Women enter menopause when they’ve had no periods for over one year. According to the Office on Women’s Health, the average age American women officially start menopause is 52. But perimenopausal symptoms start earlier. Perimenopause is known as the menopause transitional phase.

Throughout perimenopause and menopause, the levels of estrogen and progesterone in your body fluctuate as your ovaries try to keep up with your normal levels of hormone production. This fluctuation is what causes the common symptoms of menopause, like:

Learn more about these common menopause symptoms and how to deal with them to improve your overall quality of life.

Hot flashes

Phytoestrogens are plant-derived hormones that can partially reverse the hormonal changes that occur due to menopause. Soy-based foods contain high levels of phytoestrogens, so eating lots of tofu can be helpful. Other supplements in this category include:

Take care when using these products. The U.S. Food and Drug Administration (FDA) doesn’t monitor the purity or quality of supplements, and some can interfere with medications. It’s important to talk with your doctor before you begin taking supplements.

Exercise also eases hot flashes by lowering the amount of circulating follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Aim for at least 20 minutes of exercise, three times a week. According to the National Center for Complementary and Integrative Health, acupuncture may also limit hot flashes for some women.

You should also avoid triggers that can make you hotter. These include hot beverages, spicy foods, and alcohol. Stay as cool as possible by dressing in layers and keeping water on hand.

Breast tenderness

Tenderness and swelling of the breasts are also symptoms of menopause. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve) can help decrease both swelling and pain. Although it has some negative side effects,testosterone replacement can be effective in reducing severe breast pain.

Some herbs are also being studied for potential relief:

  • Black currant oil is extraordinarily high in vitamin C and is also rich in many other nutrients. It may greatly ease breast tenderness.
  • Evening primrose oil is used in some European countries to ease breast pain.

Vaginal dryness

Vaginal dryness can potentially interfere with your sex life. Over-the-counter lubricants such as KY Jelly can be used prior to sexual intercourse. Others, like Replens, are meant to be applied on a daily basis.Sesame seed oilcan also be used as a topical ointment to ease dryness.

Vaginal estrogen cream and sustained-release vaginal estrogen rings both deliver low doses of estrogen to the inside of the vagina. Estrogen can be very effective in treating dryness, but it may increase your risk of dangerous conditions, such as:

For this reason, you should use the lowest dose of estrogen possible. Women can’t take hormones at all if they have a history of any of these conditions.

Loss of libido

Menopause often causes women’s bodies to stop producing testosterone. This hormone is believed to be important in the formation of sexual desire and drive. Testosterone replacement therapy is sometimes used to treat sexual arousal disorders. However, it can have serious side effects, similar to those of estrogen therapies. Consult with your doctor to see if this option is right for you.

The following nonmedical treatment strategies may also help:

Though not well studied, the herb yohimbine (yohimbe bark extract) is believed by some to increase vaginal blood flow and boost female libido.

Urinary incontinence

Urinary incontinence can be embarrassing, but it’s also a common symptom of menopause. Kegel exercises can strengthen the pelvic floor muscles. These exercises can greatly improve urethral control.

Avoid alcohol and caffeinated beverages, which can overstimulate your bladder. Limit spicy foods too, as they can also cause bladder issues.

A pessary is a ring made of rubber, plastic, or silicone, which you insert inside your vagina. Pessaries help keep your organs in proper alignment and decrease leakage. You may also consider asking your doctor about prescription medications to help urinary incontinence.

Mood changes

Significant hormonal changes can impact your mood. Irritability, depression, and overall moodiness are the most common effects. The following solutions can help:

  • Regular, daily exercise, but not too close to bedtime.
  • Meditation or yoga.
  • Avoid alcohol.
  • Keep caffeine consumption to mornings only.
  • Eat more fruits and vegetables for a better overall mood.

Certain herbs may also help, but more studies are needed to prove their safety and effectiveness. Talk to your doctor about these possible mood boosters:

Problems concentrating and memory loss

Memory problems are often perceived as occurring with “old age,” when in fact hormones can often be the cause. The following can help improve your concentration and fight memory loss:

  • Ginkgo biloba has been used medicinally for thousands of years. Modern science has shown that it may be useful in treating problems with loss of memory and dementia. Other recommended herbal supplements include sage and ginseng.
  • Taking up a mind-exercising hobby such as sudoku, crosswords, puzzles, or model building can help keep your mind sharp and active.
  • Lifestyle changes, such as decreased alcohol and caffeine intake, eating more fruits and vegetables, and getting regular exercise can also help.
  • Get adequate sleep to improve short-term memory.

Insomnia and sleep problems

During menopause, it seems like you’re always tired. To make matters worse, hot flashes and other symptoms keep you up at night. Consider the following to help you get a better night’s sleep:

  • Get regular exercise, but avoid working out in the evenings.
  • Avoid taking naps.
  • Drink chamomile tea at bedtime.
  • Ask your doctor about using supplements like passionflower or valerian.

Practicing good sleep hygiene is always the first step to better sleep.

High cholesterol

Regular exercise and a low-fat, low-calorie diet are the best ways to keep your cholesterol in check. Eliminate foods high in animal fat from your diet and try to get 20 to 30 minutes of aerobic exercise at least three times a week.

Phytoestrogens may also partially reverse the changes in your cholesterol caused by the hormonal shifts associated with menopause.

Bone loss

The first step in preventing menopause-related bone loss is to increase the amount of calcium and vitamin D in your diet.

There are also a number of prescription medications for bone loss. Bisphosphonates (such as Fosamax) are a new class of nonhormonal drugs that can slow bone breakdown. Calcitonin is a hormone administered via nasal spray that also slows bone breakdown.

Some selective estrogen receptor modulators (SERMs) have also been shown to effectively treat menopause bone loss. Talk to your doctor to learn if any of these drugs are right for you.

Hormone replacement therapy (HRT) is a regimen of medications containing female hormones. The idea is to replace those that the body no longer makes after menopause. Usually, HRT includes estrogen and progestin, a man-made version of progesterone. Since the symptoms of menopause are caused by fluctuating hormone levels, this may be very effective at easing nearly every menopausal symptom.

For years, HRT was the standard treatment for these symptoms. However, according to the Office on Women’s Health, it may increase your risk of breast cancer, heart disease, and stroke. Ask your doctor whether HRT is right for you. There may be other options that are better for you.

Once you hit menopause, you may be counting down the days to postmenopause, a time when menopause has ended. However, you still may not be completely symptom-free.

There isn’t a definitive timeline when menopause symptoms begin and stop. Your experience will be largely based on genetics. Learning how to cope with your symptoms now can bring you months of comfort as you transition to the next phase of your life.