9 things you may not know about menopause

August 15, 2025

Providence Women's Health Team

[5 MIN READ]

Menopause, often referred to as “the change,” is the natural biological process that marks the end of a person’s reproductive years.
Although most people know the common symptoms associated with menopause, such as mood swings, night sweats and hot flashes, there are some lesser-known facts about this phase of life you may not know.
Menopause can affect everyone differently, and there’s no average age for when it begins. But no matter how it affects you, it’s critical to prioritize your health during this time of significant change.

9 things you may not know about menopause

Menopause is a time of immense change. You may find yourself suddenly needing to use the bathroom more often than usual — especially in the middle of the night — and waking up in the morning drenched in sweat. You may also notice your hair thinning significantly and your libido disappearing without a trace.

But while the headlines about menopause may feel familiar, some facts about the natural but often unpleasant part of aging might surprise you.

Dina Gordon, M.D., an OB-GYN specializing in menopause at Providence Swedish Gynecology Specialty Center in Seattle, recently joined the podcast team for an episode of Talk With A Doc to help you understand nine facts about menopause you may not know:

1) Some people “sail through” menopause.

Thirty percent of people don’t experience any menopause symptoms at all. That’s right: not a single hot flash.

“The people who come to see me aren’t that 30%, but I know they’re out there,” Dr. Gordon says.

That said, even those who don’t report symptoms during menopause may realize, years down the line, that something they experienced, like vaginal dryness or loss of bone density, was actually related to menopause.

“I have to wonder if that comes from our lack of understanding, historically, of what symptoms typically accompany menopause,” Dr. Gordon says. “Symptoms that we’ve attributed to aging in the past but are really caused by estrogen and progesterone changes in the body.”

2) You’re still in perimenopause until 12 months after your last period.

Perimenopause refers to the time before menopause itself. That can mean any number of years before your last period, and it extends to the first year after your last period.

“You must have no period for 12 consecutive months,” Dr. Gordon says. “It’s a retrospective diagnosis.”

3) The symptoms of perimenopause are subtle, but they don’t occur in a vacuum.

If you realize you haven’t felt like yourself lately — maybe you’re more forgetful than usual or you’re getting more upset about small issues than you typically would — it may be a sign you’re in perimenopause. Especially if you’re in midlife.

“I like to say it almost feels like the volume is dialed up,” Dr. Gordon says. “I also sometimes call it your truth serum. You have less of a filter and you’re just giving it to people straight, which is empowering but also, sometimes, problematic.”

Determining exactly when you enter menopause is tricky, Dr. Gordon adds: “It can be easy to doubt ourselves. But if you’re noticing things like hot flashes, night sweats, maybe you’re not sleeping as well or are feeling more anxious than usual, it’s time to start thinking about perimenopause and the hormonal changes it can cause.”

4) Once perimenopause is over, symptoms of menopause tend to subside.

One good thing about menopause symptoms is that they don’t normally last forever. According to Dr. Gordon, they tend to peak in the year after your last menstrual cycle, then slow down after that or at least become less erratic.

In addition to symptoms like hot flashes and night sweats, that can also mean you notice your overall mood improving, your brain fog lifting and the weight gain that tends to accompany perimenopause slowing down or stopping completely.

5) Different populations experience menopause differently.

Socioeconomic and cultural differences often mean people of color go through menopause earlier than white people.

“It’s not due to biological differences,” Dr. Gordon says. “It’s due to social stressors and economic ones, like less access to health care, that can contribute to earlier menopause.”

Earlier menopause onset can mean women experience more severe and longer-lasting symptoms.

6) People who have hot flashes may have an increased risk for heart disease.

Researchers believe that people with moderate to severe hot flashes are at a greater risk for developing cardiovascular disease down the road, Dr. Gordon says, adding that the risk is likely due to blood vessel damage.

“Treating people who have moderate to severe hot flashes with hormone therapy can be protective against heart disease down the line, but it’s not for everyone,” she says. “Not everyone benefits from this kind of therapy. It’s a case-by-case basis.”

7) Experiencing brain fog during menopause isn’t a marker for dementia.

People tend to worry that experiencing brain fog during menopause means they’re more likely to have dementia, but Dr. Gordon says that’s not the case.

“If you look at brain imaging tests of people going through perimenopause, you notice areas of the brain making adaptations to compensate for the effects of lower estrogen levels,” she says. “While we don’t go back to ‘normal,’ per se, most people return pretty close to the baseline of cognition they had before.”

8) Menopause can expose underlying conditions.

If you start hormone therapy — also called menopause hormone therapy (MHT) — or other treatment options to reduce the severity of certain menopause symptoms, like trouble focusing or mood changes, and they’re not going away, you may find out they’re not related to menopause at all, Dr. Gordon says.

“It’s actually becoming more common for people in perimenopause to be diagnosed with ADHD,” she says. “If you get estrogen back through hormone therapy and it doesn’t reverse your symptoms, it can lead to people suddenly having this kind of unmasking of underlying ADHD.”

Dr. Gordon adds: “Sometimes, it’s not hormones. It’s ADHD or depression or sleep apnea. If your doctor treats your symptoms with hormone therapy and it doesn’t help, you need to figure out what the true underlying cause is.”

9) There isn’t much evidence showing supplements help relieve menopause symptoms.

Despite the dozens of over-the-counter supplements currently available to women in menopause looking for symptom relief, there’s not much evidence that proves they help, Dr. Gordon says. There’s also not much safety data or quality control on supplements because they don’t require Food and Drug Administration approval.

“When it comes to supplements, it might be better to use nothing,” she says.

It’s always a good idea to talk with your doctor before adding any new supplements or medications.

Take care of yourself during menopause

Menopause is an individual journey for everyone. You may notice severe symptoms, symptoms that come and go, or absolutely nothing at all. Your genetics may have something to do with when perimenopause begins, but other factors may, too — like your overall health and wellness, as well as socioeconomic disparities.

“The best thing we can do is stay active, manage our stress and protect our sleep and physical and mental health,” Dr. Gordon says. “I know these things can be easier said than done, though. That’s why it’s also important to learn self-compassion and gratitude.”

Find the support you need

Providence Swedish offers a full range of women’s health services. Our clinics are staffed with physicians and staff who provide the full spectrum of gynecological care, ranging from routine screenings to perimenopause and postmenopausal health. Schedule an appointment today for any questions you may have related to menopause or other women’s health issues.

Contributing caregiver

Dina Gordon, M.D., is an OB-GYN specializing in menopause at Providence Swedish Gynecology Specialty Center in Seattle.

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