The stages and symptoms of menopause

The premenopausal stage occurs during the teens and twenties when you have a regular menstrual cycle and are most likely to be fertile. In the mid to late thirties or early forties is when the perimenopausal stage begins. At this stage, women begin to report that their cycles become more irregular, worsening PMS, mild hot flashes, and night sweats start to occur. Irritability, depression, and weight gain, specifically around the middle of the body, are also common occurrences in the perimenopausal stage. This can be a particularly challenging time as your body goes through rises and falls in estrogen levels while transitioning into menopause.

Once you have not had a menstrual cycle for at least twelve months, you are now in the final stage of menopause. All of the symptoms faced in the perimenopausal stage can be expected to hang around in the menopausal stage plus fatigue, difficulty falling and staying asleep, low libido, low sexual desire, changes in memory (specifically short-term memory), anxiety, and vaginal dryness.
A Closer Look

Mood and anxiety

One of the most significant complaints in menopausal women are the mood changes and anxiety. Not only are these changes unpleasant, when mood changes and anxiety levels increase, the levels of cortisol in the body are likewise elevated. Higher levels of cortisol effects metabolism and fat distribution. It also leads to inflammation throughout the entire body from the pelvic region to the brain, the heart, and the joints. Stress has many negative effects on the body and leads to lower immunity. Stress reducing techniques like meditation can lead to overall better health.

Loss of libido and low sex drive

Declining estrogen and testosterone levels lead to loss of libido. Loss of libido and low libido are one of the most common symptoms that women experience during menopause. Both estrogen and testosterone need to be replete in order for libido to be restored. It is very common for low sex drive or lack of sexual desire to begin in the perimenopausal stage and remain into menopause.

Urinary Symptoms

Menopausal women are at greater risk for urinary symptoms. Frequency, urgency, irritation, stress urinary incontinence, which means leakage of urine when you cough, laugh, sneeze, or urge incontinence. Estrogen is protective of those symptoms, so when menopause begins, symptoms such as frequency, urgency, vaginal irritation, itchiness, or burning along with urinary incontinence can occur. Prolapse of the bladder may also occur as estrogen levels decline.

Preparing for your appointment

When preparing to go see your doctor about hormone replacement therapy or menopause, it’s important for you to fill out a general medical health questionnaire with all of your past medical history, all of your medications and supplements. Tests that Dr. Berman typically order include a full hormonal profile, lipid profile, thyroid panel, human growth hormone, Vitamin D, Vitamin B12, and fasting glucose levels.

Testing and diagnosis

Diagnosis of menopause can be made by absence of menstruation for a period of 12 months. Your doctor may also ask to look at your FSH, follicle stimulating hormone, and LH, luteinizing hormone levels. Those levels, which represent ovarian function, dramatically increase during menopause.


Menopause is treated based on the symptoms the woman is having as well as their hormone levels. The symptoms are treated with hormone replacement therapy, typically a combination of estrogen, progesterone, and testosterone. Thyroid replacement may be required at times as well. If you have your uterus intact, progesterone is definitely needed as it protects the uterus.

Taking unopposed estrogen is not an option if you have your uterus in place as it will cause a thickening in the endometrial lining and can lead to changes and even cancer. While testosterone is not FDA approved to be used as a treatment in women yet, Dr. Berman is legally able to prescribe estrogen, progesterone, and testosterone off-label in the treatment of menopause. Other treatments may include thyroid replacement therapy if needed and DHEA for adrenal gland support if indicated.

Hormone replacement therapy (HRT)

Hormone replacement therapy replaces hormones that are depleted due to menopause. The hormones that typically replaced are estrogen, progesterone, and testosterone. Thyroid hormones are typically hormones that are impacted during menopause, and sometimes DHEA.

Alternative Treatment

Many herbal supplements make the claim that they can treat menopausal symptoms, of hot flashes and night sweats. Damiana, Ginseng, Gingko, and St. John’s Wort, among others. Two supplements that Dr. Berman has researched and feels confident in prescribing due to the fact that they have been sufficiently studied are Serenol and Relizen, both by the brand Bonafide. Serenol is beneficial for the relief of PMS and perimenopausal mood changes while Relizen helps relive night sweats and hot flashes. Serenol is contraindicated in women that have breast cancer or are at higher risk for breast cancer due to the bee jelly ingredient that has estrogenic effects on the body. Other treatments that can work in tandem with the treatment of menopause are acupuncture and stress reducing techniques like meditation.


Hormone imbalance and climacteric symptoms, as it is referred to in the medical profession, is a medical condition and is covered by your insurance. So, if you are experiencing menopausal symptoms associated with hormone imbalance, do not hesitate to make an appointment to speak with someone today and discover your best treatment plan.


Menopause is something that’s going to affect all of us as women. It’s not something that we can ignore, and not something that we can avoid. If you have any further questions or want to book an appointment, contact Jennifer Berman today!

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It’s estimated that 1 in 10 women have HSDD, which makes the most common sexual dysfunction in females. Women’s low sex drive and related distress can negatively impact a woman’s life, but can be fixed.

Luckily, women who suffer from low sex drive or hormone deficiency don’t have to face their problems alone any longer. Dr. Jennifer Berman is world-renowned as a leading authority in the field of women’s sexual health and has a vast amount of experience in treating women who live with hypoactive sexual desire. Women who go through menopause, experience hormone deficiency, and need compassionate low libido therapy from an experienced urologist, come to The Berman Women’s Wellness Center in Beverly Hills. Here, Dr. Berman offers a wide variety of treatments for women experiencing low libido, and can custom create a solution to bring back your passionate play. She also supports the initiative of the ‘Right To Desire’ movement to raise awareness around this condition.

Right to Desire Movement

To learn more about HSDD, women’s low sex drive and what to do to fix it contact Dr. Jennifer Berman today to schedule your consultation with a credible and relatable authority in women’s sexual and menopausal health.