Women in their 40s and 50s who are starting to experience symptoms of menopause and perimenopause frequently don’t know what to expect, and they are often reticent about bringing up symptoms during visits with their primary care providers.

By asking questions and explaining symptoms, providers can normalize symptoms of menopause and perimenopause and put patients at ease, according to Kris E. Barnsfather, M.D., OB/GYN with Norton Women’s Care.

“We assume they’re just trudging along like they were 10 years ago, and they don’t want to bring it up because they think they’re the abnormal ones,” Dr. Barnsfather said during a recent presentation on MedChat, Norton Healthcare’s continuing medical education podcast.

Symptoms of perimenopause and menopause can include hot flashes, night sweats, vaginal dryness, decreased libido, insomnia, weight gain and, less commonly, panic attacks and anxiety.

Perimenopause typically starts one to two years before the cessation of menses. Perimenopause is the time frame when the ovaries start falling behind in their estrogen levels. As a result, the body struggles to adapt.

“You have withdrawal symptoms similar to, for lack of a better word, being in rehab,” Dr. Barnsfather said. “You have to train your body to get used to the drop in estrogen.”

The most common perimenopausal symptoms are vasomotor, experienced by 50% to 80% of people going through menopause. Those with vasomotor symptoms experience hot flashes, a flushing, burning sensation that lasts for one to five minutes. These same symptoms also result in night sweats.

Like other perimenopausal symptoms, hot flashes stem from a drop in estrogen, which allows neurons at the thermoregulatory site in the hypothalamus to fire at a more chaotic and rapid pace.

Perimenopause also can cause mood irritability and, for some, panic attacks and anxiety.

“If you want to talk about unsettled, imagine you’re someone who’s been very low key — all of a sudden you start having heart palpitations and go into panic attacks for no particular reason,” Dr. Barnsfather said.

With menopause, about 40% of patients will experience vaginal atrophy or vaginal dryness. This results from the loss of the epithelial layer inside the vagina, which causes it to lose its rugae, becoming a little thinner and a little itchier.

“The first thing I always tell patients is to make sure during intercourse they use a lubricant and not to be intimidated or have fear or be upset that they have to use it,” Dr. Barnsfather said.

Bringing husbands into the conversation also can help.

“I’ll have a very genuine conversation with them that says, ‘Your wife still loves you. She’s just going through menopause,” Dr. Barnsfather said. “She is certainly turned on and emotionally attached to you just like she was three years ago, but she’s not going to make the oil and the mucus, and she’s not going to have the same lubrication that she did before. It’s not a product of your marriage. It’s just her ovaries giving up.”

Intercourse can become painful in menopause as women lose the fat pad around the introitus, which can become stenotic. The clitoral hood also can start sticking together.

“We have to ask patients questions,” Dr. Barnsfather said. “We need to make sure they know they’re normal. They’re not abnormal. And I cannot stress enough how many women come in feeling depressed and guilty for not having a sex drive.”