It’s been referred to as a time of renewal or the start of the next part of your life. But the onset of menopause can also be extremely daunting and many women have questions about this milestone. It is important to know that menopause is not a disease but rather a phase in the life cycle. Here are 10 things you may not know about this natural part of aging.

You no Longer Need Birth Control

You no longer need birth control once menopause is complete, but how do you know when that is? You most certainly need to use birth control until you have missed your menstrual cycle for 12 consecutive months. It is not unusual for women to miss several menstrual cycles only to have a period and then have to start counting missed cycles again. You can get pregnant during these ‘start and stop’ moments, so only give up birth control after the 12th-consecutive missed cycle, or as instructed by your doctor.

Not all Women get hot Flashes

Not all women get hot flashes as they move into their menopausal stage. Most women will experience some hot flashes and sweats, particularly at night. Experiencing hot flashes can continue up until five years post menopause.

Weight Gain Around Your mid-Section is Common

Weight gain around your mid-section is typical and is often due to the fact that you may need to adjust your daily total calories downward in response to a slightly slower metabolic rate and loss of muscle mass.

Hormone Therapy is Only a Treatment Option for Severe hot Flashes

Hormone Therapy (HT) is currently considered a medical treatment option only for severe, unrelenting hot flashes, due to the increased risk of breast cancer associated with HT. The safest options, including lifestyle changes, should be explored first. Prescribed medical therapy then may be considered as needed.

You may Experience Sleep Abnormalities and Anxiety

Sleep difficulties, anxiety, depression, forgetfulness, and irritability are common complaints of women who have experienced menopause. If you experience these type of complaints for two weeks or more, it is worth considering treatment so speak to your GP.

There are Alternatives to HT

If you prefer to try therapies other than HT for hot flashes, they can include increasing your intake of vitamins, specifically vitamin B complex and E. There are also certain prescription drugs, including paroxetine, clonidine, or gabapentin. Some women also respond to black cohosh, adding soy foods to their diet, using evening primrose oil, or combining some of these treatments.

Your Osteoporosis Risk Increases After Menopause

Beginning at age 65, DEXA screening for bone density is recommended. If you are younger than 65, you may get this screening if you are postmenopausal and have other risk factors such as weighing less than 126 pounds, you are a smoker, or you have medical conditions and risks for bone loss for fracture. Alternatively, a tool called the FRAX assessment can be used in women younger than 65 years to determine which women should have a DEXA scan.

Your Risk of Heart Disease Increases After Menopause

A decline in the natural hormone estrogen can be a factor in heart disease increase among post-menopausal women.

Your Voice may Change

A small subset of women can experience a voice change after menopause, though most do not. Facial hair may also increase.

You may Experience Vulvar and Vaginal Atrophy

Vaginal atrophy is when the skin and tissues in and around your vagina become drier, thinner, and less elastic. You may experience vulvar and vaginal atrophy during menopause, which can result in dryness and painful intercourse. Talk to your gynecologist about treatment options.