Menopause occurs when a woman has her final menstrual period and is confirmed after 12 consecutive months without a period. Natural menopause typically occurs between ages 45 and 58, marking the end of fertility and the beginning of a new life stage. During this transition, ovarian function declines, reducing estrogen and progesterone production, while testosterone levels may remain adequate.

Perimenopause is the phase leading up to menopause when hormone levels fluctuate and symptoms begin. These changes can start in a woman’s 30s. Because estrogen affects nearly every system in the body, declining levels may lead to hot flashes, mood and cognitive changes, sleep disturbances, weight gain, muscle and joint pain, vaginal dryness, painful intercourse, low libido, urinary urgency or incontinence, and changes in skin and hair.

Estrogen levels are closely tied to heart health. More than 70 percent of women experience hot flashes and night sweats caused by declining estrogen, beginning in perimenopause and sometimes continuing for 10 years or longer. During a hot flash, blood vessels dilate, creating sudden heat and sweating, typically in the chest and face. Episodes usually last 30 seconds to five minutes.

Repeated hot flashes may damage blood vessels and increase the risk of cardiovascular disease. Each episode triggers a cortisol spike, increasing inflammation and prompting the liver to produce more cholesterol to repair vessel walls. Over time, this may contribute to plaque buildup, making hot flashes an important symptom to address rather than ignore.

Estrogen is FDA approved to treat hot flashes and prevent bone loss. Hormone replacement therapy may be started during perimenopause when appropriate. Treatment should always be individualized to support optimal health.