Throughout the different stages of womanhood, we experience milestones that shape us—like the arrival of our first period or the excitement of pregnancy. While some of these moments are celebrated, others, like menopause, are often clouded with stigma and misunderstanding.
Menopause marks the permanent end of a woman’s menstrual cycle, typically occurring around age 51. Despite its reputation for bringing challenging symptoms, menopause is a natural transition, not the end of vitality or youth.
The good news? You don’t have to suffer through menopausal symptoms without support. Understanding perimenopause (the phase before menopause when hormone levels begin to shift) helps you prepare both physically and emotionally for what’s ahead, ensuring a smoother, more empowered transition.
We had the pleasure of exploring this topic with Dr. Saru Bala, a naturopathic doctor specializing in women’s hormonal health who has helped women all over with PMS, period pain, and heavy bleeding. With over 10 years of training, Dr. Bala’s mission is to educate women everywhere about their health so every woman can be more in tune with their hormones, periods, and bodies.
O Positiv: What are some things about menopause women don’t talk about enough?
Dr. Saru Bala: Low libido, weight gain, slowing down, the night sweats, just the up and down of not knowing what’s next. We have that trope that it’s just what women go through and this image of a cranky, grumpy, hot-flashy woman that everyone hates to be around, but that doesn’t have to be the experience you go through. People talk about menopause in such a negative light, like it just means that you’re old now. We expect to turn into this cranky [redacted] that no one likes. But just like how period pain isn’t normal and how there’s so much you can do about it, there’s also so much you can do to avoid perimenopause and menopause symptoms. In general, the conversation needs to happen more openly.
OP: What type of symptoms can a woman expect during perimenopause?
Dr. Bala: The most common symptoms are hot flashes, night sweats, headaches and migraines, weight gain, low libido, fatigue, hair loss, irregular bleeding, vaginal dryness, all the effects of losing estrogen. It’s different for everyone.
OP: What are the factors that determine when a woman begins perimenopause? I’ve seen the ages stagger so much in all the women of my life.
Dr. Bala: Menopause itself is when you haven’t had a period in 12 months or more. Once it’s been 12 full moons with no bleeding, that’s menopause. If you went 9 months, 10 months, even eleven months with no bleeding and suddenly you have a cycle, you’re still not in menopause.
OP: So much of what society tells us is that a woman’s value is intertwined with her youth. Do you think this is why many women are afraid to talk about menopause?
Dr. Bala: I personally think a huge part of why women don’t talk about it is because of its social aspect. We demonize aging, look at everyone doing all the things they’re doing to preserve their youth. You have to get micro-needling and Botox, you can’t have wrinkles but you have to have big lips and full cheeks, you have to have a lot of hair but no gray hair. In other cultures, we embrace being an elder. Getting to be a grandparent and slow down, having the privilege to retire. It’s another rite of passage and maybe that’s how it used to be here culturally, but these days, it’s not. It’s like a bad omen.
OP: I couldn’t imagine dealing with all those false stories about your worth and value being equitable to your youth. What’s some advice you would give for the mental and emotional health of women ashamed to enter menopause?
Dr. Bala: That work starts in your childhood and teenage years. It’s something we carry all the way through our lives. Our worth is not from how others see us but how we see ourselves. That’s a deeper conversation to have with yourself. The narrative is changing around how periods don’t have to be awful and I think we can get there with menopause too. A lot of women don’t think there are other options. When we work on our sleep, our nervous system, our blood sugar, our diet, and our movement, it will change our experience of menopause.
OP: Speaking to that, what are some ways to ease symptoms without using hormone therapy?
Dr. Bala: The biggest thing is liver metabolism. Especially if the main symptoms are hot flashes, night sweats, and irritability, those are usually related to estrogen levels dropping and your body having a hard time metabolizing. That can be treated by hydration, drinking more water with electrolytes, a good multivitamin, blood sugar regulation like eating three meals a day. Most of us aren’t eating three meals a day and focusing on protein. A yogurt cup and orange is not going to do it. All of that affects how you feel and your muscle mass. If you never worked out because you were afraid to have muscle, you’ll feel fatigued and sluggish much sooner.
OP: I was going to ask if there are things you should do before you enter perimenopause to make the experience easier, it seems like strength training would be one?
Dr. Bala: Strength training sets you up for life. There’s nothing I can say that isn’t positive about strength training. I have to remind myself too, I struggle to show up to strength training sometimes but I tell myself “I’m doing this so that when my daughter has kids, I’m not crippled on the couch.”
OP: Lastly, for any woman scared about this phase of their life, what are some things you wish every woman knew about menopause?
Dr. Bala: Thinking back to when I started my period and all the shame and confusion I felt around it, I wish I could tell my 12-year-old self “No, this is a great thing. You get to be a woman.” Menopause is just that next level and I’m so excited for menopause. I did my time, I had my fertile years and birthed my kids. Now my body is done. I get to have this next chapter of my life. That same little girl who was scared to start her period is now finishing that chapter and you don’t have to be afraid.
