Brain fog. Achy joints. Trouble sleeping. Weight gain around your middle. Even a painful shoulder.

What do these seemingly unrelated symptoms have in common? For some women, they may all be signs of the same underlying transition: perimenopause and menopause.

The hormonal changes of midlife can affect nearly every part of the body, yet many women struggle to connect the dots — or even know which doctor to see for help. To shed light on what’s happening during this often-confusing stage of life, Novant Health Foundation recently hosted a webinar led by Dr. Claire Bowles, an ob-gyn and medical director of Novant Health Menopause and Midlife Women’s Health.

The department was established in response to the frustration many women felt about not getting answers, relief for their symptoms or a diagnosis during menopause. Bowles, who has practiced at Novant Health for 25 years, is passionate about giving women accurate information, support and appropriate treatment.

Here are some of the key insights she shared about perimenopause symptoms, menopause, hormone therapy and women’s health.

Signs of perimenopause and menopause

Signs of perimenopause and menopause may include:

• Achy joints
• Weight gain, especially around the midsection
• Plantar fasciitis
• Bladder urgency
• Rotator cuff issues
• Brain fog
• Vaginal dryness
• Poor sleep

No wonder women are confused. Who would think brain fog and a bad rotator cuff could be related? (Decreased estrogen is the culprit in both cases.)

Part of the problem, Bowles said, is that menopause can only be diagnosed retroactively. After you’ve gone 12 months without a menstrual period, you’re officially in menopause. And there can be a very long transition period; symptoms can last 7-10 years.

Compounding the problem is this: While you may experience hormone (and mood) swings in your 20s and 30s, they’re more abrupt in your 40s. Every day is different. A blood test may show nothing’s wrong, but it’s not necessarily conclusive, since it’s just measuring one moment in time.

Three lifestyle modifications Bowles recommends to help with menopause symptoms are:

• Going to bed at the same time each night to help your brain fall asleep despite hormonal changes
• Drinking plenty of water to help support joint health and digestion, and replenish fluids lost during hot flashes
• Managing your blood sugar by eating a diet of lean protein, fruits and vegetables and healthy fats to help prevent insulin spikes and mood swings

It’s not just a “women’s issue”

Menopause doesn’t just adversely affect women’s health; it has economic repercussions, too.

Some 75% of women are working while going through menopause, and many are “running on fumes,” Bowles said.

Menopause comes at a time when women are at the height of their careers (and earning power) and of the highest value to their families and communities. Women often experience a decline in earnings — sometimes dropping by 10% or more — because they reduce their hours, leave demanding jobs or pass up promotions during peak earning years, after having earned seniority. Bowles cited studies that found about 1.3 million women enter menopause in the U.S. every year, leading to an annual productivity loss of about $1.8 billion.

Brain fog, sleep disruption and other symptoms that lead to missed work are manageable, but they must first be correctly diagnosed.

Menopause and health risks

Menopause often announces itself with impossible-to-ignore symptoms such as hot flashes and brain fog. But there are less obvious signs and risks, too.

Like heart disease. While men’s risk of heart disease increases gradually with age, women’s risk increases dramatically after menopause.

Women’s risk of bone loss goes up considerably, too. Women could lose between 2% and 5% of bone density every year for the first 10 years after menopause, putting them at greater risk for osteoporosis.

To help reduce the risk of osteoporosis in postmenopausal women, Bowles recommends:

• Taking a vitamin D supplement, which helps promote calcium absorption to help prevent bone fractures
• Lifting weights to stimulate bone-forming cells

Hormone replacement therapy (HRT)

If you are confused by hormone replacement therapy, a treatment that supplements hormones to make up for diminishing levels in the body, you’re not alone.

The confusion stems from a 2002 study conducted by an organization called the Women’s Health Initiative. The overarching takeaway from the study was, “Hormone replacement therapy causes breast cancer!” So, for about 20 years, doctors shied away from prescribing it.

But there were issues with the study, and its results were largely misinterpreted. For one thing, the average age of study participants was 63. For another, they were prescribed oral estrogen, which isn’t even a first-line treatment today.

Transdermal estrogen, which comes as a patch and a gel, is now the preferred method because it bypasses the liver. Oral estrogen goes through the liver and can lead to an increased risk of blood clots and stroke. But, oral estrogen may be the best option for younger women with no risk factors.

The study found that women who started HRT before age 60 and within 10 years of menopause experienced a number of benefits, including lower risk of heart disease, osteoporosis, diabetes and colon cancer. They did have a slightly increased risk of breast cancer, but it was negligible — less than 1%.

A more accurate takeaway would’ve been, “Hormones aren’t right for every woman, but for many, their benefits outweigh their risks.”

Talk to a doctor

If you’re experiencing perimenopausal or menopausal symptoms, talk to your primary care provider or your gynecologist. But whoever you see, make it a separate visit from your annual physical. Too many women try to squeeze it in during that visit, and there’s rarely enough time.

Or make an appointment — no referral is needed — with one of Novant Health’s menopause care clinics:

Meeting with a clinician who specializes in menopause doesn’t mean you have to continue to be seen and treated by them — although you can. “We still want you to maintain relationships with your primary care doctor and your gynecologist,” Bowles said. “With your permission, we can send them notes from your visit, and they can manage your treatment.”

An initial visit to a Novant Health menopause clinic is usually 30 minutes and involves education, a discussion about your goals and the development of a treatment plan, if it’s needed. Treatment may involve HRT, if you and your doctor determine it’s needed, or alternative (nonhormonal) treatments.

A 15-minute follow-up visit is usually scheduled 8-12 weeks after your initial visit to discuss how well treatment is working and if any adjustments are needed.

You don’t have to live with brain fog, mood swings and other symptoms. Help is available.