Is Your Patient in Menopause?

By: Nurse Barb
Barb Dehn, NP, FAANP, NCMP

Surprise, surprise! Your patients may still be having periods and starting to have hot flashes and night sweats, but they are not actually Menopausal just yet. That’s because Menopause is actually just 1 day in a woman’s life.

What? Yes, that’s because the way we define menopause is kind of strange.

Menopause is that one magical day when a woman hasn’t had any menstrual bleeding for 12 months.

The following day, she is considered post-menopausal. The average age to stop having periods for good and be menopausal is between 51 – 52.


It is not recommended by the North American Menopause Society, NAMS to do serum testing for Estradiol or FSH to determine if a woman is in menopause or perimenopause. The rationale is that the levels can vary from 1 week to the next in an individual woman and serum levels do not correlate with symptoms.

Salivary testing has not been validated and should not be employed. Rather, the clinician should base treatment options on the patient’s symptoms.


When your patients are still having cycles, even if they are sporadic, they are considered Perimenopausal. This is the hormonal roller coaster of wide swings in the hormones and every aspect of her life:

  • Erratic periods
  • Hot flashes
  • Night sweats
  • Irritability
  • Changes in memory and cognition
  • Vaginal dryness
  • Sleep disturbances
  • Weight gain
  • Reduced or absent sex drive
  • Leaking urine
  • Wrinkles
  • Aching hips and knees
  • The complete catastrophe!

You get the idea. For many women, this time in their lives is much worse than being post-menopausal, when the symptoms start to improve.

Women may experience peri-menopause symptoms starting in their 40s or 50s.

Is it hot in here, or is it just me?

Hot Flashes: Feelings of intense heat can appear out of thin air, radiating from the shoulders to the face and scalp. For some women, a racing heart accompanies hot flashes. Flushing and sweating are common, but a woman may appear cool as a cucumber, while inside, she’s experiencing a blazing inferno.

Night sweats: This is typically the first sign of menopause. Some women have only a slight sensation of warmth, while others sweat so much at night they have to get up and change their clothes. Night sweats are often accompanied by waking up with a sudden urge to go to the bathroom.

Sleep Fragmentation: We know that there are many “mini awakenings” that women may not be conscious of, and yet leave them exhausted in the morning. This sleep fragmentation takes women from deep Delta wave restorative sleep to Stage 1 or Stage 2 sleep cycles.

Hot flashes and night sweats can be triggered by:

  • Drinking alcohol
  • Smoking
  • Hot showers or baths
  • Too many clothes
  • Sudden fluctuation in temperature
  • Stress
  • Even a hot meal or drink

See Barb Dehn, NP, FAANP, NCMP speak at a 2020 Skin, Bones, Hearts & Private Parts event in Virginia BeachSan AntonioOrlandoLas Vegas