Menopause marks the permanent end to your menstrual cycle. Women officially hit this stage in life after going one year without a period. In the United States, the average age that a woman reaches menopause is 51.

Menopause can be a time of mixed emotions. While some women welcome the end of their menstrual cycle, menopause can also bring some unwelcome physical symptoms along with it. The good news is that there are plenty of ways to manage the physical and mental changes that occur during this time in your life.

Here are six symptoms of menopause that you don’t have to accept as your new normal.

Even if you don’t expect menopause to be a walk in the park, one symptom that might catch you off guard is painful sex (dyspareunia). During this transition to menopause, it’s not uncommon to have pain before, during, or right after sexual intercourse. The intensity can vary from pain only at penetration, to a deep burning or throbbing sensation that lasts for hours after penetration.

Menopause is associated with vulvar and vaginal atrophy (VVA), a condition that causes dryness and thinning of the vaginal walls due to a drop in estrogen. Both dryness and thinning can make penetration and sex uncomfortable.

But you don’t have to put the brakes on your sex life. Using over-the-counter vaginal lubrication can make penetration and sex more comfortable.

If you’re still experiencing pain, talk to your doctor about prescription treatments. They can prescribe medication to relieve vaginal dryness such as a low-dose vaginal estrogen cream or an estrogen suppository.

You can also make adjustments to your sex life. More foreplay can stimulate natural lubrication and lead to less pain and more enjoyment during sex. This involves more touching, cuddling, or kissing before actual penetration.

Hot flashes most commonly begin due to menopause, likely to due to hormonal changes. Some women can continue to experience them for more than 10 years.

Hot flashes can feel like sudden warmth or heat spreading over your body that mostly affects your upper body and face. Signs include facial flushing or redness, excessive perspiration, and a rapid heartbeat.

The frequency and intensity of hot flashes differs from woman to woman. Hot flashes may last for a few seconds or up to several minutes. You may also experience night sweats that make it difficult to sleep well.

One way to relieve hot flashes is to consider low-dose hormone therapy. Some antidepressants can also help to stop hot flashes or reduce their intensity. You and your doctor can discuss your options and find the best solution.

You may also find relief from drinking cold water at the onset of a hot flash, sleeping under a fan, and wearing lighter, layered clothing that you can easily remove. Losing weight may also improve hot flashes in some women.

Mood changes from fluctuating hormone levels are a common occurrence during your menstrual cycle. Similarly, you may experience irritability, fatigue, or sadness during menopause.

Simple lifestyle changes can help you manage your moods. Try to get at least seven to eight hours of sleep at night. Regular exercise can also help improve your mood by stimulating the production of endorphins or “feel good” hormones. Aim for at least 30 minutes of exercise most days of the week.

Reduce stress by setting limits for yourself and saying no if you’re feeling overwhelmed. Relaxation techniques like deep breathing exercises and meditation may also help.

If your mood doesn’t seem to improve and you’re experiencing symptoms of depression or anxiety, talk to your doctor. They can prescribe you an antidepressant or anti-anxiety medication or advise you to seek therapy.

Trouble sleeping is another common symptom of menopause. Although the reasons vary, you may experience insomnia due to a drop in estrogen that causes hot flashes. Lower levels of the hormone progesterone may also affect falling and staying asleep.

You can speak with your doctor about treating your hot flashes, which may end up helping your insomnia. But you can also take steps to improve your sleep hygiene.

Avoid taking naps during the day, especially in the late afternoon or close to bedtime. Also, avoid drinking alcohol, having caffeinated drinks, or eating before bedtime. Limiting screen time before bed can help you fall asleep faster, too.

Keep your room dark, cool, and quiet. If sleep problems continue, see your doctor to rule out an underlying issue.

A decrease in estrogen during menopause may weaken your urethra. As a result, you may leak urine when sneezing, laughing, or coughing. Some women may have difficulty holding their urine and find themselves rushing to the bathroom.

One way to reduce this from happening is to try Kegel exercises to strengthen your pelvic floor muscles. This can give you more control over your bladder function. Kegel exercises involve tightening and relaxing your pelvic muscles repeatedly.

Until incontinence improves, you can wear pads specifically for bladder leakage. Also, avoid any beverage that increases the urgency to urinate, such as caffeinated drinks. Excess weight can put pressure on your bladder, so losing weight may improve urinary incontinence in some women.

Memory problems and trouble focusing can develop during menopause. Some women describe this feeling as brain fog.

These problems may be related to lack of sleep and mental health issues like depression and anxiety. So, effectively treating anxiety, depression, and insomnia may gradually improve cognitive function.

It also helps to keep your mind engaged. Try activities that stimulate the brain, like crossword puzzles, and stay active socially.

Of course, not all cases of forgetfulness are due to menopause. If your memory problems don’t improve or are affecting your day-to-day life, talk to your doctor.

Menopause symptoms can last for a few years or even more than a decade. Depending on the severity of your symptoms, menopause can have a negative impact on the quality of your life.

You can’t change biology, but you can manage unpleasant symptoms. The sooner you have a conversation with your doctor, the sooner you can get relief from symptoms like hot flashes and insomnia.