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Hot Flash or Fever? Signs and Symptoms of Menopause

“Wait. Was that a Hot Flash or do I have a Fever?!” If you’re like me, your feelings are all over the place during this pandemic and you may find yourself second-guessing everything these days. Well, the “good news” is you are likely experiencing a hot flash, not a fever, but why? You may be entering the first stages of menopause. 

That’s the bad news, right?  Wrong! You are about to enter a phase of your life that can be revitalizing and bring some relief from monthly discomfort. 

Let’s look closer at menopause’s phases, how to manage through it, and some of its benefits. 

Early Signs of Menopause

If you are a woman in her 30s, 40s, or 50s, and experiencing hot flashes, difficulty sleeping, or mood swings, you may be experiencing “perimenopause” as your body is preparing to naturally transition into menopause. Each year, 1.5 million women go through menopause, as their bodies transition out of their reproductive ages.1 

While the onset of menopause will have hormone fluctuations that make us emotional and even anxious at times, understanding what symptoms are normal and natural for our bodies may better prepare us for the experience. 

First, let’s take a look at the 3 different phases of menopause, the symptoms that will be your first clues to each phase. 

The 3 Stages of Menopause

Menopause actually means the end (meno) of monthly periods (pauses) and there are three phases of menopause that include perimenopause (near the end), menopause (the end), and postmenopause (after the end).

Perimenopause is the 3 to 5-year window before menopause begins when estrogen and other hormone levels begin to drop. Perimenopause typically happens in your 40s and one of the benefits is that you will start producing less eggs that can be fertilized alleviating the symptoms associated with a monthly period. It’s imperative that you remember that while you are producing fewer eggs, it is still possible to get pregnant during this time. 

Menopause typically occurs in our early 50s. You are officially in menopause when you have missed 12 straight months of your monthly cycle, and the missed periods are unrelated to other issues like illness, pregnancy, or breastfeeding. 

For most women, this is the time to start celebrating the benefits of menopause. We no longer need to use birth control and deal with its side effects. Also, NO MORE PMS! Imagine having worry-free sex without breast tenderness, menstrual migraines/headaches, food cravings and irritability. You will no longer have to worry about tampons or pads, leaking or the fear of irregular periods. Do you know what happens when you no longer deal with monthly worry and discomfort? You get to wake up and focus less on the woes of womanhood and more on enjoying your life. 

Postmenopause occurs after 1 year has passed since your last menstrual cycle though it’s still possible to still experience symptoms that were present during perimenopause and menopause. 

If you are currently on birth control that inhibits symptoms of your monthly cycle, your doctor can determine if you undergoing menopause by checking the levels of hormones that are present in your blood.13 While estrogen, the primary hormone used  in the female reproduction system, generally decreases throughout menopause, another hormone, called follicle-stimulating hormone, tends to increase. Drs can test for your levels of each of these hormones to assess your menopausal stages.   

While there is a wide variety of manageable symptoms associated with menopause, there are 4 main types of symptoms that you may experience during your transition.

These symptoms include:

Hot flashes. The first symptom we think of when we think of menopause is hot flashes. First, what is a hot flash? It’s a moment where you might have a sudden feeling of warmth spreading through your chest, neck and face that may also give the appearance of red, blotchy skin. Your heart may begin to beat rapidly accompanied by perspiration and anxiety. After the flash is over, you may also experience body chills14.

Up to 85% of menopausal women experience hot flashes, with 55% reporting that hot flashes began during the perimenopausal years leading up to menopause.2,3 The frequency and severity of hot flashes tends to increase the further into your menopausal transition, and research has indicated that women tend to experience these hot flashes for a period of about 5 years.4–6 While these hot flashes are thought to be due to changes in hormone activity and potentially due to the resetting of a woman’s core body temperature, the details of how and why hot flashes occur during menopause are not completely understood.1 

The Good News: Hot flashes typically only last between 30 seconds and five minutes. As we get used to understanding how they feel, we can prepare for them better like dressing in layers so you can remove items to cool down and having a fan near your bed in case they happen at night. When they do occur, we can use deep breathing exercises and mindfulness to regulate our anxiety around them. 

Vaginal symptoms. The changes in hormones that occur during menopause also affect vaginal tissues. These changes include narrowing and shortening of the vagina, as well as increased vaginal dryness. Whereas hot flashes tend to go away after the transition to menopause is over, vaginal symptoms tend to persist. However, vaginal dryness can be addressed with menopausal hormone therapy.1 Hormone therapy is usually a medication that is used to replace the lack of estrogen formerly being produced14.   Women may also choose vagina moisturizers that can be applied topically or vaginal suppositories, ranging from options from your nearest drug store to natural options such as grapeseed, olive or other natural oils. 

The Good News. Once we are through menopause and we produce less hormones, we decrease our chances of developing uterine fibroids. Fibroids are noncancerous growths that may remain small or grow to enlarge our uterus. If they get large enough, we will have to have surgery to remove them, but the great news is once you get through menopause, they often shrink due the lack of estrogen and progesterone hormone production reducing the risk of needing surgery17.

Difficulty sleeping. People’s sleep quality tends to deteriorate as they age, and menopause appears to exacerbate the problem in women. Menopausal women are more than 3 times likely to experience sleep disturbances than the general public15.   Unlike other symptoms of menopause, sleep disturbances do not appear to be attributable to changes in hormones except in cases where hot flashes prevent sleep.1,10 

The Good News. There are several ways to improve your sleep. As we get older, exercise becomes even more important for our overall health and you don’t need to join a gym to get your daily exercise. Walking around 7,000 steps a day has been shown to increase sleep in middle-aged woman18. Other tips are going to bed at the same time every night and sleeping in a cool, dark room without excessive clothing or blankets. 

Changes in mood. Though depression is more prevalent in younger women than older women, the transition to menopause marks a period of vulnerability for depression.1 When depression does occur, it tends to occur before hot flashes begin.11 Women who have had previous episodes of depression are at a heightened risk for recurring depression during menopause. Other risk factors for depression during menopause include:1

  • Stressful life events
  • Smoking
  • Higher body mass index (BMI)
  • Lack of employment
  • Difficulty sleeping

The Good News. Women who experience depression during menopause are usually treated with the same types of therapies as anyone else with depression. These interventions include psychotherapy, antidepressants, or a combination of the two. If you have suffered from depression before menopause, many of the same approaches that were successful for you can be applied gain through the help of a physician. 

Strategies to Relieve Symptoms of Menopause

Work with your doctor to discuss how you can best relieve symptoms of menopause, but here are some topics you may want to discuss to help you cope with and find relief16:

OptionBenefits
Hormone therapyReplenish Estrogen to relieve hot flashes and prevent bone loss. 
Vaginal estrogenRelieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
Low-dose antidepressantsDecrease menopausal hot flashes and manage mood
GabapentinReduce hot flashes in women who cannot use hormone therapy
ClonidineReduce hot flashes in women who cannot use hormone therapy
Medications to prevent or treat osteoporosisReduce bone loss and risk of fractures
Vitamin DStrengthen bones

Once it is confirmed that you are going through menopause, you have several options to help manage your symptoms. While there are medical options, many women improve their overall well-being through lifestyle changes like physical exercise and relaxation techniques such as meditation, breathing exercises, and yoga.13

Menopause signals a milestone in our lives and even though this transition is natural, it can still feel like a big deal with major emotional upheaval. It’s important to take care of your body and your mind during this time. Self-care might be found through lifestyle changes or by leaning on supportive family members, friends, or a therapist. 

There is one thing that is 100% certain, half the planet has either gone through or is going to go through the changes you are experiencing. You are not alone and all you need to do it ask another woman for help when you need it. 

Comments 2

  1. I am 71 years old & healthy. However, I experience extreme pain from just below my belly button to my pelvic area. One time so extreme I had a seizure & fainted. I have had every test you can imagine with no success. Could this be due to pelvic health?

    1. aflugum

      Hi Marilyn,

      Sorry to hear that you are experiencing extreme pain. We have an “Ask the Doctor” series and will send your question in and let you know when it has been answered.

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