How to know you’re in menopause


Perimenopause, also referred to as the menopause transitional phase, is the period leading up to menopause. Menopause officially occurs when you stop menstruating. While they are both stages within the same transformative process, menopause and perimenopause vary in terms of symptoms and available treatment options.

What are the symptoms and signs of menopause? What changes do most women face as menopause approaches? 

During perimenopause, you’ll start to experience symptoms of menopause. They may include changes in your period cycle, hot flashes, mood swings, sleep disturbances. Symptoms vary woman to woman and there is no one-size-fits-all approach to treatment.

So how can women improve their well-being through the perimenopause phase?

Dr. Meghan MacKinnon shared with me how to know you’re in perimenopause and menopause, and what to do to make the transition easier.

She helps women improve their health through her evidence-based approach to hormone care. She believes every woman can overcome the rollercoaster ride of imbalances by harnessing the power of your hormones to enhance mood, improve energy, relieve stress, and live life to the fullest.

As a Naturopathic Doctor, and NAMS/ North American Certified Menopause Practitioner, she investigates a variety of factors that contribute to your wellbeing, will get to the bottom of your concerns, and advise on a comprehensive treatment plan that’s right for you.

How to Know What You’re Feeling is Symptoms and Signs of Menopause

Watch my interview with Dr. Meghan MacKinnon:


Maria: Let’s talk about menopause and perimenopause! How do you know you’re in perimenopause? What changes do most women face as menopause approaches?

Dr. MacKinnon: Sometimes I like to joke that there’s no welcome sign – “You’ve entered perimenopause – enjoy the ride”. Many of us wish there was because it would make us feel more comfortable and confident with understanding that there’s going to be this start today and then we’ll know that we’re in it and then we’ll have a whole expectation of what to expect. Frankly the only rule with perimenopause is that there are no rules. These are the years leading towards menopause which really means it’s a mixed bag of symptoms depending on the woman her own personal situation which makes it kind of tricky. 

Maria: What are some of the things that make you realize you’re entering this phase in your life?

Dr. MacKinnon: I think most people connect to like the most common symptoms that we hear about which are going to be like the hot flashes and night sweats conversation which do and can start well before your final menstrual period, while you’re still in perimenopause or the years leading towards menopause. Once we start experiencing cycle changes where we’re going plus or minus seven days so seven days longer or a week longer between periods or a week shorter between periods, that’s another clue that we’re in like I’m going to call it “Stage two or tier two perimenopause”. That tells us, oh definitely you’re in in there for sure.

But we have a lot of like vague symptoms that do start showing up much sooner for women as well. Some of those vague symptoms include things that can be very overlapped with a lot of other health concerns which is also where some of the confusion and mystery can sneak in for people.

One of those symptoms that I’m always watching for is sleep changes or sleep difficulties that start showing up in our late 30s or in our 40s at some point. Mood changes – so this could be new onset changes to mood worsening of PMS or it could be like a worsening of underlying mood stuff that we might already have going on.

Joint pain is another one of these kinds of weird symptoms that we don’t see talked about or we’re not thinking about from a hormone perspective but that can show up. Changes to libido; changes to body composition; changes to like vaginal health or vaginal dryness. These are all things that can sometimes fall under the umbrella of perimenopause. Then there’s of course just menstrual cycle changes in general so if we start seeing heavier bleeding heavier flow or menstrual headaches like these are all signs that stuff is different.

Maria: Not every woman is going to have the same symptoms either right?

Dr. MacKinnon: No not at all and sometimes it feels like you have symptoms and sometimes it feels like you may not and that’s actually really normal and like a very classic way that stuff will present because the whole process here is that we’re not seeing a change in hormones which is a drop off a cliff. In reality, we’re seeing ups and downs which give this mixed presentation where sometimes we might have more classic menopausal symptoms. And then sometimes, everything might feel normal and that in itself is a clue that yes we are in perimenopause.

Maria: You mentioned a bunch of symptoms but what are sort of like the ones that you hear women complain the most about when they see you?

Dr. MacKinnon: I think sleep is a common one so if I was like looking at what shows up for a lot of people, sleep and mood like irritability, those sorts of things show up a lot. Sometimes we don’t know and we can’t fully tell apart, is this the only hormone changes or is it also due to other variables that are happening in life? I think that women are commonly concerned about their bodies so there’s lots of conversation about that but that shows up on a lot of intake forms. Lots of conversations about the role of hormones involved with weight management and body composition stuff but those conversations start happening more in our early to mid 40s as well as like the heavy bleeding stuff. Then once we get closer to maybe the time of menopause closer to 50-51-ish, that’s when we start seeing more of the hot flash stuff to show up. When you talk about sleep, the kind of sleep issues you’re finding are waking up more during the night or they’re not having trouble falling asleep.

The kinds of changes should we look out for I think it can be very individual as well but I’m starting to question the role of hormones when we fall asleep okay, but our sleep is very restless – toss and turn – and we’re waking up at 3 or 4 a.m. and finding ourselves unable to go back to sleep.

Maria: The hot flashes they’re a nuisance too! Is there a way to navigate that particular symptom gracefully?

Dr. MacKinnon: It’s interesting with hot flashes because I think that sometimes women are not super bothered by them and that’s okay and then sometimes, they’re extremely disruptive towards life showing up for ourselves and in our day-to-day. I think the main thing to know is that we have treatment options and supports to address your symptoms in a way that works for you and what your goals are. I think the big part here as well is recognizing that your menopause and perimenopause symptoms don’t need to be like hidden away because like even the question about “gracefully” to me kind of implies like this regal, “I must present myself the same way I always have”. I think that the more we open up the conversation into the changes that are normal and expected so that we can stand at the front of a boardroom in a presentation and be like, “sorry I’m just having a momentary hot flash give me a little moment and I’ll come back”… like that’s the kind of energy I want people to be going for at this phase of life where we’re supporting them through it but we don’t need to be ashamed or be scared about those changes. As well, I love that love that you mentioned treatments.

Maria: Tell me a little bit some of the options that are available to help like natural supplements or when should hormone therapy be considered?

Dr. MacKinnon: This is a really big question because again if someone is not that bothered by their symptoms… so I was speaking to someone this week she’s like, “yeah I just keep the window open a little bit and I  take off take my covers off” and she was like “I’m cool with that”. That’s fine if that works! We do have some natural supplements that have good evidence to treat hot flashes and night sweats, but I also really don’t like to treat the options that we have for treatment support in a hierarchy because what works for someone might not work for somebody else. It really circles back to what our treatment goals are and when we use the language that we should consider a natural supplement first and or if things are not that bad before we reach for hormone therapy in many ways even if it’s subconscious, we’re then suggesting that hormone therapy is not a safe effective treatment option. To me, the conversation really starts to be about are we candidates for hormone therapy and supporting and educating women on what are the risks what are the side effects but also what are the potential benefits that might exist for you so that we can embrace this conversation to help us to understand – is this a treatment and supportive strategy that you want to use at this phase of life rather than thinking about it as “I’m not that bad so I don’t need to”. Or it’s like, either this or treatment or that. The big difference here too is like sometimes we are talking a lot about symptom management in perimenopause but when we’re also thinking about this in terms of post-menopause so after your final menstrual period where we can still sometimes have symptoms. A supplement to treat hot flashes is going to help your hot flashes but it might not help your sleep, it might not help to prevent osteoporosis and some of the other studied benefits of hormone therapy. Whereas hormone therapy does have some other benefits that extend beyond just the treatment of hot flashes and night sweats. That’s where the conversation also differs a little bit.

Maria: So how long can this span be? How long do I have to go through this?

Dr. MacKinnon: We need the crystal ball here because I have worked with women who have little to no symptoms – little to no hot flashes, little to no challenges throughout this transition. It’s good to know that situation also exists. There are other situations where women have been dealing with hot flashes for 7,8,9 years and I think that that can be challenging because I know when we’re making decisions for our health sometimes it’s nice to know like, “I can deal with this for 6 months if I knew it was going to be 6 months.” But when we don’t know, sometimes that makes the decision making even more challenging when we’re trying to decide, “how do we support ourselves.”

Maria: Absolutely I mean if we had that crystal ball like you said if you knew okay this is going on for five years, I don’t want to have to suffer… What are three things that women who are entering this phase of life should take away from   today?

Dr. MacKinnon: I think the most important one is probably to think about this transition in terms of building some space into your life to think about your health in terms of where are we currently at with our trajectory for our health, our physical body… but maybe also our life so that we can use this as an opportunity to redirect and reframe the conversation for ourselves and our future health. That’s what I want for all women at this phase of life – that’s my mission I think is to try to help to support women in that way.

Number two is probably to educate ourselves. I think about if we were to send our daughters into conversations about or into puberty without having a conversation with them about it, we can only bridge that in a way that that makes a zero sense whatsoever. Making sure that we feel like we have an understanding about what exists, what could be normal, what’s not normal, how might we support ourselves. And making sure we access trusted well-educated information is important.

The last one is remembering that amongst this conversation about perimenopause and menopause, there can sometimes be a undertone of fear and fear can sell a program. It can sell a supplement… but we don’t need to be fearful about this time of life. We can think about it as a time of unsettling transition. We don’t have to like it, but we can access support to help us through it. You still deserve to feel your best at this phase of life regardless of the hormone changes that are happening. Enjoy the ride – try. We’re all in this together.

Maria: Tell everyone where they can find you.

Dr. MacKinnon: I’m on Instagram at @DrMegMackinnon.nd https://www.instagram.com/drmegmackinnon.nd/   and there’s a link to my website through there. I also run a women’s health group called the Pause Prescription so you can follow me on there to hear all about that as well.