Menopause: What It Is, What Happens in the Body, and How to Prepare for the Years Ahead

Menopause is a natural part of a woman’s life, but it is often misunderstood. Beyond hot flashes and night sweats, menopause brings lasting changes to bones, the heart, metabolism, and blood sugar regulation. With the proper knowledge, women can approach this transition with confidence, clarity, and a proactive plan.

🌸 What Is Menopause?

Menopause is defined as the point in time when a woman has gone 12 consecutive months without a menstrual period, marking the end of natural fertility. The timing of menopause is primarily determined by genetics, but other factors also play a role. The average age of menopause in the U.S. is 51 years, though it can occur anytime between 45 and 55 years. Some women may experience early menopause (before 45) due to genetics, surgery, or medical treatment.

⚙️ What Causes Menopause?

The gradual decline in ovarian function drives menopause. When the ovaries stop producing eggs this significantly reduces estrogen and progesterone output.

Lifestyle and environmental factors:

• Smoking: Linked with earlier menopause - smokers may enter menopause 1–3 years earlier.

• Body mass index (BMI): Low BMI (thinness) is associated with earlier menopause; higher BMI and better overall nutrition can delay it.

• Alcohol use and physical activity: Moderate drinking and light physical activity may delay menopause, while heavy exercise or poor nutrition can hasten it.

Medical and reproductive history:

• Ovarian surgery or oophorectomy (surgical removal): Causes immediate menopause.

• Chemotherapy/radiation: Can cause loss of ovarian function, leading to early menopause.

• Early menarche, nulliparity, and certain autoimmune conditions: Can be linked to early menopause.

Other factors: Socioeconomic status, education, exposure to toxins (like lead), and some chronic health conditions can also influence timing.

📉 What Happens in the Body When Estrogen Drops

Estrogen is a multisystem hormone, and its decline affects nearly every organ system. Research shows clear long-term impacts:

🦴 Bones

• Estrogen typically inhibits bone resorption (the breakdown of bone tissue).

• After menopause, bone loss accelerates - women lose up to 20% of bone density in the 5–7 years after menopause 【NIH Osteoporosis & Related Bone Diseases National Resource Center】.

• This raises the risk of osteoporosis and fractures if proper weight bearing exercises are not performed regularly.

❤️ Heart

• Estrogen helps maintain blood vessel flexibility and healthy cholesterol levels.

• After menopause, the risk of cardiovascular disease rises sharply, partly due to increased LDL cholesterol, decreased HDL cholesterol, and vascular stiffness 【Mayo Clinic Proceedings, 2019】.

🔥 Metabolism & Weight

• Estrogen decline alters how the body stores fat, promoting visceral fat accumulation around the abdomen.  Unlike subcutaneous fat (under the skin), visceral fat is located beneath the abdominal muscles, wrapping around internal organs. It influences hormones and metabolic functions, impacting whole-body health.

• This shift is linked to higher rates of insulin resistance and metabolic syndrome.【Nature Reviews Endocrinology, 2020.】

  • Insulin is a hormone that helps glucose enter cells to be used as energy. If the body's cells don't respond properly to insulin (insulin resistance) then blood glucose levels rise leading to high blood sugar and diabetes.

  • Metabolic syndrome is a cluster of conditions occurring together that increase the risk of heart disease, stroke, and type 2 diabetes. Having at least three of these factors qualifies as metabolic syndrome:

    • Insulin resistance or elevated blood sugar: fasting blood glucose ≥ 100 mg/dL

    • Abdominal obesity: waist circumference >=4" in men and >=35" in women

    • Elevated blood pressure: Systolic ≥ 130 mm Hg and/or diastolic ≥ 85 mm Hg

    • High triglycerides: >=150 mg/dL

    • Low HDL ("good") cholesterol: <40 mg/dL men and <50 mg/dL women

🍬 Blood Sugar

• Estrogen typically improves insulin sensitivity.

• Postmenopausal women face a higher risk of type 2 diabetes, especially if weight gain and inactivity are present 【Diabetes Care, 2018】.

💪 Muscles & Sarcopenia

• Estrogen helps preserve lean muscle mass by supporting protein synthesis and mitochondrial function.

• As estrogen declines, women face accelerated sarcopenia - the age-related loss of muscle mass, strength, and function.

• Sarcopenia contributes to weight gain, insulin resistance, decreased mobility, and increased risk of falls.

• Research shows resistance training, strength-based exercise, and Pilates can slow or even reverse muscle loss by improving muscle tone, balance, core stability, and bone loading 【Journal of Aging Research, 2020】.

🔄 How Other Hormones Are Affected

• Progesterone: Declines earlier than estrogen, contributing to irregular cycles and sleep changes.

• Testosterone: Continues to decline gradually, affecting muscle mass, libido, and energy.

• Cortisol: Stress hormone becomes harder to regulate, contributing to fatigue, sleep disturbances, and belly fat.

• Thyroid: Disorders (like hypothyroidism) become more common in midlife, often overlapping with menopausal symptoms.

🌿 Managing Menopause: Evidence-Based Approaches

The scientific literature suggests multiple strategies for managing menopause and reducing long-term risks.

1. Lifestyle

• Exercise: Strength training and weight-bearing activity support bone health and metabolism. Alignment is a key component to proper strength training. Cardio supports heart and blood sugar regulation. Keep in mind though that extreme exercise can yield a stress response by the body and may elevate blood sugar levels in some.

• Sleep hygiene: Regular schedules, cool sleep environments, and relaxation practices help regulate melatonin and cortisol. (See my blog 'What happens while you sleep').

• Stress management: Mindfulness, deep breathing, yoga, and meditation reduce cortisol burden.

  
  

2. Nutrition

• Calcium & Vitamin D: Essential for bone health (diet + supplementation if necessary).

• Protein: Supports muscle maintenance as estrogen and testosterone decline. (Reference my first nutrition workshop - Understanding Nutrition for a Healthier You)

• Phytoestrogens (found in soy, flaxseeds, legumes): May provide mild estrogen-like effects and help reduce hot flashes 【Climacteric, 2015】.

• Whole foods diet: Focus on vegetables, whole grains, lean proteins, and healthy fats to improve heart and metabolic health. Stay away from fried foods, enriched grains and ultra-processed foods. They are in more than you think!

  
  

3. Supplements (should be discussed with a healthcare provider)

• Omega-3 fatty acids (heart and brain health)

• Magnesium (sleep, bone health, mood)

• B vitamins (energy, stress response)

• Adaptogens (ashwagandha, rhodiola) may support stress resilience.

  
  

4. Other Modalities

• Bioidentical Hormone Replacement Therapy (BHRT): Effective for symptom relief and prevention of bone loss; best considered within 10 years of menopause onset, individualized based on risk factors. 【NAMS Position Statement, 2022】.

• Cognitive Behavioral Therapy (CBT) Is Evidence-Based for managing hot flashes and sleep disturbances.

• Acupuncture: Some women report improvements in hot flashes and mood. (See my blog on acupuncture and Menopause)

• Pelvic floor therapy can help with urinary incontinence or vaginal dryness.

🌡️ What Symptoms Can You Expect — and For How Long?

Symptoms vary, but common ones include:

• Hot flashes & night sweats (affect ~75% of women; can last 7–10 years for some)

• Mood swings, irritability, or anxiety

• Sleep problems

• Vaginal dryness, discomfort during intimacy

• Brain fog or concentration issues

• Joint aches

• weight gain

  
  

Duration: While some women experience only a few years of symptoms, others may continue to notice changes for a decade or longer.

💡 Key Takeaway

Menopause isn’t just the end of menstruation. It’s a biological shift with wide-reaching effects on bones, muscles, the heart, metabolism, and more. By understanding what happens inside your body and proactively adopting lifestyle, nutrition, and evidence-based therapies, you can protect your long-term health and improve daily well-being.

👉 Next Step

See my workshop: “Hormone Basics: The Key Hormones Every Woman Over 40 Needs to Understand.”

You’ll learn how to recognize imbalances, what labs to ask for, and how to support your hormones during perimenopause and beyond naturally.