. This phasing-in period is known as the perimenopause.

The average age at menopause in the U.S. is 52, but can range from 45 to 55. The perimenopause can last from two to eight years. As hormone levels fluctuate, women can experience a number of symptoms.

Here are some of the common signs:

Hot flashes.

It’s one of the most common signs, affecting about 75 percent of women approaching menopause. They are characterized by a sudden sensation of warmth in the upper body and face. The skin may become red and sweaty. Hot flashes last anywhere from a few seconds to several minutes and can occur at any time of the day or night. Nighttime hot flashes and sweating can interfere with sleep.

Mood swings.

Some women experience changes in mood and/or increasing anxiety, irritability or depression. Symptoms are often attributed to swinging levels of hormones. However, sleep problems and lifestyle changes (such as “empty nest syndrome or stress of caring for aging parents) can also contribute to mood disturbances.

Cognitive problems.

Some women complain of memory problems, difficulty focusing, or confusion. Sexual problems. Loss of estrogen causes thinning and drying of the tissues lining the vagina. Lack of lubrication can make intercourse painful. In addition, some women report difficulties with arousal or low interest in sex.

Bone and body changes.

\Bone loss increases with age and accelerates for the first five years after menopause, putting women at increased risk for osteoporosis and bone fractures. In addition, women may experience hair loss, thinning of the hair on the head and/or increased hair growth on the face.  Women are also at increased risk for developing diabetes and cardiovascular disease after menopause.

Mary Peterson, M.D., Gynecologist at Magee-Womens Hospital, University of Pittsburgh Medical Center reminds women that menopause is a natural part of aging. Many women go through the “change” without a significant amount of problems. But if symptoms are distressing or intolerable, patients should get advice from a health care provider.

One of the mainstays of treatment for perimenopause symptoms is oral contraceptives, or birth control pills. The treatment uses a combination of estrogen and progestin to maintain a regular menstrual cycle and ease the symptoms associated with declining hormone levels. Peterson stresses that patients should take the lowest dose possible and for as little time as possible to ease their symptoms.

Women who smoke, have underlying medical conditions or don’t want to take birth control pills have other options. Dressing in layers enables a woman to adjust the amount of covering when a hot flash occurs. Regular exercise and a healthy diet can help prevent weight gain and reduce the risk for bone loss, diabetes and cardiovascular disease. Some antidepressants help with hot flashes and mood swings. Estrogen creams and lubricants can ease vaginal dryness and pain during intercourse.

The good news is that there is eventually an end to the symptoms. Peterson says the most common symptoms, like hot flashes and night sweats, are typically worse in the first two years, then ease, usually disappearing within five years.